Treatment of alcohol dependence in Swedish primary care: perceptions among general practitioners

Karin Hyland, Anders Hammarberg, Sven Andreasson, Maria Jirwe, Karin Hyland, Anders Hammarberg, Sven Andreasson, Maria Jirwe

Abstract

Objective: To describe general practitioners' (GPs) attitudes to the management of patients with alcohol dependence in primary care and current treatment routines and their view on a new treatment approach; internet-based Cognitive Behavioral Therapy (iCBT).

Design: A qualitative interview study with ten GPs participating in a randomized controlled trial. The interviews were analyzed using qualitative content analysis.

Setting: The participating GPs were recruited via purposeful sampling from primary care clinics in Stockholm.

Subjects: The GPs were participants in an RCT investigating if iCBT when added to treatment as usual (TAU) was more effective than TAU only when treating alcohol dependence in primary care.

Results: The GPs found alcohol important to discuss in many consultations and perceived most patients open to discuss their alcohol habits. Lack of training and treatment options were expressed as limiting factors when working with alcohol dependence. According to the respondents, routines for treating alcohol dependence were rare.

Conclusion: GPs believed that iCBT might facilitate raising questions about alcohol use and thought iCBT may serve as an attractive treatment option to some patients. The iCBT program did not require GPs to acquire skills in behavioral treatment, which could make implementation more feasible.KEY POINTSAlcohol dependence is highly prevalent, has a large treatment gap and is relevant to discuss with patients in many consultations in primary care.This study is based on interviews with 10 GPs participating in a randomized controlled trial comparing internet-based Cognitive Behavioral Therapy (iCBT) for alcohol-dependent patients to treatment as usual.GPs viewed alcohol habits as important to discuss and they perceived most patients are open to discuss this.The access to iCBT seemed to increase GPs' willingness to ask questions about alcohol and was viewed as an attractive treatment for some patients.The iCBT program did not require GPs to acquire skills in behavioral treatment, which might be timesaving and make implementation more feasible.

Keywords: Alcohol dependence; GPs’ perceptions; internet-based Cognitive Behavioral Treatment (iCBT); primary care; qualitative study.

