Although alcohol plays an important role in psychiatric morbidity, there is a general lack of strategies within psychiatric care to intervene at alcohol problems in an early stage (secondary prevention). The aim of this thesis was to increase knowledge of adequate forms of secondary alcohol prevention in psychiatric care.   The capacity of three brief screening instruments was investigated in a psychiatric outpatient sample (n=1811). The results indicate that the HED (heavy episodic drinking) screener, strongly recommended for health care settings, is not sufficiently sensitive in a psychiatric setting. Instead, the full AUDIT (Alcohol Use Disorders Identification Test) is recommended. The knowledge and attitudes of psychiatric staff members to problem-drinking patients were studied and the effects of a three-hour training course were investigated. Confidence in self-perceived capacity to intervene in more severe alcohol problems was raised among all staff after training. Awareness of early signs of problem drinking was raised among psychologists and social workers. The therapeutic attitude of the psychiatric staff was higher when compared with primary care staff. Two forms of brief intervention were delivered by clinical psychiatric staff. At 12 months, 29% of all participants had improved their drinking habits, moving from hazardous to non-hazardous level (21%) or from harmful to hazardous level (8%). In the improved group, mean AUDIT score was reduced from 11.0 points at baseline to 5.5 points. Differences in outcome between the two interventions could not be identified. Nine high-risk drinking young female psychiatric patients were interviewed, focusing on reasons for excessive drinking and factors facilitating a change in drinking habits. Alcohol played an important role in the lives of the young women. It made them feel social and helped them deal with unbearable emotions. It was also used as a means of self-harm, representing the first stage in an escalating self-harm process. They expressed a need for help from their caregivers in addressing the underlying reasons for drinking. Secondary alcohol prevention strategies including appropriate screening methods, staff training and the elaboration of tailored interventions are urgently needed in psychiatric care. The findings of this thesis can be used when forming such strategies.

This thesis investigates whether an association can be established between childhood victimization (CV) and current mental health (MH) among Swedish university students, focusing on the prevalence of anxiety, depression and hazardous alcohol use (HAU) in relation to different forms of CV. The data comes from the World Mental Health International College Student Initiative, a global survey designed to generate data on MH disorders, as well as implement and evaluate web-based interventions aimed at preventing and treating said disorders. The thesis hypothesized that high levels of CV would be positively associated with the prevalence of the aforementioned conditions and that females with a history of CV would have a higher prevalence of these conditions. Using SPSS, 23 variables related to CV were analyzed using an exploratory factor analysis (EFA), which extracted 6 factors. The 23 variables were condensed into 6 additive indexes according to findings from the EFA, as well as one additive index making up all 23 variables to check for general CV. Eight consecutive hierarchical multiple linear regression analyses (OLS) were conducted, two for each of the dependent variables; anxiety, depression, HAU as well as an index combining all three dependent variables to indicate the presence of one or more conditions. Each analysis had gender in the first block and added the CV index or the six factors in the second block. The results show positive associations between four CV factors and depression, and positive associations between anxiety and two CV factors, as well as a positive association between females and anxiety. The results also indicate a positive association between males and HAU. The findings are in line with previous research, but further research is needed to provide stronger evidence of an association between CV and MH/HAU among Swedish university students.