The DRAM, Vol. 21(1) – Addressing hazardous drinking within mental health treatment settings

Hazardous drinking among people with psychiatric disorders is a prevalent concern. Those with mental health disorders such as anxiety or depression may be twice as likely to report having an alcohol use disorder (AUD) than those without. However, there is a lack of adequate screening options and interventions for alcohol use in mental health treatment settings. This week, the DRAM reviews a study by Nathalie Kools and colleagues that examined barriers and facilitators to addressing alcohol use within mental health services in the Netherlands.

What was the research question?
What are some barriers and facilitators to identifying and intervening with AUD in mental health treatment settings?

What did the researchers do?
The researchers used purposive sampling to recruit 18 professionals (e.g., psychiatrists, health care psychologists, managers) from 13 mental health service organizations in the Netherlands. The researchers conducted interviews with each participant to learn about their experiences with identifying and intervening with hazardous alcohol use among clients. The researchers then used thematic analysis to identify key themes.

What did they find?
One theme was knowledge and skills among professionals (see Figure). Participants reported that some professionals lacked knowledge in identifying and intervening with hazardous drinking. To address that knowledge gap, they suggested implementing comprehensive training. Another theme was collaboration between mental health and addiction services. Participants stated that some professionals lacked awareness of available addiction services and thus could not provide adequate referrals. They noted that closer collaboration could mitigate that problem. Noted organizational barriers included staff shortages, time constraints, and limited funding; integrating addiction experts and treatments within mental health services would be helpful. Finally, in regards to outside influences, participants noted that inadequate health insurance reimbursement prevented certain mental health services from working with AUD diagnoses. In contrast, they suggested that government campaigns promoting AUD awareness might increase routine screening/intervention.


Figure. An overview of key barriers and facilitators to addressing alcohol use within mental health services. Click image to enlarge.

Why do these findings matter?
Identifying and intervening with hazardous drinking and other substance misuse is a crucial aspect of helping clients at mental health service centers. Mental health service organizations should focus on increasing alcohol training for their client-facing staff and improving collaboration with addiction services to better support those clients. Clients might also benefit from the implementation of integrated mental health and addiction treatment approaches.

Every study has limitations. What are the limitations in this study?
This study was conducted in the Netherlands, so the results might not be generalizable to other countries with different mental health and addiction treatment structures. Additionally, selection bias might have occurred since the researchers used a purposive sampling method.

For more information:
The National Institute on Alcohol Abuse and Alcoholism has tips and resources for people struggling with problem drinking. For additional drinking self-help tools, please visit our Addiction Resources page.

— Annette Siu

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