Anne Signe Landheim

• Skeie, Ivar; Bech, Anne Berit; Clausen, Thomas; Hjemsæter, Arne Jan; Landheim, Anne Signe & Monsbakken, Bent Berntsen [Vis alle 8 forfattere av denne artikkelen] (2026). Comparison of mortality and causes of death between treatment-engaged individuals with severe alcohol or opioid use disorder: a prospective 19-year clinical cohort study. BMC Psychiatry. 26(1), s. 1–11. doi: 10.1186/s12888-026-07832-5. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Comparisons of long-term mortality between alcohol-use-disorder (AUD) and opioid-use-disorder (OUD) groups within clinical cohorts are scarce. This study aimed to do this within one clinical cohort comprising groups suffering various severe substance use disorders. METHODS: Design: Observational cohort design. Prospective study of mortality 1998–2016, Cox regression. Sample/setting: 464 persons in specialist SUD treatment at start of observation period. Three subgroups defined by SUD characteristics at the beginning of the observation period, were studied: participants with 1) OUD, on opioid agonist treatment (OAT), (OUD/OAT-group), 2) AUD, no other SUDs (AUD-alone group), 3) AUD as part of a poly-substance-use disorder (AUD/PSUD group). Measures/covariates: Comparison of mortality risks and causes of death (somatic diseases/traumatic causes/substance-induced deaths/unknown cause) between OUD/OAT versus AUD-alone, and AUD-alone versus AUD/PSUD groups. Hazard ratio (HR) adjusted for baseline age (1 January 1998), sex, and socioeconomic/SUD characteristics. RESULTS: AUD-alone versus OUD/OAT: Unadjusted mortality risk was higher in the AUD-alone group [HR 1.99 (95% CI 1.33–2.99)]. However, in adjusted analysis type of SUD showed no statistically significant association with increased mortality [aHR 0.91 (0.54–1.54)], only male sex and increasing baseline age were independently associated with increased mortality risk. Cause-of-death distributions were very similar and somatic diseases caused over 50% of deaths in both groups. AUD-alone versus AUD/PSUD: Unadjusted mortality risk was higher in the AUD-alone group [(HR 2.57 (1.65–4.00)]. However, in adjusted analysis type of SUD showed no statistically significant association with increased mortality [aHR 1.40 (0.81–2.44)], only male sex, increasing baseline age, and “not being in work or education at study inclusion” were independently associated with increased mortality risk. Substance-induced deaths were most common in the AUD/PSUD group (43%). CONCLUSION: In adjusted analyses there were no statistically significant differences in mortality risk between the three subgroups. Somatic diseases were the main cause of death. Besides efforts to improve social rehabilitation and to treat the substance use disorders as such, early and targeted lifestyle interventions, and measures for early detection, treatment and follow-up of somatic disorders are essential to reduce mortality in both AUD and OUD populations. CLINICAL TRIAL NUMBER: Not applicable

• Johansen, Marthe; Ness, Ottar; Stuen, Hanne Kilen; Brekke, Eva & Landheim, Anne Signe (2026). 'They really want to find some kind of box they can put you in': How young people with severe mental health problems and complex needs talk about their past treatment in traditional Child and Adolescent Mental Health Services - A critical discourse analysis. Frontiers in Psychiatry. 17. doi: 10.3389/fpsyt.2026.1759231. Fulltekst i vitenarkiv Vis sammendrag

  Challenges in Child and Adolescent Mental Health Services (CAMHS), including complex and fragmented services, are well documented, particularly to young people with severe mental health problems and complex needs. Research on young people's experiences of CAMHS is scarce. Especially studies on young people who have dropped out of CAMHS and/or transitioned to alternative services are lacking. This article addresses the following research question: Which discourses can be identified when young people with severe mental health problems and complex needs enrolled in Youth Flexible Assertive Community Treatment (Youth Flexible ACT) articulate their past treatment in CAMHS, and contrast it with their current treatment? We conducted a qualitative study using semi-structured interviews with 12 participants aged 15 to 19, recruited via convenience sampling from three Youth Flexible ACT teams in Norway. The interview data were analysed using a Fairclough-inspired critical discourse analysis (CDA), where discourse is understood as a particular way of understanding and talking about the world, and language is seen as a social practice rather than an individual activity. We identified three dominant discourses when the young people talked about conventional services/CAMHS in Norway: a biomedical, a paternalistic and a neoliberal. The findings suggest that treatment in CAMHS is shaped by a market-oriented understanding of mental health (neoliberal discourse), a medical model that reduces complex problems to medical terms (biomedical discourse), and a lack of user participation (paternalistic discourse). The findings indicate a gap between what young people see as helpful, the aims outlined in guidelines and the young participants' descriptions of CAMHS. The lack of user involvement and the unequal power balance need to be actively addressed with concrete practices that support more equal participation. The findings highlight the need for more differentiated treatment pathways for this group of young people, enabling timely, tailored support and reducing the risk of ineffective initial interventions. Our findings indicate that the framework in CAMHS is poorly suited to the needs of this group. In contrast, differently organised services, such as Youth Flexible ACT, may offer an alternative by providing a coherent framework for holistic, integrated and person-centred care.

• Nord-Baade, Silje; Ness, Ottar; Rowe, Michael; Jensen, Camilla Bergsve & Landheim, Anne Signe (2026). Social inclusion among young adults with mental illness and complex needs in Flexible Assertive Community Treatment: A qualitative study on team staff’s understanding and experiences. PLOS ONE. 21(1). doi: 10.1371/journal.pone.0341358. Fulltekst i vitenarkiv Vis sammendrag

  Background Social inclusion is increasingly highlighted through policies, practices, research, and broader societal awareness. Young adults with mental illness and complex needs are among the most marginalized in society and face significant challenges. Public health and welfare services play a critical role in either facilitating or hindering social inclusion through adequate or inadequate service provision. The services are often critiqued for treating individuals in isolation from their social contexts. Methods In this qualitative study semi-structural individual interviews and thematic analysis were used to explore: How do service providers in FACT teams understand and promote social inclusion among young adults with mental illness and complex needs?. Results The results showed that staff employed efforts to promote social inclusion and acknowledged this as important. However, they had limited conceptual understanding and revealed a lack of systematic promotion in the teams. Several barriers for social inclusion were evident in the material, from individual and structural to societal. Conclusions There is a need to develop and operationalize the concept to enable systematic and holistic approaches to promote social inclusion, moving beyond employing single interventions. Policies must be developed, and training and education provided to create context sensitive mental health services.

