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In 2016, a new addiction treatment service, Allorfik, was introduced in Greenland. Allorfik has, throughout the implementation and after, used auditing of patient records with feedback to develop the quality of care in treatment. Audits and feedback are routinely done in each treatment center. This study wishes to investigate the development of the quality of treatment through the case notes from the journal audits. This study is based on case notes audits from 2019, 2020 and 2021. In the audits, the focus has been on the quality of documentation and content for ten specific areas in each patient record. Each area was scored on a Likert scale of 0–4 for both outcomes. Statistical analyses were done using Stata 17, and P-values < 0.05 were considered statistically significant. We present baseline characteristics for patients and illustrate the development of quality for both outcomes as time trends with scatter plots. The analysis was based on data from 454 patients and audits of their case notes. The mean number of weeks in treatment is 12.72, and the mean age for the people in the audited case notes is 39. Time had a positive effect on both outcomes, and so each month, documentation increased by 0.21 points (p-value = <0.001), and content increased by 0.27 points (p-value = <0.001). For documentation and content, the quality level has increased significantly with time, and the quality of case notes is at an excellent level at the final audits of all treatment centers. [ABSTRACT FROM AUTHOR]

Depression and anxiety are highly prevalent among patients seeking outpatient treatment for alcohol use disorders (AUD) and if depression and anxiety are addressed the prognosis is improved. Screening instruments for depression and anxiety have been validated in populations suffering from drug use disorders, but not in populations suffering from AUD. The aim of this study was to validate four self-administrated screening instruments (PHQ-9, GAD-7, Kessler-6, and SRQ) and calculate the optimal cut-off value for identifying depression and anxiety. The study included 73 patients with self-reported depression or anxiety during AUD treatment. Each patient filled out the above-mentioned instruments and was subsequently interviewed by trained clinicians blinded to the results of the instruments with the Present State Examination to establish a diagnosis of depression or anxiety according to ICD-10. ROC curves were constructed for each instrument and the area under the curve (AUC) was calculated using patients with no depression or anxiety as reference. Youden's index was calculated to assess the optimal cut-off for each instrument. A total of 33 (45.2%) were diagnosed with depression or anxiety. The AUC for PHQ-9, GAD-7, Kessler-6, and SRQ were 0.767, 0.630, 0.793, and 0.698 respectively. Kessler-6, the instruments performing best based on the AUC, identified 27 (82%) of the 33 patients using a cut-off of 10 points. Kessler-6 seems to be valid and reliable in identifying patients requiring treatment for depression or anxiety among patients seeking treatment for AUD who are reporting depression or anxiety. [ABSTRACT FROM AUTHOR]

Many patients with alcohol use disorders are challenged by cravings leading to repeated relapses. Both cue exposure therapy (CET) and acamprosate target alcohol cravings and are often combined (CET + acamprosate). The main aim of this study was to investigate whether aftercare treatment consisting of CET combined with acamprosate is equivalent to (A) CET as monotherapy, (B) aftercare as usual (AAU) as monotherapy or (C) AAU combined with acamprosate. Patients were randomized to receive either CET with urge-specific coping skills (USCS) as aftercare or AAU. Acamprosate prescription data were extracted from patient case records. Alcohol consumption, cravings, and USCS were assessed at pre-aftercare, post-aftercare, and 6-month follow-up. Overall, patients increased their alcohol consumption during and following aftercare treatment, thereby relapsing despite any treatment. However, CET + acamprosate achieved greater abstinence compared to AAU + acamprosate at follow-up (p=.047). CET + acamprosate also reduced number of drinking days (p=.020) and number of days with excessive drinking (p=.020) at post-aftercare, when compared to AAU monotherapy. CET monotherapy increased sensible drinking at post-aftercare compared to AAU monotherapy (p=.045) and AAU + acamprosate (p=.047). Only CET monotherapy showed improvement in cravings, when compared to AAU at follow-up (mean urge level: p=.032; peak urge level: p=.014). The study showed that CET both as monotherapy and combined with acamprosate was superior to AAU monotherapy and AAU + acamprosate in reducing alcohol consumption. Only CET + acamprosate was capable of reducing alcohol consumption in the longer term, indicating that anti-craving medication may not impede CET from exerting an effect on alcohol consumption. Trial registration: ClinicalTrials.gov ID: NCT02298751 (24/11-2014). [ABSTRACT FROM AUTHOR]

