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Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: qualitative study in primary care

Geoff McCombe (School of Medicine, University College Dublin, Dublin, Ireland)
Anne Marie Henihan (Graduate Entry Medical School, University of Limerick, Limerick, Ireland)
Jan Klimas (Urban Health Research Initiative, University of British Columbia, Vancouver, Canada) (School of Medicine, University College Dublin, Dublin, Ireland)
Davina Swan (Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK)
Dorothy Leahy (School of Medicine, University College Dublin, Dublin, Ireland)
Rolande Anderson (Charlemont Clinic, Dublin, Ireland)
Gerard Bury (University College, Dublin, Ireland)
Colum Dunne (Graduate Entry Medical School, University of Limerick, Limerick, Ireland)
Eamon Keenan (HSE, Dublin, Ireland)
David Meagher (Graduate Entry Medical School, University of Limerick, Limerick, Ireland)
Clodagh O’Gorman (Department of Public Health and Primary Care, Trinity College, Dublin, Ireland)
Tom O’Toole (Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA)
Jean Saunders (CSTAR, University of Limerick, Limerick, Ireland)
Bobby P. Smyth (Addiction Services, Health Service Executive, Dublin, Ireland)
John S. Lambert (Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland)
Eileen Kaner (Institute of Health and Society, Newcastle University, Newcastle, UK)
Walter Cullen (School of Medicine, University College Dublin, Dublin, Ireland)

Drugs and Alcohol Today

ISSN: 1745-9265

Article publication date: 5 December 2016

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Abstract

Purpose

Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is to describe a qualitative feasibility assessment of a primary care-based complex intervention to promote screening and brief intervention for PAU, which also aims to examine acceptability and potential effectiveness.

Design/methodology/approach

Semi-structured interviews were conducted with 14 patients and eight general practitioners (GPs) who had been purposively sampled from practices that had participated in the feasibility study. The interviews were transcribed verbatim and analysed thematically.

Findings

Six key themes were identified. While all GPs found the intervention informative and feasible, most considered it challenging to incorporate into practice. Barriers included time constraints, and overlooking and underestimating PAU among this cohort of patients. However, the intervention was considered potentially deliverable and acceptable in practice. Patients reported that (in the absence of the intervention) their use of alcohol was rarely discussed with their GP, and were reticent to initiate conversations on their alcohol use for fear of having their methadone dose reduced.

Research limitations/impelications

Although a complex intervention to enhance alcohol screening and brief intervention among primary care patients attending for OAT is likely to be feasible and acceptable, time constraints and patients’ reticence to discuss alcohol as well as GPs underestimating patients’ alcohol problems is a barrier to consistent, regular and accurate screening by GPs. Future research by way of a definitive efficacy trial informed by the findings of this study and the Psychosocial INTerventions for Alcohol quantitative data is a priority.

Originality/value

To the best of the knowledge, this is the first qualitative study to examine the capability of primary care to address PAU among patients receiving OAT.

Keywords

Acknowledgements

Paper presented at the following scientific meetings: McCombe, G., Henihan, A.M., Klimas, J., Swan, D., Leahy, D., Anderson, R., Bury, G., Dunne, C., Keenan, E., Lambert, J.S., Meagher, D., O’Gorman, C., O’Toole, T., Saunders, J., Smyth, B.P., Kaner, E. and Cullen, W. (2015). Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: qualitative study in primary care. Addiction Health Services Research, Los Angeles, CA. McCombe, G., Klimas, J., Henihan, AM., Swan, D., Anderson, R. and Cullen, W. (2015). Experiences of a complex intervention to identify/treat problem alcohol use among patients receiving opiate substitute treatment in primary care settings in Ireland: a qualitative study of patients’ and GPs’ experiences. AUDGPI 18th Annual Scientific Meeting. Queen’s University, Belfast. Disclosure: the authors report no conflicts of interest. Funding: Health Research Board of Ireland funded the study (Grant ID: HRA-HSR-2012-14).

Citation

McCombe, G., Henihan, A.M., Klimas, J., Swan, D., Leahy, D., Anderson, R., Bury, G., Dunne, C., Keenan, E., Meagher, D., O’Gorman, C., O’Toole, T., Saunders, J., Smyth, B.P., Lambert, J.S., Kaner, E. and Cullen, W. (2016), "Enhancing alcohol screening and brief intervention among people receiving opioid agonist treatment: qualitative study in primary care", Drugs and Alcohol Today, Vol. 16 No. 4, pp. 247-258. https://doi.org/10.1108/DAT-03-2016-0010

Publisher

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Emerald Group Publishing Limited

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