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Background: The 15-method is an opportunistic screening and brief intervention tool for alcohol-related problems in primary healthcare. A Danish feasibility study of the 15-method indicated that adjustments were needed to improve its contextual fit to Danish general practice. This adjustment process was conducted in two parts. The first part focused on identifying barriers, facilitators, and user needs for addressing alcohol using the 15-method. The second part will address the identified barriers and user needs to finalize a Danish version of the method. This study reports on part one of the adjustment process. Methods: Semi-structured individual interviews and focus group interviews with healthcare professionals (n = 8) and patients (n = 5) from general practice in Denmark. Data analysis was conducted using thematic content analysis. The results were condensed into two focus areas that will form the basis for user workshops in part two of the adjustment process. Results: The main barriers for addressing alcohol using the 15-method were patients and healthcare professionals not having the same agenda, having difficulty opening a conversation on alcohol, and workflow in the practices. Main facilitators included high interpersonal skills, taking the patient's perspective, and good routines and interdisciplinary work. Suggested adjustments and additions to the method included digitalization, visual icebreakers, quotes and examples, and development of a quick guide. The identified focus areas for user workshops were Communication and Material, and Integration to Workflows. Conclusion: Healthcare professionals found the opportunistic screening approach exemplified by the 15-method to be beneficial in identifying and addressing alcohol-related problems. They appreciate the method's structured framework that assists in presenting treatment options. Identified adjustment areas to the 15-method will lay the groundwork for future efforts to develop a finalized Danish version of the 15-method. [ABSTRACT FROM AUTHOR]

Background: The 15-method is a targeted screening and treatment approach for alcohol problems in primary care. The 15-method used in primary care has proven as effective as specialized treatment for mild to moderate alcohol dependence in Sweden. A feasibility study of the 15-method in Danish primary care found the method acceptable and feasible. Aims: To evaluate the effectiveness of the 15-method in a Danish primary care setting in (1) lowering the proportion of patients exceeding the Danish low-risk alcohol consumption limit of ten standard units per week and a maximum of four standard units on a single day for men and women, and (2) increasing the likelihood of alcohol use being addressed during a consultation in general practice. Further, the rate of prescribed pharmacological treatment for alcohol problems (Disulfiram, Naltrexone, Acamprosate, and Nalmefene) will be measured along with the use of the biomarkers Alanine Transaminase and Gamma-Glutamyl Transferase. Methods: Stepped wedge cluster randomized controlled trial in sixteen general practices in the Region of Southern Denmark. Following a three-month baseline, the practices are randomly assigned to launch dates in one of four clusters. General practitioners and nurses receive three hours of training in the 15-method before launch. Patient questionnaires will collect data on alcohol consumption levels among patients affiliated with the practices. The healthcare professionals will register consultations in which alcohol is addressed in their patient filing system. Pharmacological treatment rates and the use of biomarkers will be collected through Danish national registries. The study follows the Medical Research Council's guidelines for developing and evaluating complex interventions. Discussion: From the patient's perspective, the 15-method may help identify alcohol-related problems at an earlier stage with flexible treatment offers in a familiar setting. For healthcare professionals, it addresses a traditionally challenging topic by equipping them with concrete tools, communication training, and clear treatment directives. From a societal perspective, primary care holds a unique position to identify hazardous and harmful alcohol use across different age groups, with potential public health and economic benefits through early identification and intervention. Trial registration: Clinicaltrials.gov NCT05916027. Retrospectively registered 22 June 2023. [ABSTRACT FROM AUTHOR]

Background: Alcohol and cannabis use constitutes the major public health problems in Greenland. Thus, it is important to assess if Allorfik, a new national outpatient addiction treatment service introduced in 2016, was implemented successfully and how it is perceived. Allorfik introduced local treatment centers offering a treatment methodology (motivational interviewing and cognitive therapy) new to addiction treatment in Greenland with limited evidence from Indigenous populations such as the Greenlandic. The present study investigates the implementation of Allorfik from the perspective of those engaged in the process and the field. Methods: Data consisted of transcribed interviews with 23 individuals from both Allorfik and organizations collaborating with or supposed to collaborate with Allorfik. The theme of the interviews was their perspectives on the implementation process, enablers, and obstacles in the process and how Allorfik was performing at the time of the interview. The interview guide was informed by implementation theory. The transcribed material was analyzed using a general inductive approach. Results: The analysis resulted in three overall and interconnected themes, namely, implementation, collaborations, and challenges. The implementation was overall considered a success by the interviewees as all components were implemented as planned with a few adaptions, e.g., a treatment guideline update. The collaborations are considered challenging but important to all interviewees. Collaborations seem to rely on personal commitment as opposed to well-defined structures, making it unstable and vulnerable to changes in staff. One of the main challenges highlighted by the interviewees is the number of problems other than addiction among people in treatment, which makes addiction treatment and recovery difficult to achieve. Nevertheless, the high levels of other problems being treated in Allorfik highlights the need for easily accessible therapy as many find that Allorfik is the only place to turn to in times of crisis. Conclusion: Allorfik seems to have been implemented in accordance with original intentions and plans for addiction treatment service but has also become more than just a service for addiction treatment with easy access in a country with vast distances and limited resources. [ABSTRACT FROM AUTHOR]