• Martinsen, Randi; Landheim, Anne Signe & Bronken, Berit Arnesveen (2025). A turning point after FACT: a qualitative study of family members’ experiences and follow-up provided by flexible assertive community treatment. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-13485-z. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Service users living with severe mental illness are often in need of treatment from different health care professionals. Their family members play an important but underreported role in their treatment and care. Following the implementation of the flexible assertive community treatment (FACT) model in Norway since 2013, FACT teams have been evaluated from different perspectives. The overall aim of this study was to explore how family members of people living with SMI experience their situation and the follow-up provided by FACT teams. Methods Forty-one family members aged 31 to 78 years took part in nine focus groups representing seven FACT teams from both rural and urban areas in Norway. Most of the participants had parental roles. The data was analysed using qualitative content analysis. Results The results revealed the following two main themes and five sub-themes: (1) An all-consuming and demanding role ( A life of love , care and despair and A life affecting health and well-being) , and (2) A turning point after FACT ( From a patchwork to more integration and continuity , Family involvement as a vital part of care and Availability of support outside regular opening hours). Conclusions Being family members of service users with SMI are experienced as an all-consuming and demanding role. The family members experience the FACT team as an important support in their day-to-day life. However, they wish to receive more support and inclusion in the treatment than they currently do. Further strengthening the involvement and collaboration between the family members and the FACT teams is recommended. Psychoeducational interventions arranged by the FACT team could support family members’ situations. To share their stories with professionals and/or peers would further contribute to their well-being. Extending the opening hours of FACT is recommended as it might mitigate family members’ everyday challenges and improve their subjective well-being.

• Nord-Baade, Silje; Ness, Ottar; Rowe, Michael; Jensen, Camilla Bergsve & Landheim, Anne Signe (2025). The mattering citizen: young adults with mental illness and complex needs’ experiences and perceived opportunities of social inclusion. Frontiers in Psychology. 16, s. 1–12. doi: 10.3389/fpsyg.2025.1504767. Fulltekst i vitenarkiv Vis sammendrag

  The negative effects of social exclusion are well known, as are the effects of social inclusion on quality of life and well-being. Young adults with mental illness and complex needs are among the most marginalized people in the community. There is a pressing need to better define and promote social inclusion in mental health and substance use services, addressing both objective and subjective factors. The aim of this qualitative study was to examine the experiences and perceived opportunities of social inclusion among young adults with mental illness and complex needs. This was done to develop a comprehensive understanding of social inclusion that can be applied by providers in the fields of welfare, mental health, and substance use. Seven young adults (three males/four females, aged 22–29) were recruited through Flexible Assertive Community Treatment teams and participated in the study through qualitative semi-structured interviews. The material was analyzed employing an abductive thematic analysis. The findings show the interconnection between the elements of Citizenship and Mattering and underline the need for a framework including both the psychological and sociological perspectives. Developing the Citizenship framework and incorporating the Mattering approach is suggested as a multifaceted approach to promote social inclusion in practice, calling for further research on this.

• Brekke, Eva; Lamu, Admassu Nadew; Angeles, Renira Corinne S; Clausen, Hanne Kristin & Landheim, Anne Signe (2025). Changes in inpatient mental health treatment and related costs before and after flexible assertive community treatment: a naturalistic observational cohort study. BMC Psychiatry. 25. doi: 10.1186/s12888-025-06614-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Flexible Assertive Community Treatment (FACT) is currently implemented in Norwegian mental health services, aiming to ensure comprehensive and rights-based services for persons with severe mental illness and complex needs, but also motivated by assumed cost-effectiveness. We need knowledge about the consequences of this service innovation. The aim of this study was to investigate changes in total and involuntary inpatient mental health treatment and associated changes in costs of inpatient days before and after enrolment into FACT for persons with severe mental illness and complex needs in Norway. Methods In this naturalistic observational cohort study of 397 patients in eight Norwegian FACT teams, we compared total and involuntary admissions, total and involuntary inpatient days, and the costs of total and involuntary inpatient days, for two periods: 24 months before and 24 months after enrolment in FACT. We used paired t-test. Results There was a significant reduction in involuntary admissions, involuntary inpatient days, and total inpatient days after enrolment in FACT. We found a slight but non-significant reduction in total admissions to inpatient mental health treatment. There was a significant reduction in the costs of total inpatient days and involuntary inpatient days. Conclusion Patients in FACT were admitted to inpatient treatment as frequently as before enrolment in FACT, but involuntary admissions were less frequent. Furthermore, the duration of involuntary and total inpatient treatment was reduced, with a corresponding reduction in costs as expected. Results suggest that targeted and well-timed interventions from FACT may reduce the need for prolonged involuntary inpatient treatment, implying reduced disadvantages for the individual and more efficient allocation of health service funding.

• Johansen, Marthe; Stuen, Hanne Kilen; Brekke, Eva; Jensen, Camilla Bergsve & Landheim, Anne Signe (2024). A qualitative study of the experiences of young people with severe mental health problems and complex needs regarding youth flexible assertive community treatment. Frontiers in Psychiatry. 15. doi: 10.3389/fpsyt.2024.1478345. Fulltekst i vitenarkiv Vis sammendrag

  Youth Flexible Assertive Community Treatment (Youth Flexible ACT) is a service model for children and young people with severe mental health problems and complex needs aimed at providing integrated, continuous and holistic care. Studies on young people’s experiences of Youth Flexible ACT or similar models are scarce. The present qualitative study aimed to explore and describe how young people with severe mental health problems and complex needs experience follow-up and treatment provided by Youth Flexible ACT teams. Semi-structured interviews were conducted with 14 young people (age range, 15–19 years) who were being followed up by a Youth Flexible ACT team. Qualitative content analysis was used, and the following two overarching themes characterizing the young people’s experiences of follow-up and treatment provided by Youth Flexible ACT teams were identified: (1) trusting and collaborative relationships, and (2) organization matters. The participants experienced a more personal relationship with the staff, who behaved more like friends and paid attention to resources, interests, solutions and their context. The participants emphasized and valued components that coincided with the Youth Flexible ACT model, indicating a match between what the young people needed and wanted and what the model was supposed to provide. The team providing these relationships and youth-friendly and developmentally sensitive care appeared to be facilitated by how the service model was organized, with the teams being flexible and accessible while providing integrated, multifaceted help and systemic follow-up.