Background: Alcohol Use Disorder (AUD) is a destructive and serious problem among indigenous populations around the world. The drinking pattern differs from the non-indigenous populations by being short-term risky drinking such as binge drinking. In general, the treatment offered is based on conventional western strategies, though, in many regions' treatment facilities are poor. The present review summarizes the researched possibilities for alcohol treatment specific to indigenous populations. Method: A systematic search in four databases, Pubmed, Psyinfo, Cochcrane and Cinahl within the past ten years identified 19 articles that investigate the effect of different approaches to treat indigenous people with AUD. Result: Several studies suggest implementing native and traditional ways of healing in the treatment. Community-driven approaches have shown effect in the reduction of AUD among indigenous youth, as well as a web based brief intervention, motivational interviewing, and alcohol restrictions. Also, naltrexone as firstline medical treatment is suggested. Discussion and conclusion: In general, the studies included have a moderate to low quality and are difficult to compare but can provide an overview of elements that seem important in the treatment of indigenous people. There is a lack of research of both conventional treatment and treatment specific tailored to indigenous populations. The latter specifically minded to community prevention, the involvement of local people and implementing cultural traditions and healing methods and rebuilding native identity, seems as important elements in future treatment and prevention strategies. [ABSTRACT FROM AUTHOR]

The aim of the investigation was to describe the association between negative life events on morbidity in homeless seeking treatment for substance abuse in Greenland. Cross sectional study on register data comparing homeless and individuals in secure housing initiating alcohol or substance abuse treatment in Greenland between 1 January 2017 and 14 December 2019, (N = 950). Results: Homeless were socio-economically disadvantaged compared to treatment seekers in secure housing. They had a heavier burden of psychiatric morbidity and suffered more negative life experiences. Controlled for having experienced abuse, most morbidity measures' predictive value was slightly less pronounced with psychiatric morbidity as an exception. The results indicate that both the morbidity and most analyzed negative life events are associated with being homeless and are mutually linked. [ABSTRACT FROM AUTHOR]

The aim was to describe the treatment-seeking population with alcohol use disorder by means of data from the AUDIT questionnaire at referral and to evaluate and discuss if this information can be of use in treatment and service planning. Data from 2016 to 2018 were extracted from the National Database on Substance Abuse Treatment. The sample included 1281 individual treatment seekers from all over Greenland. Mean age was 38.2 years (SD 12.1 years). Only 60.1% had a total AUDIT score suggesting dependency, and 15.5% had a harmful use. While most only drank 2–4 times a month, about 95% binge drank. Half reported loss of control at least weekly, and one of three had been unable to do what was expected of them, or needed a drink first thing in the morning weekly or more often. In two-third others had been concerned about the drinking. Users of cannabis had a higher AUDIT score, while gambling was unassociated to alcohol use. Substantial gender and regional differences were seen. The AUDIT screening was found useful in individual and national treatment planning. Data suggested that particular focus should be given to women in treatment, and the service offered to the East Greenlandic population. [ABSTRACT FROM AUTHOR]