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

References

    1. Rehm J, Allamani A, Elekes Z, et al. . Alcohol dependence and treatment utilization in Europe - a representative cross-sectional study in primary care. BMC Fam Pract. 2015;16(1):90.
    1. Andréasson S, Danielsson A-K, Hallgren M.. Severity of alcohol dependence in the Swedish adult population: association with consumption and social factors. Alcohol. 2013;47(1):21–25.
    1. World Health Organization . Global status report on alcohol and health 2018. Geneva (Switzerland): WHO; 27 September 2018. Available from:
    1. Griswold MG, Fullman N, Hawley C, et al. . Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2018;392(10152):1015–1035.
    1. Rehm J, Gmel GE, Gmel G, et al. . The relationship between different dimensions of alcohol use and the burden of disease—an update. Addiction. 2017;112(6):968–1001.
    1. Rehm J, Anderson P, Gual A, et al. . The tangible common denominator of substance use disorders: a reply to commentaries to Rehm et al. (2013a). Alcohol Alcohol. 2014;49(1):118–122.
    1. Rehm J, Roerecke M.. Reduction of drinking in problem drinkers and all-cause mortality. Alcohol Alcohol. 2013;48(4):509–513.
    1. Wood K, Kaptoge S, Butterworth A, et al. . Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. The Lancet. 2018;391(10129):1513–1523.
    1. WHO Library Cataloguing-in-Publication Data Global status report on alcohol and health – 2014 ed. . available from:
    1. Blomqvist J, Cunningham JA, Wallander L, et al. . En rapport från “Improving drinking habits”—different patterns of change and the importance of treatment. Social Res Alcohol Drugs. 2007;7:1–147.
    1. Kohn R, Saxena S, Levav I, et al. . The treatment gap in mental health care. WHO Bull. 2004;82(11):858–866.
    1. Wallhed Finn S, Bakshi A-S, Andréasson S.. Alcohol consumption, dependence, and treatment barriers: perceptions among nontreatment seekers with alcohol dependence. Subst Use Misuse. 2014;49(6):762–769.
    1. Schomerus G, Lucht M, Holzinger A, et al. . The stigma of alcohol dependence compared with other mental disorders: a review of population studies. Alcohol Alcohol. 2011;46(2):105–112.
    1. Field CA, Klimas J, Barry J, et al. . Problem alcohol use among problem drug users in primary care: a qualitative study of what patients think about screening and treatment. BMC Fam Pract. 2013;14(1):98.
    1. Storbjörk J, Room R.. The two worlds of alcohol problems: who is in treatment and who is not? Addict Res Theory. 2008;16(1):67–84.
    1. Aasland OG, Bruusgaard D, Rutle O.. Alcohol problems in general practice. Br J Addict. 1987;82(2):197–201.
    1. Anderson P, Wojnar M, Jakubczyk A, et al. . Managing alcohol problems in general practice in europe: results from the European ODHIN survey of general practitioners. Alcohol Alcohol. 2014;49(5):531–539.
    1. Keurhorst M, van Beurden I, Anderson P, et al. . GPs’ role security and therapeutic commitment in managing alcohol problems: a randomised controlled trial of a tailored improvement programme. BMC Fam Pract. 2014;15(1):70.
    1. Geirsson M, Bendtsen P, Spak F.. Attitudes of Swedish general practitioners and nurses to working with lifestyle change, with special reference to alcohol consumption. Alcohol Alcohol. 2005;40(5):388–393.
    1. Nygaard P, Aasland OG.. Barriers to implementing screening and brief interventions in general practice: findings from a qualitative study in Norway. Alcohol Alcohol. 2011;46(1):52–60.
    1. Wilson G, Heather B, Kaner N.. New developments in brief interventions to treat problem drinking in nonspecialty health care settings. Curr Psychiatry Rep. 2011;13(5):422–429.
    1. Van Beurden I, Anderson P, Akkermans RP, et al. . Involvement of general practitioners in managing alcohol problems: a randomized controlled trial of a tailored improvement programme. Addiction. 2012;107(9):1601–1611.
    1. Segura L, Anderson P, Gual A.. Optimizing the delivery of interventions for harmful alcohol use in primary healthcare: an update. Curr Opin Psychiatry. 2018;31(4):324–332.
    1. Saitz R. Alcohol screening and brief intervention in primary care: absence of evidence for efficacy in people with dependence or very heavy drinking. Drug Alcohol Rev. 2010;29(6):631–640.
    1. Glass JE, Hamilton AM, Powell BJ, et al. . Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction. 2015;110(9):1404–1415.
    1. Kiritzé-Topor P, Huas D, Rosenzweig C, et al. . A pragmatic trial of acamprosate in the treatment of alcohol dependence in primary care. Alcohol Alcohol. 2004;39(6):520–527.
    1. Oslin DW, Lynch KG, Maisto SA, et al. . A randomized clinical trial of alcohol care management delivered in department of veterans affairs primary care clinics versus specialty addiction treatment. J Gen Intern Med. 2014;29(1):162–168.
    1. Thompson A, Ashcroft DM, Owens L, et al. . Drug therapy for alcohol dependence in primary care in the UK: a clinical practice research Datalink study. PLoS One. 2017;12(3):e0173272.
    1. Wallhed Finn S, Hammarberg A, Andreasson S.. Treatment for alcohol dependence in primary care compared to outpatient specialist treatment-a randomized controlled trial. Alcohol Alcohol. 2018;53(4):376–385.
    1. Vernon ML. A review of computer-based alcohol problem services designed for the general public. J Subst Abuse Treat. 2010;38(3):203–211.
    1. Riper H, Hoogendoorn A, Cuijpers P, et al. . Effectiveness and treatment moderators of internet interventions for adult problem drinking: an individual patient data meta-analysis of 19 randomised controlled trials. PLoS Med. 2018;15(12):e1002714.
    1. Holst A, Nejati S, Björkelund C, et al. . Patients’ experiences of a computerised self-help program for treating depression – a qualitative study of Internet mediated cognitive behavioural therapy in primary care. Scand J Prim Health Care. 2017;35(1):46–53.
    1. Hyland K, Hammarberg A, Hedman-Lagerlof E, et al. . The efficacy of iCBT added to treatment as usual for alcohol-dependent patients in primary care: study protocol for a randomized controlled trial. Trials. 2019;20(1):790.
    1. Graneheim U, Lundman B.. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–112.
    1. Patton MQ. 2002. Qualitative research & evaluation methods. 3rd ed. London (UK): Sage Publications.
    1. Malterud K, Siersma VD, Guassora AD.. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–1760.
    1. Lid TG, Malterud K.. General practitioners’ strategies to identify alcohol problems: a focus group study. Scand J Prim Health Care. 2012;30(2):64–69.
    1. O'Donnell A, Hanratty B, Schulte B, et al. . Patients’ experiences of alcohol screening and advice in primary care: a qualitative study. BMC Fam Pract. 2020;21(1):68–11.
    1. Wallhed Finn S, Hammarberg A, Andréasson S, et al. . Treating alcohol use disorders in primary care – a qualitative evaluation of a new innovation: the 15-method. Scand J Prim Health Care. 2021;39(1):51–59.

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