• Bahl, Nina Kavita Heggen; Nafstad, Hilde Eileen; Blakar, Rolv Mikkel; Tømmervik, Kristin; Brodahl, Morten & Ness, Ottar [Vis alle 8 forfattere av denne artikkelen] (2024). Psychological Sense of Community in Recovery Processes of Emerging and Older Adults: Ideological Antecedents and Implications for Public Health. Journal of Community and Applied Social Psychology. ISSN 1052-9284. 35(1). doi: 10.1002/casp.70029. Fulltekst i vitenarkiv Vis sammendrag

  Across the world, governments are struggling to help people recover from substance use problems. Due to their particular risk factors, two age groups are of special interest to public health: emerging adults and older adults. Psychological sense of community (PSOC) is a key dimension in their recovery. Yet, to develop context-sensitive and effective strategies tailored for these groups, there is a need to understand their discourses of PSOC as situated within their context. This study offers a multi-level and comparative analysis of discourses of PSOC for 21 emerging adults and 23 older adults recovering within the same context. Using a discourse analytic tool and a comparative approach ideological impacts on the two groups' discourses of PSOC were identified. Both groups' discourses suggest that achieving and maintaining PSOC in recovery is challenging within a developing neo-liberal context. Furthermore, the findings demonstrate differences between the two groups' with respect to (a) the particular impact of ideologies, (b) sources for PSOC in recovery and (c) challenges in community participation. The article builds on the findings to suggest strategies targeting the two groups. Please refer to the Supporting Information section to find this article's Community and Social Impact Statement.

• Nord-Baade, Silje; Ness, Ottar; Rowe, Michael; Jensen, Camilla Bergsve & Landheim, Anne Signe (2024). “I’ve always felt like I’m on the outside”: Identity and social inclusion among young adults with mental illness and complex needs – a qualitative study. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 20(1). doi: 10.1080/17482631.2024.2433320. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Addressing social inclusion often involves objective measures and means related to work, education, housing and economy. However, important subjective factors, such as the relationship between identity on social inclusion among young adults with mental illness and complex needs, are understudied. The study objective is to explore how young adults with mental illness and complex needs experience their identity in relation to social inclusion. Materials and methods: The study adopted a qualitative, explorative, and participatory design. Seven young adults (three males/four females, aged 22-29) were recruited though Flexible Assertive Community Treatment (FACT) Teams, and semi-structured interviews were conducted. Reflexive thematic analysis was employed in the analysis. Results: The analysis resulted in two main themes. Theme one, "Who they are", included three subthemes: "A lifelong sense of being someone on the outside", "Feeling different from others", and "Someone who is worthless and doesn't matter". Theme two, "Who they want to be", included two subthemes "Wanting to be someone else", and "The need to redefine oneself". Conclusions: This study underlines the importance of working systematically on subjective aspects such as identity, in addition to objective measures, to address social exclusion in a vulnerable and marginalized group. Future directions for research and the development of a more tangible and holistic approach to promote social inclusion are suggested.

• Nord-Baade, Silje; Ness, Ottar; Jensen, Camilla Bergsve; Rowe, Michael; Opheim, Elin & Landheim, Anne Signe (2024). Barriers and facilitators for social inclusion among people with concurrent mental health and substance use problems. A qualitative scoping review. PLOS ONE. 19(12). doi: 10.1371/journal.pone.0315758. Fulltekst i vitenarkiv Vis sammendrag

  Background People with concurrent mental health and substance use problems are among the most socially excluded groups in our society, yet little attention has been paid to what socially excluded people see as central to promoting their social inclusion. The aim of this qualitative scoping review is to provide an overview of barriers and facilitators for social inclusion among people with concurrent mental health and substance use problems, based on first-person perspectives, to help guide future research, policies, and practice. Methods We explored first-person perspectives on social inclusion among people with concurrent mental health and substance use problems, employing Arksey and O’Malleys framework. We searched Medline, PsycINFO, Embase, Scopus, Cinahl, and other sources for studies published between January 2000 and September 2023. We employed content analysis and followed the PRISMA checklist. Results We included 55 articles included in our review and identified sub themes of: Intrapersonal baseline (identity, belonging), Components of social inclusion (relationships, meaningful activities, employment, economy), and Systemic failure or success (housing, public health and welfare services, the criminal justice system). Conclusion Social inclusion is rarely studied outside the context of direct services. Our results point to knowledge gaps in addressing social inclusion in a broad, societal context; implementing gaps in services; and developing policies to assure the fundamental needs and human rights of socially excluded persons.

• Bakken, Regine; Benth, Jurate Saltyte; Fauske, Halvor; Lien, Lars & Landheim, Anne Signe (2024). Individual Trajectories of Specialist Substance Use Disorder and Mental Health Treatment Utilization Among Young Adults With Substance Use Problems: A Cohort Study. Journal of Dual Diagnosis (JDD). ISSN 1550-4263. 20(3), s. 251–265. doi: 10.1080/15504263.2024.2341092. Fulltekst i vitenarkiv
• Ruud, Torleif; Selle, Maria; Clausen, Hanne Kristin; Heiervang, Kristin Sverdvik; Odden, Sigrun & Stuen, Hanne Kilen [Vis alle 7 forfattere av denne artikkelen] (2024). Clinical outcomes and outcome predictors of two-year assertive community treatment in Norway: an explorative prospective pre–post study. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-06181-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Assertive Community Treatment (ACT) teams have become a part of mental health services for people with severe mental illness in many high-income countries. Studies in several countries have investigated the outcomes of ACT, and knowledge is also needed about outcomes of ACT teams in Norway. Our aims were to study clinical outcomes of ACT, how the outcomes were associated with characteristics of patients and treatment, and whether they differed across ACT teams. Methods Our explorative, prospective, pre–post multicenter study involved 142 patients who received ACT for two years from the first 12 ACT teams established in urban and rural areas of Norway. There was no control group. The primary outcome was change in clinician-rated psychiatric symptoms. Secondary outcomes were clinician-rated change in functioning and engagement and change in community tenure compared with 2 years prior to ACT. We measured fidelity to the ACT model using the Tool for Measurement of Assertive Community Treatment. We performed linear mixed-effects modeling to analyze outcomes and their associations with characteristics of patients and treatment. Results After two years, psychiatric symptoms were significantly reduced with a small effect size. Negative symptoms, anxiety and depression, and agitation and mania had significant reductions, while positive symptoms had nonsignificant changes. Functioning, engagement, and community tenure all significantly increased with small effect sizes. Age, difficulty to engage, problematic use of alcohol, frequent previous use of inpatient services, total number of sessions, and team’s fidelity to the ACT model were associated with different groups of symptoms. Less improvement in functioning was associated with team fidelity and number of sessions. Change in engagement was not associated with any predictors. Increased community tenure was greater for younger patients and patients who were on community treatment orders at treatment start. Conclusions ACT for two years led to significant positive outcomes with small effect sizes for psychiatric symptoms, functioning, engagement, and community tenure. The outcomes were associated with some potential predictors, and some team-level variance emerged. Positive significant outcomes after two years indicate that larger improvements may be achieved from longer-term treatments by ACT teams.