This study aims to investigate the attitudes and opinions that are present among patients and health professionals toward addressing patients' alcohol use during a hospital stay. We conducted semi-structured interviews with nine health professionals and five patients to explore their opinions and attitudes toward asking and being asked about alcohol during a hospital stay. The data were analyzed using an ad hoc method consisting of primarily close reading and meaning condensing. The main barriers about alcohol as a topic in healthcare lie with health professionals. While patients have reservations and preferences regarding when and how they are asked about alcohol, they all consider knowledge about alcohol habits as important for the health professional to have. The study's results suggest that actions to better preventive efforts regarding inexpedient alcohol use should mainly focus on breaking barriers hindering the health professionals in asking their patients. This can be done by focusing on education for the health professionals on this topic and developing tangible guidelines for when and how to ask patients for the health professionals to depend on. [ABSTRACT FROM AUTHOR]

Introduction: Premature drop-out and lack of success from alcohol treatment is common. Within recent years, Shared Decision Making (SDM) has gained increased attention in treatment planning in health care. Results from research in SDM in addiction treatment points in different directions, hence this review focuses on alcohol addiction only. Furthermore, studies on Informed Choice is included in this review. The objective is to measure outcome results on the following four measures: (1) drinking outcome, (2) quality of life, (3) enrollment, and (4) adherence. Method: MEDLINE, PubMed and PsychInfo databases were searched. Studies included were RCT or Quasi-RCT measuring SDM or informed choice in treatment planning in alcohol addiction. The PRISMA guidelines was followed. Two researchers measured the quality of the studies. If disagreement could not be resolved by discussion, a third researcher was consulted. Results: 1203 studies were identified. Thirteen met the inclusion criteria, of which 7 were excluded. The remaining 6 studies were too heterogeneous to perform a meta-analysis, resulting in a narrative discussion of results. Discussion: The inadequate evidence limits the conclusions on our four objectives. (1) Drinking outcome, it seems that patient involvement in treatment planning does not have an effect. (2) Quality of life might be improved. (3) Enrollment might be increased. (4) Adherence was improved. Conclusion: Very few studies have been performed in this field; hence, no clear recommendation can be given to clinical practice at this point. PROSPERO Registration code: CRD42019124794 [ABSTRACT FROM AUTHOR]

Objective: Understanding the variation of alcohol use disorder (AUD) among a clinical sample of patients aged 60 and older, by identifying latent classes of AUD and exploring risk factors and outcomes of treatment associated with the class. Method: We used the Danish subsample (n = 341) from the Elderly Study. Latent class analysis was used to identify classes based on the 11 symptoms of DSM-5 AUD. We analyzed the associations between class membership and sociodemographic variables, alcohol consumption, and drinking-related outcome of treatment. Results: Three latent classes were identified. Individuals in the low-symptomatic class (34.85%) displayed low endorsement of DSM-5 criteria "Withdrawal", "Time Spent", "Less activities" compared to the other classes, and had fewest drinks per drinking day. Individuals in the moderate-symptomatic class (32.69%) were most likely to be intoxicated in hazardous situations, and those in the high-symptomatic class (32.47%) displayed, with a few exceptions, the highest probabilities of all DSM-5 criteria. Female gender, living alone and prior AUD treatment was associated with increased risk of being in the high-symptomatic class. No difference between classes was found with respect to years with AUD and frequency of drinking days, and latent class membership had no effect on drinking outcome after treatment, when controlling for baseline. Conclusions: Three classes of DSM-5 AUD among older adults in treatment emerged, displaying a low-moderate-high distribution, advocating for a unidimensional construct of DSM-5 AUD. Although different with respect to baseline risk factors, no strong connection between DSM-5 latent class and alcohol consumption after AUD treatment was found. Among 341 older alcohol use disorder (AUD) outpatients, three latent classes of DSM-5 AUD emerged. The classes of DSM-5 AUD displayed a low-moderate-high endorsement of DSM-5 AUD characteristics. The three classes had similar alcohol-related treatment outcomes. [ABSTRACT FROM AUTHOR]