Background: Adolescent hazardous alcohol use is prevalent and has serious short- and long-term consequences. The trial 'Our Choice' examines efficacy, feasibility and acceptability of prevention interventions targeting school, parent, and student levels at Danish high schools. We hypothesize that students in a structural intervention (school and parent levels) reduce hazardous alcohol use and related health behaviors compared to students in an assessment only control group 12 months post baseline; and that adding group-based Motivational Interviewing (group MI) yields further improvements. The study examines the efficacy of interventions targeting multiple levels with the aim of providing novel insights into prevention of adolescent hazardous alcohol use and related health outcomes. Method: The study employs a parallel group cluster randomized controlled trial design with three conditions: (1) structural condition targeting school and parent levels, (2) structural condition combined with group MI which also targets the student level, and (3) assessment-only control condition. A participatory approach is used to adapt and develop interventions. Sixteen high schools in Denmark and about N = 3100 first-year students (15–18 years) enrolled in high school in August 2023 will be recruited. Data will be collected via online questionnaires pre-interventions (baseline), 2, 6, 9 and 12 month post baseline and analyzed with generalized linear mixed models. The primary outcome is past month high intensity drinking; secondary outcomes are alcohol use, alcohol-related consequences, well-being, tobacco, and illegal substance use. Feasibility and acceptability will be assessed via surveys (students) and interviews (high school staff) to inform future implementation. Discussion: 'Our Choice' is the first trial to compare the efficacy of a structural intervention targeting school- and parent levels to an intervention targeting these levels and the student level via group MI – on hazardous drinking and related health outcomes among students. Preventing and reducing hazardous alcohol use during adolescence is crucial due to the short- and long-term negative consequences. The tested interventions can be implemented at low cost. The study has significant implications for adolescent health and well-being and has potential to inform evidence-based decisions on alcohol prevention policy, education, and health professions. Trial Registration Number: The trial was retrospectively registered at ClinicalTrials.gov on August 24th, 2023. Trial Registration Number: ID NCT06018389. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorder (AUD) causes significant morbidity, mortality, and injuries. According to reports, approximately 5% of all registered deaths in Denmark could be due to AUD. The problem is compounded by the late identification of patients with AUD, a situation that can cause enormous problems, from psychological to physical to economic problems. Many individuals suffering from AUD never undergo specialist treatment during their addiction due to obstacles such as taboo and the poor performance of current screening tools. Therefore, there is a lack of rapid intervention. This can be mitigated by the early detection of patients with AUD. A clinical decision support system (DSS) powered by machine learning (ML) methods can be used to diagnose patients' AUD status earlier. Methods: This study proposes an effective AUD prediction model (AUDPM), which can be used in a DSS. The proposed model consists of four distinct components: (1) imputation to address missing values using the k-nearest neighbours approach, (2) recursive feature elimination with cross validation to select the most relevant subset of features, (3) a hybrid synthetic minority oversampling technique-edited nearest neighbour approach to remove noise and balance the distribution of the training data, and (4) an ML model for the early detection of patients with AUD. Two data sources, including a questionnaire and electronic health records of 2571 patients, were collected from Odense University Hospital in the Region of Southern Denmark for the AUD-Dataset. Then, the AUD-Dataset was used to build ML models. The results of different ML models, such as support vector machine, K-nearest neighbour, decision tree, random forest, and extreme gradient boosting, were compared. Finally, a combination of all these models in an ensemble learning approach was selected for the AUDPM. Results: The results revealed that the proposed ensemble AUDPM outperformed other single models and our previous study results, achieving 0.96, 0.94, 0.95, and 0.97 precision, recall, F1-score, and accuracy, respectively. In addition, we designed and developed an AUD-DSS prototype. Conclusion: It was shown that our proposed AUDPM achieved high classification performance. In addition, we identified clinical factors related to the early detection of patients with AUD. The designed AUD-DSS is intended to be integrated into the existing Danish health care system to provide novel information to clinical staff if a patient shows signs of harmful alcohol use; in other words, it gives staff a good reason for having a conversation with patients for whom a conversation is relevant. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorders (AUD) are among the most highly stigmatized medical conditions. Only a minority of individuals with AUD seek treatment, and stigma is one of the most prominent barriers to treatment-seeking. However, there is a lack of knowledge about the associations between stigma and preferences for help-seeking, and the associations between stigma and preferences for treatment seeking. Aim: to investigate the associations between stigma and preferences for where to seek help and treatment for AUD. As sub-analyses, associations between stigma, level of alcohol use and preferences for help-seeking and treatment preferences will be analyzed. Method: Cross-sectional design, including n = 3037 participants aged 30 – 65 years, living in Denmark. Data: In 2020, an online questionnaire was administered by a market research company. The questionnaire covered demographics, preferences for help-seeking and treatment for AUD, stigma measured with the Difference, Disdain & Blame Scales for Public Stigma, and alcohol use measured with the Alcohol Use Disorder Test (AUDIT). Analyses: restricted cubic spline models were applied to model outcomes. Odds ratios were calculated. Results: A lower level of stigma was associated with a higher probability of preferring formal and informal help-seeking for AUD. Both high and low levels of stigma were associated with a higher probability of preferring to consult general practitioners. Stigma was not associated with other preferences for treatment-seeking, nor trying to change oneself or a passive strategy. The sub-analyses, grouped by level of alcohol use, showed similar results. Conclusion: Stigma is associated with lower preferences for formal and informal help-seeking, however not type of treatment preferred. Future studies should address stigma in relation to other factors of the treatment-seeking process. [ABSTRACT FROM AUTHOR]