• Bakken, Regine; Lien, Lars; Fauske, Halvor & Landheim, Anne Signe (2023). Education and employment status among young adults three years after entering residential substance use treatment. A longitudinal data-linkage study. Journal of Substance Use. ISSN 1465-9891. doi: 10.1080/14659891.2023.2281966. Fulltekst i vitenarkiv Vis sammendrag

  Aims This study aims to investigate three-year follow-up among young adults who entered residential substance use disorder (SUD) treatment with regard to outcomes related to education, work and mortality. Methods Participants who entered residential SUD treatment between 2011 and 2016 aged 16–29 years were included in the study. In this study, we used data from the electronic health records of the treatment facility of the participants and linked these with data from nationwide registries. The data included de-identified, person-level information on patient demographics, crime, treatment use and socioeconomic factors. The primary outcome was education and employment status, analyzed using logistic regression. Results At the follow-up, two-fifths of the sample were in education or employment, half were receiving welfare benefits and the annual income level was low. 3.6% of the sample had died. Those who were in education or work were less likely to have post-treatment convictions and to use residential SUD treatment services than those who were not. Conclusion Being in education or employment and not engaging in crime or severe substance use can create a life situation that helps to sustain recovery. There is a need to establish SUD treatment for young adults that includes education- and employment-focused interventions.

• Brekke, Eva; Clausen, Hanne Kristin; Brodahl, Morten & Landheim, Anne Signe (2023). Patients’ experiences with coercive mental health treatment in Flexible Assertive Community Treatment: a qualitative study. BMC Psychiatry. 23(1). doi: 10.1186/s12888-023-05264-z. Fulltekst i vitenarkiv Vis sammendrag

  Background: Flexible Assertive Community Treatment (FACT) teams have been implemented in Norwegian health and social services over the last years, partly aiming to reduce coercive mental health treatment. We need knowledge about how service users experience coercion within the FACT context. The aim of this paper is to explore service user experiences of coercive mental health treatment in the context of FACT and other treatment contexts they have experienced. Are experiences of coercion different in FACT than in other treatment contexts? If this is the case, which elements of FACT lead to a different experience? Method: Within a participatory approach, 24 qualitative interviews with service users in five different FACT teams were analyzed with thematic analysis. Results: Participants described negative experiences with formal and informal coercion. Three patterns of experiences with coercion in FACT were identified: FACT as clearly a change for the better, making the best of FACT, and finding that coercion is just as bad in FACT as it was before. Safety, improved quality of treatment, and increased participation were described as mechanisms that can prevent coercion. Conclusion: Results from this study support the argument that coercion is at odds with human rights and therefore should be avoided as far as possible. Results suggest that elements of the FACT model may prevent the use of coercion by promoting safety, improved quality of treatment and increased participation.

• Haugom, Espen Woldsengen; Benth, Jurate Saltyte; Stensrud, Bjørn; Ruud, Torleif; Clausen, Thomas & Landheim, Anne Signe (2023). Shared decision making and associated factors among patients with psychotic disorders: a cross-sectional study. BMC Psychiatry. 23(1). doi: 10.1186/s12888-023-05257-y. Fulltekst i vitenarkiv Vis sammendrag

  Background: Shared decision making is a process where patients and clinicians collaborate to make treatment choices based on the patients' preferences and best available evidence. The implementation of shared decision making remains limited for patients with psychotic disorders despite being recommended at policy level, being advocated as ethical right and wanted by the patient's. A barrier to implementation that is often mentioned is reduced decision-making capacity among patients. The challenges of implementing shared decision making highlights a need for more knowledge on shared decision making for these patients. Moreover, the association between patient-related characteristics and shared decision making is unclear, and further research have been suggested. More knowledge of factors associated with involvement in shared decision making can enhance understanding and help to empower patients in the decision-making process. The current study examined the extent of reported shared decision making among patients with a psychotic disorder in mental health care and factors associated with shared decision making. Methods: This study included 305 participants with a psychotic disorder from 39 clinical inpatient and outpatient sites across Norway. Shared decision making was assessed using the CollaboRATE survey. A linear mixed model was estimated to assess characteristics associated with shared decision making scores. Results: The CollaboRATE mean score was 6.3 (ranging from 0 to 9), the top score was 14.1% and increased global satisfaction with services was significantly associated with a higher level of shared decision making (regression coefficient 0.27, 95% confidence interval (0.23; 0.32), p < 0.001). Conclusions: The low top score shows that few patients felt that they received the highest possible quality of shared decision making, indicating that many patients found room for improvement. This suggests that services for patients with psychotic disorders should be designed to give them a greater role in decision making. Shared decision making might play a key role in mental health care, ensuring that patients with psychotic disorders are satisfied with the services provided. Trial registration: NCT03271242, date of registration: 5 Sept. 2017.

• Bahl, Nina Kavita Heggen; Øversveen, Emil Mortensrud; Brodahl, Morten; Nafstad, Hilde Eileen; Blakar, Rolv Mikkel & Landheim, Anne Signe [Vis alle 7 forfattere av denne artikkelen] (2023). Multiple psychological senses of community and community influences on personal recovery processes from substance use problems in later life: a collaborative and deductive reflexive thematic analysis. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 18(1). doi: 10.1080/17482631.2023.2190200. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: There is a pressing need for substance use services to know more about how to promote recovery from substance use problems, particularly in later life. Psychological sense of community (PSOC) is an important recovery dimension. This study aims to clarify in what ways PSOC and communities influence later life recovery processes. Method: A collaborative and deductive reflexive thematic approach was used to analyse 23 interviews with older adults in recovery from different substance use problems. Results: The findings suggest that PSOC and recovery in later life include multiple communities (relational, geographical, substance use-related, ideal and service-related) and affective states (PSOC and NPSOC). Older adults' recovery, moreover, can be described as personal and heterogenic (with respect to community relationships, individual needs, type of substance use problem, age of onset and meaningful activities). Conclusions: The findings confirm age of onset, type of substance use problem and community memberships as essential to later life recovery. They also supplement prior evidence on community resources and challenges to later life recovery. Importantly, the new findings extend and nuance current understandings of later life recovery. Taken together, the article illustrates MPSOC as a useful concept, with central practical and theoretical implications for later life recovery.