Introduction: In 2016, a new addiction treatment service was established in Greenland to tackle the addiction problems with alcohol, cannabis and gambling among the population. The new service has established a treatment center in each of the five municipalities and works in partnership with a central private provider of treatment for those who reside in areas without a local treatment center. Methods: The national addiction database provided us with data from the Alcohol Use Disorder Identification Test, Alcohol Severity Index and questions on cannabis use and gambling behavior received at referral to, and at initiation of treatment. The data were analyzed for differences between the population in local or central treatment using SPSS version 25 (SPSS Inc., Chicago, IL). Results: Significant differences between the individuals in local and central treatment were revealed. Individuals in local treatment are more often women with minor children and a job, and their alcohol use is concentrated on weekends/holidays. Individuals in central treatment are more equal in both genders, few have minor children living at home, heavy drinking is more pronounced, and cannabis is used more frequently as well. Discussion: The findings support our expectations of local treatment being more attractive to individuals with obligations at home. The differences in the populations are worth considering when planning the treatment service, as the needs of the populations might differ. The findings are limited by many missing in the analyses, which we believe is caused by the establishing process of the new service. [ABSTRACT FROM AUTHOR]

Creative writing may help patients find new powers in the acts of making art and expanding horizons beyond illness, including addiction. The aim of the present pilot study was to introduce creative writing workshops to alcohol use disorder (AUD) patients and investigate self-perceived rehabilitating impact, improvement in quality of life, and executive functions. The study was conducted in a mixed methods design; primarily semi-structured group and individual interviews as well as participant observation, supplemented by a small evaluation questionnaire at baseline and follow-up at the end of exposure. The patients had experienced the workshop as having influenced their lives in a positive direction, impacted by doing creative writing, sharing and receiving feedback, and the community of the group. The patients perceived both advantages and disadvantages about discussing alcohol in the workshop. The patients experienced an increase in quality of life from the beginning to the end of the workshop. There could be a need for creative writing workshops as add-ons to ordinary AUD treatment. In such an offer, creative writing might function as a means to improve patient rehabilitation, quality of life, and executive functions. [ABSTRACT FROM AUTHOR]

Purpose: This study examined 6-month drinking outcomes of elderly patients compared with middle-aged patients in a clinical sample after initiation of outpatient treatment for alcoholism. Materials and methods: In a clinical prospective cohort study, 1398 consecutive patients from a municipality outpatient alcohol clinic were included. A total of 208 elderly patients aged from 60 to 82 years and 1190 middle-aged patients from 40 to 59 years participated in the study. The following psychosocial treatment interventions were offered: cognitive behavioral therapy, family therapy and supportive consultations. Using an 'intention-to-treat' method, primary outcomes included drinking outcomes (self-reported abstinence rates, drinking 3 drinks or less per day, and change in Addiction Severity Index [ASI] composite scores) during the 30 days prior to 6-month follow-up; secondary outcome was compliance to the recommended treatment. Results: Compared to middle-aged, among elderly patients a higher proportion were females (33.5% vs. 42.8%) and had a lower family/social ASI-composite score (0.17 vs. 0.12) at baseline. Higher alcohol and family/social ASI-composite scores were inversely correlated with abstinence. Elderly patients had a higher chance for abstinence compared to middle-aged patients (Odds ratio 95% [confidence interval]) 1.40 (1.03-1.92). The proportion of elderly patients that drank 3 or less drinks per day was 17.8%, compared to 10.8% among middle-aged (p < .01). Finally, elderly patients obtained a higher compliance, which was similarly associated with abstinence (OR =2.46 (1.95-3.11)). Discussion and conclusions: Elderly patients, who receive psychosocial outpatient treatment for alcoholism, have better 6-month outcomes within a range of drinking outcome measures compared to middle-aged patients. [ABSTRACT FROM AUTHOR]

