|dc.description.abstract||Denne avhandlingen undersøker kliniske karakteristika og faktorer ved pasientene som var i døgnbehandling for rusmiddelavhengighet.
Det empiriske materialet er basert på to bekvemmelighetsutvalg innsamlet på rusbehandlingsinstitusjoner i Midt-Norge. Materialet fra det første utvalget (N=95) er spørreskjemadata kombinert med deler av et strukturert intervju av pasienter på vei inn i behandling, og inkluderer oppfølging etter tre måned. Det andre (N=85) er et kryss-seksjonelt utvalg og data er fra spørreskjema besvart av pasienter i ferd med å avslutte sitt døgnopphold i rusbehandlingsinstitusjoner og av behandler fra institusjonen.
I denne studien fant vi ikke støtte for at instrumentet “University of Rhode Island Change Assessment (URICA)” er egnet til predikasjon av motivasjon til atferdsendring fra rusmiddelavhengighet i denne populasjonen, og konkluderer med at URICA derfor bør benyttes med varsomhet.
Motsatt konkluderer vi at “Symptom Check List 90-Revised (SCL-90-R)” er egnet til å undersøke symptomtrykk på psykiske lidelser på pasienter i rusbehandling. Og videre at komposittskåren fra “Global Severity Index (GSI)” er en egnet global indeks. Pasienter i ferd med å avslutte sitt behandlingsopphold hadde høyere gjennomsnittlig GSI-skåre enn et utvalg fra normalpopulasjonen.
Sammenligning av pasient og behandler rapportering om pasientens psykiske lidelser viste sammenfall i 72 prosent av tilfellene, til tross forskjeller i 24 av 85 av disse rapportene. Denne forskjellen var statistisk signifikant for affektive lidelser (p =.05) og personlighetsforstyrrelser (p =.02). Behandlerne vurderte alvorlighetsgraden av pasientenes mentale helse og rusmiddelbruk ved å anvende Kvadrantmodellen. De fleste pasientene (70%) ble vurdert til å ha høy alvorlighetsgrad i rusmiddelbruk og lav i psykiske problemer. En av fem pasienter ble imidlertid vurdert til å ha høy grad av alvorlighet i både rusmiddelbruk og psykiske problemer.
Rusbehandlingsinstitusjoner tilbyr hjelp på mange ulike problemområder. Det var også noen ulikheter i problemområder, opplevd utbytte av behandling og behandlingsintervensjoner mellom pasienter med og uten psykiske lidelser. Pasientene rapporterte at de var fornøyd med behandlingen de hadde mottatt.
Denne avhandlingen støtter viktigheten av at behandling for pasienter med rusmiddelavhengighet er multimodal, med individuelle tilpasninger der det er nødvendig.||nb_NO
|dc.description.abstract||The main purpose of the present thesis was to investigate factors associated with individuals
in substance use disorder in-patient treatment and the treatment they received. The chosen
factors were motivation and its predictive abilities related to the change of substance use
behaviour, mental health, differences between self-reports and reports from treatment
personnel related to substance use and psychiatric disorders, help with problem domains and
treatment interventions in substance use disorder treatment, and perceived benefit from
treatment. The results from this thesis are based on two convenient samples from substance
use disorder clinics in Central Norway. Sample 1 (N = 95) is a sample where data are
collected through a survey combined with an interview of patients about to enter substance
use disorder treatment, with a follow-up three months after baseline. Sample 2 (N = 85) is a
sample where a cross-sectional survey was carried out among patients about to end their inpatient
stay at substance use disorder clinic and their treatment personnel. Sample 1 was used
in paper I, while paper II-IV applied sample 2.
Treating substance use disorder is challenging because patients often have many additional
problems. Motivation is believed to be important to make individuals seek and stay in
treatment. In paper I the University of Rhode Island Change Assessment (URICA) instrument
was used to investigate whether motivation predicted if patients remained in treatment three
months after baseline. The Readiness To Change (RTC) and Committed Action (CA)
composite scores were used in order to explore this relation. The study did not find any
evidence of a relationship between motivation measured with the use of RTC and CA and
whether patients remained in treatment three months after baseline. The paper questions if the
URICA instrument should be used as a measure of motivation among patients with substance
Many patients with a substance use disorder have co-occurring mental health problems. The
research reported in paper II explored whether the Symptom Check List 90-Revised (SCL-90-
R) instrument was suitable for assessing this pattern of comorbidity. No evidence was found
to support the original nine-factor structure of the SCL-90-R. The instrument appears to have
a uni-dimensional structure and using the Global Severity Index (GSI) appears to be a
reasonable solution. Mean GSI scores were also used to investigate whether patients had more
mental health problems than a sample from the general population in Norway. Participants
who were about to end an in-patient treatment stay for substance use disorders had higher
mean GSI scores than the general population, indicating that there were more psychiatric
symptoms in this clinical substance use sample. The scores of GSI was also associated with
self-reported psychiatric disorders and prescribed medication for mental illness, which also
supports the discriminant validity of GSI on the SCL-90-R.
Reports from patients and treatment personnel about psychiatric disorders and substance use
and discrepancies between their reports were investigated in paper III. The study showed
discrepancies between patients’ and treatment personnel’s assessments of patient’s mental
health in 24 out of 85 patients. The discrepancy was statistically significant for affective and personality disorders. There was no significant discrepancy found between self-reported
substance use and substance use disorders reported from treatment personnel. The treatment
personnel were also asked to assess the severity of all patients’ mental health and substance
use problems using the quadrant model. This model consists of four quadrants where
individuals are categorized depending on the considered level (high or low) of severity in
substance use and mental health. Most patients were assessed as having severe substance use
problems and less severe mental health problems. However, one in five patients had severe
mental health problems in addition to severe substance use problems.
Paper IV explored the interventions used in in-patient treatment for substance use disorders,
the problem domains for which patients received help, and in which problem domains they
felt they had benefited from treatment. The most common interventions according to
treatment personnel were interventions targeted to improve relationships with family and
important others, applied relaxation techniques, psychodynamic therapy, cognitive
behavioural therapy and motivational interviewing. Patients reported receiving most help in
the domains of relapse prevention, physical health, daily functioning, relationships with
others, psychological health and self-esteem. The patients reported benefiting most from
physical activities, support from co-patients, group therapy, counseling, and assessment and
treatment of psychological health problems. There were differences between patients with and
without co-occurring disorders on several measures. Patients with co-occurring disorders were
given more motivational interviewing and cognitive behavioural therapy interventions. They
also reported receiving more help with their self-esteem and coping with psychiatric
symptoms, and benefiting most from treatment of psychological health problems, acute help,
and help with social situations than those without comorbid problems.
In summary, findings in this thesis support that several psychological aspects are important in
understanding and treating substance use disorders and co-occurring mental health problems.
Among the variables of importance are general distress, psychological and physical health,
and social support. Motivation is also perceived to be of importance, but the relation between
motivation and change in substance use behaviour got inconclusive support when assessed by
the URICA in this thesis. Patients with co-occurring disorders received some differential
treatment. This thesis supports the significance of targeting multiple problem domains to all
patients, with individual adjustments when necessary. The findings from this thesis support
the important of implementing the national guideline for assessment, treatment and
rehabilitation of persons with co-occurring substance use disorders and psychiatric disorders.||nb_NO