• Bakken, Regine; Lien, Lars; Fauske, Halvor; Benth, Jurate Saltyte & Landheim, Anne Signe (2023). Criminal thinking and psychosocial characteristics among young adults entering residential substance use treatment. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. 40(4), s. 339–354. doi: 10.1177/14550725231160337. Fulltekst i vitenarkiv Vis sammendrag

  Background and aim: Young adults with substance use (SU) problems face a high risk of co-occurring problems, including criminality. The aim of the present study was to assess the psychosocial characteristics, SU problems, and criminal thinking young adults entering SU treatment have, and whether the SU characteristics, sex and age are associated with criminal thinking scores. Methods: The sample was 407 young adults aged 16–29 years who underwent an entry assessment between January 2011 and December 2016 at a residential SU treatment institution in Norway. All study data were extracted from electronic health records, including survey information from the Achenbach System of Empirically Based Assessment and the Psychological Inventory of Criminal Thinking Styles. Results: In the present sample, severe SU, high rates of psychosocial problems, and criminal thinking were reported. Almost three-quarters (72.67%) of young adults reported high levels of criminal thinking (≥60). However, male participants were more likely to report high levels of criminal thinking compared to female participants (p=0.031). In bivariate regression models, only sex and having stimulants/opioids as primary drug were associated with mean levels of criminal thinking. The same was true in the multiple regression model. Conclusion: Young adults in residential SU treatment are a multi-problem high-risk/high-need group of people. Due to the elevated levels of criminal thinking, we recommend that young adults in SU treatment should be screened for criminogenic treatment needs, such as criminal thinking, regardless of justice involvement.

• Trane, Kristin; Aasbrenn, Kristian; Rønningen, Martin; Odden, Sigrun; Lexén, Annika & Landheim, Anne Signe (2022). Integration of Care in Complex and Fragmented Service Systems: Experiences of Staff in Flexible Assertive Community Treatment Teams. International Journal of Integrated Care (IJIC). 22(2). doi: 10.5334/ijic.6011. Fulltekst i vitenarkiv Vis sammendrag

  ntroduction: To provide more integrated care, several countries have implemented the Flexible Assertive Community Treatment (FACT) model. However, this model does not guarantee full integration, especially in complex and fragmented service systems like in Norway. Hence, we investigated which barriers that might reduce the potential for integrated care in the Norwegian system, as described by staff in FACT teams, and how they adjust their way of working to increase the opportunities for integration.Methods: Online focus group interviews involving 35 staff members of five Norwegian FACT teams were conducted using a semi-structured interview guide. The material was analysed using thematic text analysis.Results: Six themes described the barriers to integrated care in the service system: fragmentation, different legislation and digital systems, challenges in collaboration, bureaucracy and limited opening hours. Three themes described adjustments in the teams’ way of working to enhance integration: working as the responsible co-ordinator, being a collaborator, and the only entry channel into the service system.Conclusion: The FACT team staff described several barriers to integration within the system. However, they made some adjustments in their way of working that might provide opportunities for integrated care within complex and fragmented service systems. © 2022 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.

• Skeie, Ivar; Clausen, Thomas; Hjemsæter, Arne Jan; Landheim, Anne Signe; Monsbakken, Bent Berntsen & Thoresen, Magne [Vis alle 7 forfattere av denne artikkelen] (2022). Mortality, Causes of Death, and Predictors of Death among Patients On and Off Opioid Agonist Treatment: Results from a 19-Year Cohort Study. European Addiction Research. ISSN 1022-6877. 28(5), s. 358–367. doi: 10.1159/000525694. Fulltekst i vitenarkiv Vis sammendrag

  Background: Mortality is increased among people with opioid use disorder but reduced while on opioid agonist treatment (OAT). However, the impact of patient and treatment characteristics on mortality and causes of death is insufficiently studied. Objectives: The objective of this study was to explore mortality and causes of death and examine the impact of patient and treatment characteristics on mortality in an OAT cohort with high retention in treatment. Methods: Design: longitudinal cohort study. Setting: Norway. Observation period: time from OAT start as of 1998 until death or end of 2016, 2,508 person-years (PY) in total. Sample: 200 persons starting OAT 1998–2007. Data sources: hospital records, interviews, the Norwegian Cause of Death Registry, Statistics Norway. Results: Retention: 86.4% of the observation period was on OAT, 9.0% off, 4.6% unknown OAT status. All-cause crude mortality rate per 100 PY during the whole observation period was 1.64 (95% CI: 1.19–2.20), for deaths of somatic cause 0.88 (0.56–1.31), for drug-induced deaths 0.44 (0.23–0.76), and traumatic deaths 0.24 (0.10–0.50). Off-versus-on-OAT all-cause mortality ratio was 2.31 (1.00–4.85). On OAT, 58% of the deaths were of somatic cause and 21% drug-induced; off OAT, 38% of somatic cause and 50% drug-induced. Increasing baseline age and rate of somatic hospital treatment episodes were independently associated with increased all-cause mortality risk, while increasing rate of in-patient psychiatric treatment episodes was associated with reduced risk. Increasing duration of nicotine and cannabis use and alcohol dependence as well as increasing severity of polydrug use were associated with increased all-cause and somatic mortality adjusted for age and sex. Conclusion: The long observation period made it possible to demonstrate the importance of long-term retention in OAT to reduce mortality. Further, the preponderance of somatic and reduction of drug-induced causes of death during OAT underlines the need for follow-up of chronic diseases and health-promoting lifestyle changes. These findings add to the knowledge about long-term OAT effects, not least in ageing OAT populations. © 2022 The Author(s). This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY) (http://www.karger.com/Services/OpenAccessLicense). Usage, derivative works and distribution are permitted provided that proper credit is given to the author and the original publisher.