Background: Patients with alcohol use disorder (AUD) exhibit deficits in various cognitive domains, including executive functioning, working memory, and learning and memory, which impede the effectiveness of conventional AUD treatment and enhance relapse. Mobile health (mHealth) services are promising in terms of delivering cognitive training in gamified versions. So far, studies examining the effects of mHealth-based cognitive training in AUD patients have, however, focused on specific rather than multiple cognitive domains and overlooked the importance of clinical outcomes. Furthermore, research has yet to investigate the acceptability and feasibility of this type of cognitive training. Aims: The aims of this pilot study are to examine (1) whether using smartphone-based, multi-domain cognitive training with gamified elements as part of conventional treatment for AUD indicate effect, and (2) whether the intervention is acceptable and feasible as a part of conventional treatment for AUD. Methods: Patients from the alcohol outpatient clinic, Odense Municipality, Denmark will be invited to participate in the study on a consecutive basis until a total of 60 patients have been recruited. The study will be performed as a combined parallel randomized controlled trial (RCT) and qualitative feasibility study. The patients will be randomly assigned to one of two groups. The intervention group (n = 30) will receive smartphone-based, multi-domain cognitive training with gamified elements together with treatment as usual (TAU). The active control group (n = 30) will receive a sham version of the same cognitive training together with TAU. Cognitive outcomes will be assessed via the training application at baseline and post-treatment. Clinical outcomes will be assessed at baseline, post-treatment, and at 6-month follow-up using the Addiction Severity Index. Furthermore, the 30 patients randomized to the intervention group will be invited to participate in the second phase, that is the feasibility study, at post-treatment. A questionnaire inquiring about the use of mHealth treatment in general will be administered. Further, feedback regarding functionality and meaningfulness of the application in addition to other qualitative aspects relating to the use of the application will be collected. The patients will also be asked to provide suggestions about how to improve and potentially implement the tool. Implications: It is anticipated that this pilot study will provide tentative evidence for the effectiveness of smartphone-based, multi-domain cognitive training as well as information about the usability and feasibility of this type of training, including acceptability and compliance. The study will also contribute with feedback derived from the patients about how to improve and implement the tool. If promising, the findings will be used to plan a large-scale RCT. Since cognitive deficits are not addressed in current treatments for AUD, gamified cognitive training delivered through smartphones may increase the effectiveness of current treatment for AUD as well as introduce more mHealth-based treatment that is both accessible and cost-effective. [ABSTRACT FROM AUTHOR]

Background: Only a minority of individuals with problematic alcohol use ever seek alcohol treatment. Knowledge of general help‐seeking behavior in the healthcare system can identify possibilities for prevention and intervention. Method: The current study describes healthcare use, burden of disease, and prior morbidities over a 15‐year period by current alcohol use behavior among Danish adults aged 60–70. The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2014–2016) were linked to Danish national registers to collect annual information on healthcare use and morbidity for the 15 years prior to inclusion. Participants from the 3 largest Danish municipalities were divided into 4 groups with varying drinking patterns and no recent treatment [12‐month abstinent (n = 691), low‐risk drinkers (n = 1978), moderate‐risk drinkers (n = 602), and high‐risk drinkers (n = 467)], and a group of treatment‐seeking individuals with a 12‐month DSM‐5 alcohol use disorder (AUD; n=262). Negative binomial regression models were utilized to compare rates of healthcare use and logistic regressions were used to compare odds of diagnoses. Results: Low‐, moderate‐, and high‐risk drinkers had similar rates of past healthcare utilization (low‐risk mean yearly number of contacts for primary care 7.50 (yearly range 6.25–8.45), outpatient care 0.80 (0.41–1.32) and inpatient care 0.13 (0.10–0.21)). Higher rates were observed for both the 12‐month abstinent group (adjusted RR = 1.16–1.26) and the group with AUD (ARR = 1.40–1.60) compared to the group with low‐risk alcohol consumption. Individuals with AUD had higher odds of previous liver disease (adjusted OR = 6.30), ulcer disease (AOR = 2.83), and peripheral vascular disease (AOR 2.71). Twelve‐month abstinence was associated with higher odds of diabetes (AOR = 1.97) and ulcer disease (AOR = 2.10). Conclusions: Looking back in time, we found that older adults had regular healthcare contacts, with those who received treatment for AUD having had the highest contact frequency and prevalence of alcohol‐related diseases. Thus, healthcare settings are suitable locations for efforts at AUD prevention and intervention. [ABSTRACT FROM AUTHOR]