This study investigates the benefit of adding a data-driven actuarial matching system and focus on motivation to routine outpatient alcoholism treatment. The study is a two-cohort quasi-experimental study. One cohort (188 clients) were assigned to treatment based on clinician judgment. Cohort 2 (175 clients) were assigned to treatment based on actuarial matching procedures. Both cohorts were followed for 12 months. A total of 37% of Cohort 2 dropped out of treatment, compared to 52% of Cohort 1. Cohort 2 also showed greater reduction in alcohol consumption and greater improvement. Actuarial matching procedures appear to have improved treatment retention and outcome. [ABSTRACT FROM AUTHOR]

Purpose: Many patients with alcohol use disorder (AUD) fail to initiate outpatient treatment after being discharged from inpatient detoxification. The aim of the present study was to investigate the effect of outreach visits (OV) on subsequent attendance in outpatient AUD treatment. Methods: Patients admitted to a detoxification unit at a mental health hospital were randomized to either referral as usual (TAU) or OV. OV involved a nurse from the outpatient clinic meeting the patients at the hospital and advising them about outpatient treatment, presenting an ‘attendance contract’ and offering a first appointment. Results: One hundred consecutive patients were randomized while hospitalized, 55 received TAU and 45 OV. About 84.4% OV patients presented for treatment at the outpatient clinic compared to 58.2% TAU-patients (p = .004). About 46.7% OV patients received continuing care for at least 3 months compared to 23.6% TAU-patients (p = .016). Conclusion: OV are an effective strategy for ensuring continued treatment. [ABSTRACT FROM AUTHOR]

Objective: Assessment is pivotal to the work of health care professionals and social workers, as it provides fundamental, systematic information that is essential when planning interventions. Many patients have addiction problems as well as psychiatric illness and they very often interact. An assessment tool addressing both areas would be beneficial for this large group of patients. This pilot study explores feasibility and adequacy of the Danish translation of the Measurements in Addiction for Triage and Evaluation (MATE) assessment in the following sectors: drug and alcohol treatment, psychiatry, and social service. Methods: Thirty staff members from psychiatric hospital, social services, and treatment institutions for alcohol and substance abuse were recruited. Staff that had direct contact with clients were planned to perform at least two MATE interviews. Results: Nineteen interviews were completed. Information gathered from MATE was reported to be adequate for making a triage decision, but psychiatric staff reported that MATE gathered too much irrelevant information, especially concerning daily life functioning. Overall feasibility was satisfactory, but staff and patients were at some points critical of wording, casting doubt on the understanding of some questions. Conclusions: This pilot study found that MATE gathers relevant and sufficient information in an appropriate amount of time. [ABSTRACT FROM AUTHOR]

This systematic review seeks to expand the description and understanding of late-onset AUD and asks “Which risk factors have been reported for late-onset heavy drinking and AUD?”Method: Using PRISMA guidelines, a literature review and search was performed on May 19, 2015 using the following databases: MEDLINE, EMBASE, PubMed, and PsychInfo. Nine studies were included in the final review.Results: The search revealed that only very few studies have been conducted. Hence, the evidence is limited but suggests that stress, role/identity loss, and friends' approval of drinking are associated with an increased risk for late-onset AUD or heavy drinking, whereas retirement, death of a spouse or a close relative does not increase the risk.Discussion: Inherent differences in measurements and methodologies precluded a meta-analysis. Therefore, the results presented here are descriptive in nature. Most studies base their conclusions on a certain preconception of older adults with alcohol problems, which leads to a row of circular arguments. The factors that have been measured seem to have changed over time.Conclusion: There has been a lack of focus on the field of late-onset AUD since the 1970s, which possibly has led to misrepresentations and preconceptions on the complex nature of late-onset AUD. There is limited evidence for any specific risk factor for late-onset AUD or heavy drinking. We suggest the adoption of a qualitative approach to uncover what is intrinsic to late-onset AUD followed by quantitative studies with more agreement on methods and definitions. [ABSTRACT FROM PUBLISHER]