• Bahl, Nina Kavita Heggen; Øversveen, Emil; Brodahl, Morten; Nafstad, Hilde Eileen; Blakar, Rolv Mikkel & Ness, Ottar [Vis alle 8 forfattere av denne artikkelen] (2022). In what ways do emerging adults with substance use problems experience their communities as influencing their personal recovery processes? Journal of Community Psychology. ISSN 0090-4392. 50(7), s. 3070–3100. doi: 10.1002/jcop.22816. Fulltekst i vitenarkiv Vis sammendrag

  Applying the multiple psychological sense of community concept (MPSOC), this study explored how emerging adults with substance use problems experience the influences of various senses of community and communities on their personal recovery processes. Semi-structured interviews with 21 emerging adults from different urban contexts in Norway were analysed using a collaborative, seven-step, deductive, and reflexive thematic approach. MPSOC is shown to be a key concept for achieving a broad, in-depth understanding of emerging adults' senses of community and personal experiences of community influences on recovery processes from substance use. Positive and negative senses of community in geographical, relational, substance use-related and ideal communities influence the potentials and challenges in emerging adults' recovery processes. Supportive and motivating community relationships, meaningful activities with peers, and distance from recovery-impeding communities were identified as important recovery components. To promote recovery and prevent substance use in emerging adults, community approaches and tools applied in substance use treatment have to take into account and utilise multidimensional and age group-specific aspects of belonging.

• Trane, Kristin; Aasbrenn, Kristian; Rønningen, Martin; Odden, Sigrun; Lexén, Annika & Landheim, Anne Signe (2022). Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model. Frontiers in Public Health. 10, s. 1–11. doi: 10.3389/fpubh.2022.913159. Fulltekst i vitenarkiv Vis sammendrag

  Background: Flexible assertive community treatment (FACT) is an innovative model for providing long-term treatment to people with severe mental illness. The model was developed in the Netherlands but is now used in other countries, including Norway, which has a geography different from the Netherlands, with many rural and remote areas. Implementation of innovations is context dependent. The FACT model's potential in rural and remote areas has not been studied. Therefore, we aimed to gain knowledge regarding the challenges and modifications of the model in rural and remote contexts and discuss how they can affect the model's potential in such areas. This knowledge can improve the understanding of how FACT or similar services can be adapted to function most optimally in such conditions. We sought to address the following questions: Which elements of the FACT model do team leaders of the rural FACT teams find particularly challenging due to the context, and what modifications have the teams made to the model? Methods: Digital interviews were conducted with five team leaders from five rural FACT teams in different parts of Norway. They were selected using purposive sampling to include team leaders from some of the most rural teams in Norway. The interviews were analyzed using thematic text analysis. Results: The following three themes described elements of the FACT model that were experienced particularly challenging in the rural and remote context: multidisciplinary shared caseload approach, intensive outreach and crisis management. The following eight themes described the modifications that the teams had made to the model: intermunicipal collaboration, context-adaptive planning, delegation of tasks to municipal services, part-time employment, different geographical locations of staff, use of digital tools, fewer FACT board meetings, and reduced caseload. Conclusions: Rural and remote contexts challenge the FACT model's potential. However, modifications can be made, some of which can be considered innovative modifications that can increase the model's potential in such areas, while others might move the teams further away from the model. Keywords: flexible assertive community treatment (FACT); innovation; mental health; modification; remote; rural. Copyright © 2022 Trane, Aasbrenn, Rønningen, Odden, Lexén and Landheim.

• Haugom, Espen Woldsengen; Stensrud, Bjørn; Beston, Gro; Ruud, Torleif & Landheim, Anne Signe (2022). Experiences of shared decision making among patients with psychotic disorders in Norway: a qualitative study. BMC Psychiatry. 22(1). doi: 10.1186/s12888-022-03849-8. Fulltekst i vitenarkiv Vis sammendrag

  Background: Shared decision making (SDM) is a process where the patient and the health professional collaborate to make decisions based on both the patient’s preferences and the best available evidence. Patients with psychotic disorders are less involved in making decisions than they would like. More knowledge of these patients’ experiences of SDM may improve implementation. The study aim was to describe and explore experiences of SDM among patients with psychotic disorders in mental health care. Methods: Individual interviews were conducted with ten persons with a psychotic disorder. They were service users of two community mental health centres. The transcribed material was analysed using qualitative content analysis. Results: Four-ffths of the participants in this study found that they received insufcient information about their health situation and treatment options. All participants experienced that only one kind of treatment was often presented, which was usually medication. Although the study found that diferent degrees of involvement were practised, two thirds of the participants had little impact on choices to be made. This was despite the fact that they wanted to participate and felt capable of participating, even during periods of more severe illness. The participants described how important it was that SDM in psychosis was based on a trusting relationship, but stated that it took time to establish such a relationship. Conclusions: This study with ten participants indicates that patients with psychotic disorders experienced that they were not allowed to participate as much as they wanted to and believed they were capable of. Some patients were involved, but to a lesser degree than in SDM. More and better tailored information communicated within a trusting relationship is needed to provide psychotic patients with a better basis for active involvement in decisions about their health care. Keywords: Shared decision making, psychotic disorders, mental health services, qualitative research

• Trane, Kristin; Aasbrenn, Kristian; Rønningen, Martin; Odden, Sigrun; Lexén, Annika & Landheim, Anne (2021). Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers. International Journal of Mental Health Systems. 15(38), s. 1–12. doi: 10.1186/s13033-021-00463-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Implementing innovative health service models in existing service systems is complicated and context dependent. Flexible assertive community treatment (FACT) is a multidisciplinary service model aimed at providing integrated care for people with severe mental illness. The model was developed in the Netherlands and is now used in several countries, such as Norway. The Norwegian service system is complex and fragmented, with challenges in collaboration. Limited research has been performed on FACT teams and other new integrative health service models as part of such systems. However, such knowledge is important for future adjustments of innovation processes and service systems. Our aim was to explore how FACT teams are integrated into the existing formal public service system, how they function and affect the system, and describe some influencing factors to this. We sought to address how service providers in the existing service system experience the functioning of FACT teams in the system. Methods Five focus group interviews were undertaken 3 years after the FACT teams were implemented. Forty service providers representing different services from both levels of administration (primary and specialist healthcare) from different Norwegian regions participated in this study. Team leaders of the FACT teams also participated. Service providers were recruited through purposeful sampling. Interviews were analysed using thematic text analysis. Results The analysis revealed five main themes regarding FACT teams: (1) They form a bridge between different services; (2) They collaborate with other services; (3) They undertake responsibility and reassure other services; (4) They do not close all gaps in service systems; and (5) They are part of a service system that hampers their functioning. Conclusions The FACT teams in this study contributed to positive changes in the existing service system. They largely contributed to less complex and fragmented systems by forming a bridge and undertaking responsibility in the system and by collaborating with and reassuring other services; this has reduced some gaps in the system. The way FACT teams function and needs of the existing system appear to have contributed positively to these findings. However, complexity and fragmentation of the system partly hamper functioning of the FACT teams.