Background: The approach-avoidance training program (AATP) has shown preliminary promise as an add-on to standard treatment for alcohol dependence. However, knowledge is lacking as to whether the effectiveness of AATP can be enhanced further when performed in a typical drinking situation. The main aim of this study is to investigate whether approach-avoidance training implemented in a virtual reality bar environment is superior to the classical joystick PC-version of the AATP. Methods: The study will be implemented as a randomized controlled trial. A total of 204consecutively enrolled alcohol use disorder (AUD) patients, recruited from alcohol inpatient clinics in Germany, Poland and Denmark, will be randomized into one of three groups at the start of standard alcohol treatment: group A) stimuli-relevant AATP + treatment as usual (TAU); group B) stimuli-relevant AATP in virtual reality + TAU, and group C) TAU only (control group). Treatment outcomes will be assessed at pre-treatment, post-treatment and 3-month follow-up. Repeated-measures ANOVA will be applied to compare the trajectories of the groups over time on drinking, craving and impulsiveness outcomes. It is hypothesized that the two experimental groups will achieve better treatment outcomes compared to group C and that group B will achieve better outcomes than group A. Discussion: This study is the first trial examining the effectiveness of stimuli-relevant AATP delivered in a VR environment. The use of VR has shown promise in enhancing the effectiveness of other psychological treatments and since AATP has already been shown effective as add-on treatment, it is of interest to investigate whether these effects can be further enhanced by implementing the program in more ecologically valid environments. If proven effective, the AATP-VR can, like the AATP, be implemented easily and cheaply as add-on treatment or continued care to enhance the effectiveness of current evidence-based treatment. Trial registration: ClinicalTrials.gov ID: NCT04283305 Registration date: 24.02.20 [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]

Aim: To examine whether adding the Community Reinforcement Approach for Seniors (CRA‐S) to Motivational Enhancement Therapy (MET) increases the probability of treatment success in people aged ≥ 60 years with alcohol use disorder (AUD). Design A single blind multi‐centre multi‐national randomized (1 : 1) controlled trial. Setting: Out‐patient settings (municipal alcohol treatment clinics in Denmark, specialized addiction care facilities in Germany and a primary care clinic in the United States). Participants: Between January 2014 and May 2016, 693 patients aged 60+ years and fulfilling DSM‐5 criteria for AUD participated in comparing MET (n = 351) and MET + CRA‐S (n = 342). Intervention and comparator: MET (comparator) included four manualized sessions aimed at increasing motivation to change and establishing a change plan. CRA‐S (intervention) consisted of up to eight further optional, manualized sessions aimed at helping patients to implement their change plan. CRA‐S included a specially designed module on coping with age and age‐related problems. Measurements The primary outcome was either total alcohol abstinence or an expected blood alcohol concentration of ≤ 0.05% during the 30 days preceding the 26 weeks follow‐up (defined as success) or blood alcohol concentration of > 0.05% during the follow‐up period (defined as failure). This was assessed by self‐report using the Form 90 instrument. The main analysis involved complete cases. Findings The follow‐up rate at 26 weeks was 76.2% (76.9% in the MET group and 76.0% in the MET + CRA‐S group). The success rate in the MET group was 48.9% [95% confidence interval (CI) = 42.9–54.9%] versus 52.3% (95% CI = 46.2–58.3%) in the MET + CRA‐S group. The odds of success in the two conditions did not differ (odds ratio = 1.22. 95% CI = 0.86–1.75, P = 0.26, Bayes factor = 0.10). Sensitivity analyses involving alternative approaches to missing values did not change the results. Conclusions: In older adults with an alcohol use disorder diagnosis, adding the 'community reinforcement approach for seniors' intervention to brief out‐patient motivational enhancement therapy treatment did not improve drinking outcome. [ABSTRACT FROM AUTHOR]

Objective: The patient's free choice of treatment goals for alcohol use disorder (AUD) is predictive for treatment outcome. Presently there is limited knowledge of whether the age at onset of AUD influences the choice of goal for treatment. The present study investigates whether there are differences in choice of treatment goal between patients with very late onset alcohol use disorder (VLO AUD ≥ 60 years) and those having early or mid-age onset of AUD (EMO AUD < 60 years). Method: Participants were 341 persons, voluntarily enrolled in the Elderly Study, who were seeking treatment for AUD in outpatient centres for alcohol treatment in Denmark. Data regarding thoughts about abstinence, alcohol use in the last 90 days, motivation for treatment and psychiatric diagnosis were collected via questionnaires. A logistics regression was used to analyse the data. Results: 32.1% of the participants with VLO AUD chose temporary abstinence goals, compared to 18.2% of the patients with earlier-onset AUD (p = 0.024). Further, 10.7% of participants with VLO AUD chose total abstinence goals compared to 31.3% of participants with early or mid-age onset AUD (p = 0.002). Conclusion: There are significant differences in choice of goal between participants with very late onset AUD and early or mid-age onset AUD. Individuals with very late onset alcohol use disorder tend to choose temporary abstinence over any other treatment goal whereas, in general, individuals with early onset alcohol use disorder choose permanent abstinence over other treatment goals. [ABSTRACT FROM AUTHOR]

