A qualitative study of patient's experiences of receiving alcohol interventions according to the 15-method in psychiatric care.

BACKGROUND AND AIM: Comorbidity between psychiatric disorders and alcohol use disorders (AUD) is common. Swedish national guidelines recommend integrated treatment for both disorders, however, compliance to the guidelines is low. To facilitate uptake, health care staff at psychiatric units in Region Stockholm, Sweden, have participated in training and implementation of the 15-method for screening and treatment of AUD. Few studies focus on the patient perspective of interventions for AUD in psychiatric care. The aim of this study was to investigate how patients in psychiatric outpatient care perceived receiving interventions according to the 15-method, within the context of a large-scale implementation project. METHODS: Qualitative study with data collected through individual interviews involving 15 adults who had Alcohol Use Disorder Identification Test (AUDIT) score >6 for women/ >8 for men and contact with a psychiatric unit whose staff had taken part in the implementation project of the 15-method. The interviews were analyzed with reflexive thematic analysis using the four constructs of the Normalization Process Theory; coherence, cognitive participation, collective action and reflexive monitoring, as a framework. RESULTS: All participants had received alcohol screening, four had received the assessment in the second step in the 15-method, three received pharmacotherapy, however, none reported receiving the psychological treatment. A majority found it natural to discuss alcohol within the psychiatric care setting and described that these conversations led to increased awareness about their hazardous alcohol consumption (coherence). Alcohol use was perceived as a sensitive topic and staff attitude was important to create a working alliance (cognitive participation). Conversation about alcohol could evoke behavior change but few participants had been offered alcohol interventions beyond screening (collective action) and expressed a wish to receive more support (reflexive monitoring). Treatment for psychiatric symptoms was described as conditioned to non-hazardous level of alcohol consumption (coherence), leading to active actions to become eligible for treatment (cognitive participation). Moreover, conditioning of care mainly led to short-term behavior changes (reflexive monitoring). CONCLUSIONS: Patients in psychiatric care are positive to receiving alcohol-interventions within this context, indicating that psychiatric care offers a window of opportunity to address comorbidity. However, future staff training and implementation initiatives should be tailored to the specific challenges in psychiatric care, such as conditioning of care. CLINICAL TRIAL NUMBER: Not applicable.