• Brekke, Eva; Clausen, Hanne Kristin; Brodahl, Morten; Lexén, Annika; Keet, René & Mulder, Cornelis L. [Vis alle 7 forfattere av denne artikkelen] (2021). Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study. Frontiers in Psychology. 12. doi: 10.3389/fpsyg.2021.727013. Fulltekst i vitenarkiv Vis sammendrag

  The aim of this study was to explore and describe service user experiences of how receiving services from a Flexible Assertive Community Treatment (FACT) team may support or inhibit citizenship. Within a participatory design, individual interviews with 32 service users from five Norwegian FACT teams were analyzed using thematic, cross-sectional analysis. The findings showed that FACT may support citizenship by relating to service users as whole people, facilitating empowerment and involvement, and providing practical and accessible help. Experiences of coercion, limited involvement and authoritarian aspects of the system surrounding FACT had inhibited citizenship for participants in this study.

• Bahl, Nina Kavita Heggen; Landheim, Anne; Nafstad, Hilde Eileen; Blakar, Rolv Mikkel & Brodahl, Morten (2021). Mapping, assessing and promoting multiple psychological senses of community (MPSOC) through clinical pathways for treating substance use problems. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. s. 1–18. doi: 10.1177/1455072520985976. Fulltekst i vitenarkiv Vis sammendrag

  Aim: The recent nationally implemented clinical pathways for the treatment of substance use problems in Norway require mapping and assessing of patients’ needs, challenges, and resources. However, there is a lack of tools for systematically mapping and assessing patients’ social situations and social networks as part of the national guidelines. The aim of this article is to present a tool developed to map and assess the patient’s social situation, and to propose approaches for promoting multiple psychological senses of community (MPSOC) through clinical pathways for treating substance use problems. Methods: The proposed tool and approaches are developed based on findings in a previous in-depth collaborative study of MPSOC and recovery among people with substance use problems who received help and services from Norwegian municipalities. Findings: The findings suggest that multiple communities (geographical, relational and ideal) and senses of communities (within and outside treatment) simultaneously can influence individual recovery processes from problematic substance use in both positive as well as negative ways. As such, these community dimensions are of central importance to include in mapping and assessing of patients’ social situations, as well as in the promotion of MPSOC through clinical pathways. Conclusions: The suggested tool and approaches can increase the likelihood of achieving key aims of the national clinical pathways. Most important, mapping, assessing and promoting MPSOC through clinical pathways may promote long-term recovery processes and positive recovery capital for persons with substance use problems. Keywords clinical pathway, multiple psychological senses of community, recovery process, substance use problem, substance use service

• Hjemsæter, Arne Jan; Bramness, Jørgen Gustav; Drake, Robert; Skeie, Ivar; Monsbakken, Bent Berntsen & Benth, Jurate Saltyte [Vis alle 7 forfattere av denne artikkelen] (2020). Levels of mental distress over 18 years after entering treatment for substance use disorders: A longitudinal cohort study. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. 37(4), s. 352–364. doi: 10.1177/1455072520947249. Fulltekst i vitenarkiv Vis sammendrag

  Levels of mental distress over 18 years after entering treatment for substance use disorders: A longitudinal cohort study Show less Arne Jan Hjemsæter, Jørgen G Bramness, Robert Drake, Ivar Skeie, Bent Monsbakken, Jūratė Šaltytė Benth, Anne S LandheimFirst Published August 17, 2020 Research Article https://doi.org/10.1177/1455072520947249 Article information Open AccessCreative Commons Attribution, Non Commercial 4.0 License Abstract Aims: The aims were to investigate whether baseline characteristics and problematic substance use were related to change in mental distress over time in patients with substance use disorders during an 18-year period. Method: This was a prospective, longitudinal study of patients followed for 18 years after entering specialised treatment for substance use disorders. A sample of 291 patients was recruited in 1997 and 1998. Mental distress was measured using the Hopkins Symptom Checklist 25 at baseline, and at six and 18 years. Lifetime psychiatric disorders and substance use disorders at baseline were measured using the Composite International Diagnostic Interview, while personality disorders were measured using the Millon Clinical Multiaxial Inventory II. At the six- and 18-year follow-ups, substance use was measured using the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test. Linear mixed model was estimated to assess the overall level of mental distress over 18 years for participants with complete data at baseline (n = 232). Results: In an adjusted model, problematic substance use assessed simultaneously with mental distress, having lifetime affective, anxiety and personality disorder at baseline were associated with greater levels of mental distress over the 18-year period. The change in mental distress from baseline to the six-year, but not to the 18-year, follow-up was significantly larger among females than among males. Conclusion: The results suggests a reciprocal relationship over time between substance use and mental health problems. Also, there seems to be an additive effect between ongoing problematic substance use and lifetime mental disorders on greater levels of mental distress. This addresses the importance of integrated treatment for both substance use disorders and mental disorders to improve the long-term course for patients with these comorbid disorders.

• Clausen, Hanne Kristin; Ruud, Torleif; Odden, Sigrun; Benth, Jurate Saltyte; Heiervang, Kristin S. & Stuen, Hanne Kilen [Vis alle 7 forfattere av denne artikkelen] (2020). Improved Rehabilitation Outcomes for Persons With and Without Problematic Substance Use After 2 Years With Assertive Community Treatment—A Prospective Study of Patients With Severe Mental Illness in 12 Norwegian ACT Teams. Frontiers in Psychiatry. 11. doi: 10.3389/fpsyt.2020.607071. Fulltekst i vitenarkiv Vis sammendrag

  Background: Persons with severe mental illness often face difficulties in accessing and receiving adequate services enabling them to live independently. Many have co-occurring substance use problems that increase the risk of adverse outcomes. Community-based service models have been implemented around the world, including assertive community treatment (ACT), but the knowledge of rehabilitation outcomes in different subgroups is limited. We aimed to explore rehabilitation outcomes among patients suffering severe mental illness with and without substance use problems who had received ACT services for at least 2 years. Additionally, we compared differences in changes between the two groups. Methods: A total of 142 patients who received services for 2 years from the first 12 Norwegian ACT teams were included. Eighty-four (59%) had problematic substance use, while 58 (41%) did not. Data regarding housing, activity, symptoms, functioning, and subjective quality of life were collected upon enrollment into ACT and at 2 years of follow-up. Clinician-rated scales and self-report questionnaires were used. Changes within the two groups and differences in change between the groups were assessed using generalized linear mixed models. Results: Both groups were more likely to have good housing, higher level of functioning, and less anxiety and depressive symptoms after 2 years. The odds of good housing among participants with problematic substance use increased only after adjusting for age and gender. Participants with problematic substance use had less severe symptoms, particularly negative and manic symptoms, while participants without problematic substance use reported improved satisfaction with life in general. Neither group experienced a change in having a meaningful daily activity, positive symptoms, practical and social functioning, or subjective quality of life. The reduction of manic symptoms in the substance use group was the only difference between the groups. Conclusion: After 2 years, patients with and without problematic substance use experienced improvements in several important domains. Furthermore, the improvements were similar in both groups for most outcomes. This may suggest that ACT has a place in the continued effort toward integrated and comprehensive community services empowering patients with severe mental illness to achieve and sustain an independent life, including marginalized groups with severe substance use. Keywords: activity; assertive community treatment; co-occurring substance use; functioning; housing; psychiatric symptom; quality of life; severe mental illness. Copyright © 2020 Clausen, Ruud, Odden, Benth, Heiervang, Stuen and Landheim.