Background: In the present study, we investigated the overall lifestyles of patients with hazardous alcohol use and alcohol dependence who were admitted to the hospital and investigated unhealthy lifestyle factors and their clustering in inpatients.Methods: Patients admitted to the gastrointestinal, neurologic or orthopedic departments at Odense University Hospital or to the emergency department at Aabenraa Hospital in the inclusion period, October 2013 to June 2016, completed a lifestyle questionnaire asking questions about their diet, alcohol consumption, exercise and smoking habits. Patients were divided into three groups depending on their score from the alcohol use disorder identification test, which was embedded in the lifestyle questionnaire, and odds ratios were calculated using logistic regression.Results: Patients with alcohol dependence had statistically significantly higher odds of being smokers, having unhealthy diets and being physically inactive compared with patients without alcohol problems. Among patients with hazardous alcohol drinking, we found an increased occurrence of smokers and an inverse association between hazardous alcohol drinking and being physically inactive. Many of the patients had attempted to change their unhealthy lifestyles.Conclusion: We found that alcohol problems are related to a clustering of other lifestyle factors and that many of the patients admitted to certain departments showed signs of various kinds of alcohol problems. Therefore, specific hospital departments could be opportune settings for preventive alcohol interventions. [ABSTRACT FROM AUTHOR]

Aim: In 2007, the legal obligation to deliver alcohol treatment to the public was transferred to the 98 municipalities of Denmark. This resulted in changes in how alcohol treatment centers in Denmark work. The aim of the present study was to describe the patient profiles and treatment outcomes in the alcohol treatment centers regarding regional variation and changes over time.Subjects and methods: This is a descriptive, register-based study of patients enrolled in alcohol treatment centers from 2006–2014 in Denmark. Only patients above the age of 15 years and with a valid postal code were included. The sample was restricted to the patients’ first contact with the alcohol treatment register (n = 44,516).Results: Patients who initiated treatment in the period 2006–2014 and were registered in the National Alcohol Treatment Register were primarily males (69–70%) with an average age between 46 and 49 years. Most had a vocational education (38–41%) on top of their primary education. The number of years with excessive alcohol use started out as being quite different in the five regions, but became more homogeneous over the study period. Treatment duration in the various regions followed a similar pattern, with all five of them having a similar treatment duration time of 160–230 days by 2014.Conclusion: We found that treatment for alcohol use disorder became more homogeneous across the regions in Denmark over time and that by 2014 it was difficult to identify any differences across the country. [ABSTRACT FROM AUTHOR]

Introduction This is a pioneering qualitative phenomenological hermeneutical study investigating a so far under-investigated group of older adults with very late-onset alcohol use disorder. The number of older adults is increasing, and the number of older adults with alcohol problems is increasing accordingly. We investigated older adults with very late-onset alcohol use disorder to identify what causes some people to develop problems with alcohol after the age of 60. Method We interviewed 12 Danish individuals (seven men) whose alcohol use disorder started after the age of 60. For our analysis, we used the Interpretative Phenomenological Analysis framework, rigorously following the six steps it prescribes. Participants were included until data saturation was achieved. Findings After a lifelong unproblematic (at times heavy) use of alcohol, it seemed that using alcohol as a coping strategy was one of the main factors in very late-onset alcohol use disorder among our participants. We found that the participants experienced a marked loss of identity when they had no activities to fill up their time after retirement. Social activities involving alcohol were also closely related to very late-onset alcohol use disorder. Conclusion Loss of identity, coping with physical and psychological problems, an overarching societal and social culture surrounding alcohol and the interrelationship between social life, alcohol use and heavy drinking are important factors that need be addressed clinically and preventively, and specifically for individuals experiencing very late-onset alcohol use disorder. [ABSTRACT FROM AUTHOR]

Background: This paper is embedded in a randomised controlled trial (Alcohol and Employment) that investigated whether welfare-to-work schemes combined with alcohol treatment were more effective than welfare-to-work schemes alone for helping unemployed welfare recipients with alcohol problems get back to employment and reduce their alcohol problems. The implementation of Alcohol and Employment turned out to be challenging, and fewer welfare recipients than expected were enrolled. The aim of this paper was to identify and investigate obstacles to the implementation of Alcohol and Employment. Our main objective was to study the job consultants' role in the implementation process as they were key personnel in conducting the trial. Methods: The process evaluation was conducted in four Danish municipalities in 2011-2012. Data for identifying factors important for the implementation were collected through observations and focus group interviews with job consultants. Data were analysed thematically and thoroughly discussed among members of the project team; emerging themes were then grouped and read again repeatedly until the themes were consistent. Results: Three themes emerged as the main factors influencing the degree of implementation of Alcohol and Employment: (1) The job consultants' personal attitudes toward alcohol were an important factor. The job consultants generally did not consider a high alcohol intake to be an impediment to employment, or they thought that alcohol problems were only symptoms of more profound problems. (2) The job consultants' perception of their own roles and responsibilities in relation to the welfare recipients was a barrier: they felt that addressing alcohol problems and at the same time sustaining trust with the welfare recipient was difficult. Also, they did not consider alcohol problems to be their responsibility. (3) Shortage of time and resources among the job consultants was determined to be an influential factor. Conclusions: We identified important factors at the individual level among the job consultants who threatened the implementation of Alcohol and Employment. Future studies in similar settings can take advantage of these findings when preparing interventions that are implemented by job consultants or similar professionals. [ABSTRACT FROM AUTHOR]

