Those who misuse alcohol in the United States do not regularly seek treatment on their own to reduce use and avoid consequences of misuse. Because of the association between alcohol misuse, alcohol-related risk behaviors, and injury; alcohol misuse in the United States has serious societal and individual repercussions. To alleviate these problems, health care professionals; including doctors, nurses, and social workers; have an opportunity to screen injured patients for alcohol misuse and provide brief interventions. Although some brief intervention research has demonstrated reductions in alcohol misuse and other injury-related behaviors, other evidence indicates that brief alcohol interventions are not equally effective for all injured patients. Moreover, screening and brief alcohol interventions are not reimbursed in most states, leaving providers and medical centers uncompensated for providing services. A possible way to address these challenges is to target intervention services to patients who are most likely to make positive changes. Therefore, this dissertation used mixture modeling to identify subclasses of injured patients based on their past injury-related consequences and risks of alcohol misuse in order to describe which subgroups made the greatest reductions in drinking in the year following discharge from a Level-1 trauma center. This dissertation also identified which subclasses of patients made the greatest behavioral improvements for injury-related consequences and risks of alcohol misuse during the year following discharge from the trauma center. Patients with profiles that contained high probabilities of multiple consequences and risks and those with histories of alcohol-related accidents and injuries reported some of the largest improvements in drinking and injury-related consequences and risks following discharge. Those classes that made the fewest changes had profiles that consisted of fighting and taking foolish risks while drinking or that consisted of low probabilities of risks or consequences of alcohol misuse. This dissertation provides tentative evidence for targeting intervention services to injured patients. Further research should verify which subclasses of patients are most likely to reduce alcohol misuse and other alcohol-related risk behaviors in order to more effectively target brief alcohol interventions, increase cost savings, and improve the health and behavioral health outcomes for injured patients who misuse alcohol. / text

Alcohol and drug abuse are strong predictors of suicide. While screening methods have proven effective at identifying and treating substance abuse in non-treatment-seeking users (e.g., screening and brief intervention [SBI]), less attention has been given to the co-occurrence of suicidality among this population, including its correlates and etiology. The current study addresses this gap by presenting data from early adult emergency department (ED) patients (mean age = 27; N = 505), screened for substance abuse and suicidal ideation. Prevalence of past year ideation was high (15%). Results demonstrated a significant and positive indirect effect of cocaine use severity on likelihood of suicidal ideation, mediated through family support. The implications for SBI practices in the ED and suicide etiology among non-treatment-seeking substance abusers are discussed.

Bakgrund: En hög alkoholkonsumtion är en av de levnadsvanor som utgör störst hälsorisk. Trots detta screenas sällan patienter för sitt alkoholbruk i kontakten med primärvården vilket går emot rådande rekommendationer och riktlinjer från flera instanser.Syfte: Syftet med denna litteraturstudie var att klargöra de bakomliggande orsaker som hindrar diskussionen kring alkoholvanor i vårdpersonalens möte med patienten inom primärvården.Metod: Litteraturstudie med kvalitativ ansats. Litteratur söktes i databaserna PubMed och CINAHL med sökord grundade i POR-modellen. Vidare identifierades MeSH-termer och CINAHLheadings för att öka specificiteten i litteratursökningarna. Valda artiklar granskades med hjälp utav SBU:s mall för granskning av kvalitativa artiklar. Sedan genomfördes en innehållsanalys för att framställa resultaten. Resultat: Två övergripande områden identifierades vilka var Organisatoriska förutsättningar och Personalens attityder och syn på patienten. Vårdpersonalen uttryckte främst tidsbrist, kunskapsbrist samt ineffektiva verktyg och rutiner kring screening för alkoholbruk som hinder relaterade till de Organisatoriska förutsättningarna. Under Personalens attityder och syn på patienten visade sig personalens egna attityder och föreställningar om hur patienten skulle reagera utgöra barriärer för diskussionen kring alkohol. Konklusion: Då framförallt tids- och kunskapsbrist sågs som ett hinder för att diskutera alkoholvanor var det av vikt att verksamheten tillgodoser tidsbehovet samt stöd och fortbildning för att öka personalens känsla av trygghet. För att kringgå de hinder relaterade till vårdpersonalens attityd och förförståelse, kunde de bemöta patienten på ett icke-dömande sätt samt fokusera på det medicinska och hälsofrämjande perspektivet. / Background: A high level of alcoholic intake is one of the most hazardous lifestyle risk factors. Despite this risk, patients visiting the primary health care are rarely screened for their alcohol use, thereby neglecting existing recommendations and guidelines presented by several institutions.Aim: The aim of this literature review was to elucidate the underlying reasons impeding on the discussion about alcohol habits when the health-care staff and the patient meets in a primary health-care setting.Methods: Literature review with a qualitative approach. The literature-search was undertaken in the PubMed- and CINAHL-databases, using terms stemming from the POR-model. Further, MeSH-terms and CINAHLheadings were identified to increase the specificity of the literature search. The chosen articles were reviewed using the SBU-template for qualitative research, and then a textual data analysis was undertaken.Findings: Two overarching factors were identified as Organizational Conditions and The Attitudes of Health-Care Staff and Their View of the Patient. The staff expressed the lack of time, lacking knowledge as well as inefficient tools and routines for screening alcohol use as barriers related to the Organizational Conditions. Relating to the The Attitudes of Health-Care Staff and Their View of the Patient, the attitudes of the staff and their presumptions about the patients expected reactions formed the main barriers for discussing alcohol.Conclusion: The lack of time and knowledge were seen as barriers for discussing alcohol habits, therefore it is of importance for the organization to provide the needed time and continuous education to increase the confidence of the personnel. To avoid the presumed negative patient reactions, the staff could treat the patient in a non-judgemental way as well as focus on the medical and health-promoting perspective.