The aim of the study was to describe patient perspectives on optional videoconferencing-based treatment for alcohol use disorders. The study was a qualitative descriptive study based on semistructured interviews with 27 patients using an interview guide. The analysis strategy used was qualitative content analysis. Videoconferencing was found relevant when having a choice was found positive, no differences to face-to-face were registered, the sense of security was enhanced, flexibility was enhanced, attending treatment was encouraged, and the treatment course was “blended care.” Videoconferencing was found irrelevant when intimacy was desired, there were concerns about the technical equipment, and a treatment form unsuitable for videoconferencing was offered. [ABSTRACT FROM PUBLISHER]

Adopting a phenomenological hermeneutical approach, this qualitative study focuses on an understudied group of older adults experiencing very-late-onset alcohol use disorder. This group constitutes 11% to 16% of all older adults with alcohol problems. To illuminate the experiences of the older adults the authors interviewed 12 older adults age 60 to 76 years (7 men). The participants were interviewed for 45 to 60 minutes using a semistructured format. The analysis was done in accordance with the principles of interpretative phenomenological analysis which allows for description and interpretation. Generally, findings are in accordance with existing literature. The authors found that older adults tend to define their alcohol problems in a unique way, which has implications for treatment and prevention efforts. The authors identified a tendency for the participants to define alcohol problems in relation to work or inability to take care of family. Further the findings suggest that older adults might try to avoid stigmatization. Hence, older adults with onset of alcohol use disorder after age 60 years may evaluate their alcohol use with respect to a “private” self-regulation standard thereby resisting labelling themselves as “alcoholics.” This might keep them from initiating treatment or may delay treatment seeking. [ABSTRACT FROM AUTHOR]

Background: Studies examining the effect of alcohol treatment among patients with alcohol use disorders (AUD) and co-morbid depression and/or anxiety are few and show inconsistent, but mainly negative drinking outcomes. Aims: To describe the prevalence of anxiety and depression among Danish patients seeking treatment for an AUD, and to investigate the influence of psychiatric co-morbidity on the course and effect of treatment. Method: A consecutive sample of 363 outpatients with an AUD diagnosis according to the ICD-10 Diagnostic Criteria for Research was assessed by the means of the Addiction Severity Index at treatment start and 276 (76%) followed up after 1 year. Results: 15.7% of the patients suffered from depression and 12.7% from anxiety at baseline. Both patients with or without co-morbidity had improved on drinking outcome measures at follow-up with medium to large effect sizes. No difference was found between patients with and without co-morbidity. Conclusion: In contrast to the majority of prior studies, this study provides evidence that depression and anxiety do not have an effect on alcohol treatment. However, because of the naturalistic setting, a number of limitations should be taken into consideration interpreting the results. [ABSTRACT FROM AUTHOR]

The association between alcohol dependence and suicidal behaviour is well established and patients with suicidal behaviour in treatment for alcohol dependence present a considerable challenge for clinical services. The aim of this study is to identify risk factors for suicide attempts and to evaluate the outcome of treatment in patients in treatment for alcohol dependence. Semi-structured, detailed interviews were administered at baseline and at three sequential follow-up interviews with a large sample of 1692 patients at an outpatient treatment centre in the county of Funen in Denmark. Characteristics of, predictors for and outcome among suicidal patients were studied. Alcohol-dependent patients with a history of suicide attempts were found to constitute a highly selected group in alcohol abuse treatment as they often had a more severe course of alcohol dependence, were unemployed, younger, were more often lowly educated, and had more physical and psychiatric problems. Traumatic childhood experience related to physical or sexual abuse was found as a major predictor for suicidal behaviour among alcohol-dependent patients. We found no significant difference in the effect of treatment in patients with and without suicidal behaviour. These results support the hypothesis that alcohol-dependent patients with a history of suicide attempts are a selected group in respect to a number of demographical and psychosocial factors, but we found no difference in the outcome of treatment. This may imply that suicidal patients in treatment for alcohol abuse are treated effectively within the present treatment settings. [ABSTRACT FROM AUTHOR]