Aims: To test if a brief motivational intervention (BMI) in a non-treatment seeking population of heavy drinkers results in a reduced alcohol intake. Methods: Screening of 12,364 participants in a Danish health examination survey led to 1026 heavy drinkers of whom 772 were included and randomized to a BMI group (n = 391) or a control group (n = 381) receiving two leaflets about alcohol. Follow-up took place after 6 and 12 months including 670 and 616 participants respectively. The outcome measure was self-reported weekly alcohol consumption. Data were analysed according to the intention-to-treat principle. We used the Motivational Interviewing Treatment Integrity 3.0 code (MITI) as a quality control of the interventions delivered. Results: The intervention effect of the BMI was −1.0 drinks/week, but the effect was not significant. The MITI analysis showed that the quality of the BMI delivered was sub-optimal, as only one of four aspects was above the recommended level for beginning proficiency. Conclusion: We found no effect of a BMI in reducing alcohol consumption. The generalizability of the study is questionable, as individuals with the lowest level of education, low income and unmarried individuals are under-represented. [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]

Background: Around 585,000 people in Denmark engage in harmful use of alcohol with 140,000 suffering from outright alcohol dependence. The concerned significant others (CSOs) are affected by the drinking, often suffering almost as much as the person with alcohol use disorder. Community Reinforcement and Family Training (CRAFT) is aimed at CSOs who struggle unsuccessfully, in an effort to motivate their loved ones to stop drinking and seek treatment. The aims of this study are 1) To implement CRAFT interventions into the daily routine of operating Danish alcohol treatment centers 2) To investigate whether 6-week-individual CRAFT, 6-week-open group-based CRAFT or CRAFT based on self-help material, is efficient in getting problem drinkers to seek treatment for their alcohol problems 3) To investigate which of the three interventions (individual, group or self-directed CRAFT) is the most effective and in which group of population.Methods: The study is a three-arm, cluster randomized controlled trial: A: individual CRAFT, group CRAFT, and CRAFT as a self-help intervention. A total of 405 concerned significant others to persons with alcohol abuse will be recruited from 24 alcohol outpatient clinics. The participants will fill out a questionnaire regarding i.e. life quality, if the drinking person entered treatment (main outcome) and satisfaction with the intervention, at baseline and after 3 and 6 months.Discussion: We expect to establish evidence as to whether CRAFT is efficient in a Danish treatment setting and whether CRAFT is most effective at individual, group or self-help material only.Trial Registration: Clinical trials.gov ID: NCT03281057 . Registration date: September 13th, 2017. [ABSTRACT FROM AUTHOR]

A minority of individuals with alcohol use disorder (AUD) seek treatment. In Denmark, a mass media campaign, "RESPEKT", aiming to increase treatment seeking, has been broadcasted nationwide since 2015. The campaign is unique from an international perspective. Similar interventions have, up until now, not been scientifically evaluated. To investigate whether there was an association between campaign periods and treatment seeking for AUD. A secondary aim was to investigate possible gender differences. The hypotheses were that treatment seeking would increase during the campaign periods, and that men would increase their treatment seeking more compared to women. Study design: Interrupted time-series analysis. Participants: Adults aged 18 years and above in the Danish population seeking AUD treatment. Exposure: Campaign periods year 2015–2018. Outcome: Changes in treatment seeking defined as treatment entry respectively filled prescription of AUD pharmacotherapy. Data: National Alcohol Treatment Register on treatment entries for specialist addiction care and National Prescription Registry for filled prescriptions on AUD pharmacotherapies 2013–2018. Analysis: Segmented negative binomial regression, including the full cohort and stratified by sex. The results show no association between campaign periods and treatment seeking. Nor were there any gender differences in treatment seeking. The hypotheses were not confirmed. The campaign periods showed no association with treatment seeking. Eventual future campaigns should possibly focus on earlier steps of the treatment seeking process, as problem recognition, to increase treatment seeking. There is a great need to develop other ways to narrow the treatment gap for AUD. • There was no association between the repeated annual mass media campaign periods and treatment seeking for AUD. • No gender differences were found. • Other interventions are needed to increase treatment seeking for AUD. [ABSTRACT FROM AUTHOR]

Aim: To test the feasibility of a participatory design intervention aimed at reducing the risk of cardio-vascular disease among patients suffering from alcohol use disorder (AUD) or severe mental illness (SMI)., Methods: The intervention was developed by patients from the Community Mental Health Center and the Alcohol Treatment Facility in Odense, Denmark, and consisted of eight modules (health interviews, screening and treatment, introduction, diet/alcohol, physical activity, smoking, health app, and sleep problems). The intervention was tested using pre- and post-measurements of selected variables, patients' intervention attendance, and interviews and dialogue workshops at the end of the study., Results: A total of 21 out of 42 eligible patients from the Alcohol Treatment Facility and two out of 443 eligible patients from the Community Mental Health Center accepted participation in the study. The two patients from the Community Mental Health Center were not included in the analyses due to General Data Protection Regulation (GDPR). All patients accepted being screened for risk factors at inclusion, and the majority enrolled in at least one of the subsequent modules. The study indicated that the patients followed recommendations from their GPs., Conclusions: There is a great need for focus on cardio-vascular disease in patients with SMI and those with AUD. Results indicate that the intervention is feasible for patients with AUD, but due to inclusion of too few patients with SMI, nothing can be concluded for this patient group. Patients and staff in the Alcohol Treatment Facility agreed that the intervention has future perspectives.

Background: A minority of all individuals with alcohol use disorders (AUD) seek treatment, where stigma is one prominent barrier. Social support is important to facilitate health and increase treatment-seeking. Whether there is an association between stigma and attitudes towards others' help-seeking for AUD is unknown. The aim of this study was to investigate the associations between stigma and support towards others' help-seeking for AUD, also to explore possible gender differences., Method: Cross-sectional study, n = 2895, including Danish adults aged 30-65 in the general population. Year 2020, an online questionnaire was administrated, which covered demographics, attitudes towards others' help-seeking for AUD, and stigma measured with the Difference, Disdain & Blame Scales. Analyses were performed with Restricted Cubic Spline models, and odds ratios were calculated., Results: Lower level of stigma was associated with a higher probability for endorsing an "active support strategy". Level of stigma was not associated with "not knowing what to say or do" or "sharing my concern with others". There were few gender differences: among men, higher level of stigma was associated with a higher probability of "avoidance". Among women, lower level of stigma was associated with a lower probability of "avoidance"., Conclusion: There is a clear association between stigma and attitudes towards supporting others' help-seeking for AUD. The results highlight the need to reduce stigma and promote engagement towards others' treatment-seeking., (© 2023. Evans Medical Foundation, Inc. and BioMed Central Ltd.)

Background: 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., Methods: 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., Results: 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., Conclusion: 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.

Background: The 15-method: a new brief intervention tool for alcohol problems in primary care has shown promising results in Sweden for mild to moderate alcohol use disorders. The present study evaluated the 15-method's usability, organizational integration, and overall implementation feasibility in Danish general practice in preparation for a large-scale evaluation of the method's effectiveness in identifying and treating alcohol problems in general practice., Methods: Five general practices in the Central and Southern Region of Denmark participated: seven general practitioners (GPs), eight nurses. Participants received a half day of training in the 15-method. Testing of implementation strategies and overall applicability ran for 2 months. A focus group interview and two individual interviews with participating GPs along with five individual patient interviews concluded the study period., Results: Results indicate that implementation of the 15-method is feasible in Danish general practice. The healthcare professionals and patients were positive about the method and its possibilities. The method was considered a new patient centered treatment offer and provided structure to a challenging topic. An interdisciplinary approach was much welcomed. Results indicate that the method is ready for large scale evaluation., Conclusions: Implementation of the 15-method is considered feasible in Danish general practice and large-scale evaluation is currently being planned., (© 2022. The Author(s).)

Aims: The objective of this paper was to examine 20-year trends of the socioeconomic status (SES) measures income and employment and their association with current alcohol use behaviors in Danish adults aged 60-70., Methods: Data from The Danish National Health Survey 2013 and the baseline assessment of the Elderly Study (2013-2016) were combined to form four groups from the general population with various drinking patterns, but with no recent treatment for alcohol use disorder (AUD), and one group seeking treatment: Abstinent (n = 691), low- (n = 1978), moderate- (n = 602), and high-risk (HR) drinkers (n = 467), and DSM-5 AUD seeking treatment (n = 262). For all groups, Danish national register data were linked at the individual level obtain find annual information on income and employment during the 20 years prior to interview. Mixed effects models were utilized to model trajectories of income and employment for the five groups., Results: Lower income and employment status was observed from middle-aged adulthood when comparing 12-month abstinence or AUD to individuals with low or moderate alcohol consumption. At the end of the study period, moderate-risk drinkers experienced an increase, and HR drinkers a decrease, in income and rate of employment relative to the low-risk drinkers., Conclusions: Alcohol use behaviors observed in older adults are related to distinct long-term trajectories regarding income and employment status, which are observable already in middle-aged adulthood., (© The Author(s) 2020. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Background and Aims: The Motivational Interviewing Treatment Integrity code (MITI) measures fidelity to, and the quality of, Motivational Interviewing (MI), and can also be used when MI is combined with other treatment methods. The current study presents a fidelity measurement with the MITI 4.2.1, in both Motivational Enhancement Therapy sessions and the combined Community Reinforcement Approach-Senior (CRAS)., Method: The MITI 4.2.1 was used to evaluate treatment sessions provided in the Elderly Study, a multi-national randomized trial evaluating treatment for alcohol use disorders in the elderly. Following expert recommendations, training was conducted at two international sites as well as at the Danish site. Twenty percent of the sessions at the Danish study site were rated. Twelve percent were multiply rated by all raters. Interrater reliability was assessed by the Intraclass Correlations Coefficient (ICC)., Results: Mean ICC of the 52 sessions rated by all raters was 0.78 (95% CI: 0.70; 0.86). The rare measures confront and emphasize autonomy, and the global measure softening sustain talk only reached fair levels of ICC, while the remaining measures were good or excellent. In the sessions of MI combined with other treatment approaches in the CRAS, the MITI 4.2.1 has a similar reliability as in MET sessions only, except for the measure persuade with permission., Conclusion: The MITI 4.2.1 is a reliable instrument for measuring fidelity to Motivational Interviewing elements, also in the context of Community Reinforcement Approach Senior. However, in softening sustain talk, the rare measures, and persuade with permission it has proved more difficult to reach high levels of interrater reliability., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

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.

Background: Research on matching patients to treatment has shown that matching grounded in expert views is little better than allocating patients by chance. Furthermore, there is growing emphasis on involving patients in their own treatment as a key to health behavior change. Research on the benefit of having patients choose their treatment from among options, in contrast to being assigned to a treatment by experts, has been limited. Consequently, we designed a rigorous test of patient self-matching to determine whether it does improve retention, adherence, and outcome in alcoholism treatment., Methods/design: The present study is being conducted as a randomized controlled trial. Four hundred consecutive patients aged 18 years or older will be enrolled and randomized to either self-matching or expert-matching to one of five different treatment approaches. All patients entering the alcohol outpatient clinic in Odense are offered the opportunity to participate in the study. Exclusion criteria are cognitive dysfunction as measured with the Mini Mental State Examination, and non-Danish- or non-English-speaking individuals. The following instruments will be administered at intake to provide standardized measures of alcohol problems: the Addiction Severity Index, Timeline Followback, the World Health Organization quality of life questionnaire, the NEO Five-Factor Inventory 3, and the Personal Happiness Form. For each outcome measure, two analyses will be conducted. Intention-to-treat analyses (ITT) will be carried out with all patients, regardless of whether they complete the interventions or are reinterviewed. Regarding incomplete data, multiple imputations will be used together with ITT analysis. Completer analyses will also be carried out with patients who complete their respective interventions. The primary outcome is decrease in number of monthly excessive drinking days 6 months after initiation of treatment. Secondary outcomes are compliance and 2 quality of life. The influence of personality traits on outcome will also be examined in both groups., Discussion: The debate on matching patients to treatment has been going on for decades. This study will cast light on this issue by focusing on patients' choice and thereby clarifying if patients' perceived autonomy yields better outcomes., Trial Registration: ClinicalTrials.gov, NCT03278821 . Registered on 12 September 2017.

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.

This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent or drinking no more than 21 standard drinks per week). Patients with harmful alcohol use or dependence as their primary problem who were seeking psychosocial treatment at one of four alcohol clinics in Denmark participated in the study. After implementation of the clinical pathway system, which incorporated a structured intake, a referral and independent follow-up system, checklists, audit, and feedback, there was no change in length of stay, but significantly more patients had a good clinical outcome (stopped or moderated their consumption) at the end of treatment (OR = 1.9; 1.2-3.1). The study documents the feasibility of using a clinical pathway framework, incorporating a local monitoring system, checklists, audit, and feedback to enhance treatment quality and improve outcomes for alcohol use disorders.

Background: Internet-based interventions for heavy drinkers show promising results, but existing research is characterized by few studies in nonstudent adult populations and few comparisons with appropriate control groups., Objective: To test whether a fully automated Internet-based brief personalized feedback intervention and a fully automated Internet-based personalized brief advice intervention in a non-treatment-seeking population of heavy drinkers would result in a reduced alcohol intake., Methods: We conducted a 3-arm parallel randomized controlled trial in a general population-based sample of heavy drinkers. The 54,157 participants (median age of 58 years) were screened for heavy drinking. Of the 3418 participants who had a weekly alcohol consumption above 14 drinks for women and 21 drinks for men, 1380 (619 women) consented to take part in the trial and were randomly assigned to an Internet-based brief personalized feedback intervention group (normative feedback, n = 476), an Internet-based personalized brief advice intervention group (n = 450), or a nonintervention control group (n = 454). Follow-up after 6 and 12 months included 871 and 1064 participants, respectively, of all groups combined. The outcome measure was self-reported weekly alcohol consumption. We analyzed the data according to the intention-to-treat principle. To examine changes over time and to account for the multiple time measurements, we used a multilevel linear mixed model. To take attrition into account, we used multiple imputation to address missing data., Results: The intervention effect of the Internet-based brief personalized feedback intervention, determined as the mean additional difference in changes in alcohol consumption in the Internet-based brief personalized feedback intervention compared with the control group, was -1.8 drinks/week after 6 months and -1.4 drinks/week after 12 months; these effects were nonsignificant (95% confidence interval -4.0 to 0.3 at 6 months, -3.4 to 0.6 at 12 months). The intervention effect of the Internet-based personalized brief advice intervention was -0.5 drinks/week after 6 months and -1.2 drinks/week after 12 months; these effects were nonsignificant (95% confidence interval -2.7 to 1.6 at 6 months, -3.3 to 0.9 at 12 months)., Conclusions: In this randomized controlled trial we found no evidence that an Internet-based brief personalized feedback intervention was effective in reducing drinking in an adult population of heavy drinkers., Trial Registration: ClinicalTrials.gov NCT00751985; http://clinicaltrials.gov/ct2/show/NCT00751985 (Archived by WebCite at http://www.webcitation.org/68WCRLyaP).