• Haugom, Espen Woldsengen; Stensrud, Bjørn; Beston, Gro; Ruud, Torleif & Landheim, Anne (2020). Mental health professionals’ experiences with shared decision-making for patients with psychotic disorders: a qualitative study. BMC Health Services Research. 20(1). doi: 10.1186/s12913-020-05949-1. Fulltekst i vitenarkiv Vis sammendrag

  Background: Shared decision-making (SDM) is a process whereby clinicians and patients work together to select treatments based on both the patient's preferences and clinical evidence. Although patients with psychotic disorders want to participate more in decisions regarding their care, they have limited opportunities to do so because of various barriers. Knowing about health professionals' experiences with SDM is important toward achieving successful implementation. The study aim was to describe and explore health professionals' SDM experiences with patients with psychotic disorders. Methods: Three focus group interviews were conducted, with a total of 18 health professionals who work at one of three Norwegian community mental health centres where patients with psychotic disorders are treated. We applied a descriptive and exploratory approach using qualitative content analysis. Results: Health professionals primarily understand the SDM concept to mean giving patients information and presenting them with a choice between different antipsychotic medications. Among the barriers to SDM, they emphasized that patients with psychosis have a limited understanding of their health situation and that time is needed to build trust and alliances. Health professionals mainly understand patients with psychotic disorders as a group with limited abilities to make their own decisions. They also described the concept of SDM with little consideration of presenting different treatment options. Psychological or social interventions were often presented as complementary to antipsychotic medications, rather than as an alternative to them. Conclusion: Health professionals' understanding of SDM is inconsistent with the definition commonly used in the literature. They consider patients with psychotic disorders to have limited abilities to participate in decisions regarding their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM. Keywords: Mental health care; Mental health professionals; Psychotic disorders; Shared decision-making.

• Pettersen, Henning; Havnes, Ingrid Amalia & Landheim, Anne (2020). Housing Preferences Among Persons With Severe Mental Illness and Co-Occurring Substance Use in Assertive Community Treatment: A Qualitative Study. American Journal of Psychiatric Rehabilitation (AJPR). ISSN 1548-7768. 23(1-2), s. 76–100. Fulltekst i vitenarkiv
• Hjemsæter, Arne Jan; Bramness, Jørgen Gustav; Drake, Robert; Skeie, Ivar; Monsbakken, Bent Berntsen & Thoresen, Magne [Vis alle 7 forfattere av denne artikkelen] (2019). Predictors of problematic substance use 18 years after treatment: a longitudinal cohort study of persons with substance use disorders. Cogent Psychology. 6:1634325, s. 1–13. doi: 10.1080/23311908.2019.1634325. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To examine the extent of substance use and explore which baseline factors predicted current problematic substance use 18 years after treatment in surviving patients. Methods: This longitudinal cohort study used a mailed self-report questionnaire on a group of patients with long-term problematic substance use, and high psychiatric comorbidity, 18 years after they received treatment for substance use disorders. A consecutive sample of patients with substance use disorders (n = 287, mean age 38.6 years, 72% male; 45% alcohol use disorder only and 55% other substance use disorders) was recruited in 1997 and 1998. Baseline measurements included the Composite International Diagnostic Interview, the Millon Clinical Multiaxial Inventory II, the Hopkins Symptom Checklist 25 and demographic data. In the 18-year follow-up study (n = 91), the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test were used. A multivariate logistic regression analysis was used to identify predictors of having current problematic substance use 18 years after treatment for participants with full data collection at baseline (n = 75). Results: Of the 91 participants who responded at the 18-year follow-up study, 47 (52%) had no current problematic substance use and 44 (48%) had current problematic substance use during the past 12 months. Of participants with no current problematic substance use, 17 (36%) reported total abstinence from alcohol, illicit substances and misuse of pharmaceuticals during the past 5 years. Mental distress measured with the Hopkins Symptom Checklist 25 at baseline predicted having current problematic substance use 18 years after treatment (n = 75). Conclusions: In a group of patients with long lasting substance use disorders and high psychiatric comorbidity that entered treatment, close to half of those participating at a follow-up study had current problematic substance use during the past 12 months 18 years later. Mental distress at baseline predicted having current problematic substance use 18 years after treatment, adjusted for other factors. Self-reported general mental health symptoms can be a relevant predictor of the long-term course of substance use disorders.

• Pedersen, Monica Stolt; Landheim, Anne; Møller, Merete & Lien, Lars (2019). First-line managers' experience of the use of audit and feedback cycle in specialist mental health care: A qualitative case study. Archives of Psychiatric Nursing. ISSN 0883-9417. 33(6), s. 103–109. doi: 10.1016/j.apnu.2019.10.009. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Audit and feedback was the main strategy to facilitate implementation of The National Guideline for Persons with Concurrent Substance Use Disorders and Mental Disorders in specialist mental health services. Studies have shown that leadership support contributes to implementation success. The aim of the study was to explore how first-line managers in a District Psychiatric Centre experienced using audit and feedback cycle. Method The study had a qualitative case study design with individual interviews with five first-line managers from a District Psychiatric Centre in Norway. Qualitative content analysis was conducted. Results First-line managers were positive to contribute to better practice for the patient group and apply available tools. Four themes emerged: 1) Lack of endurance, where first-line managers saw their role as being process leaders, but failed to persist, 2) Lack of support in the process, where first-line managers called for a stronger organisational focus 3) Lack of ownership, where first-line managers felt the process was imposed on them, and 4) Lack of leader autonomy, where first-line managers seemed insecure about their role between professional leadership and own management. Conclusion First-line managers were not sufficiently experienced or equipped to solve the implementation process satisfactorily. They were torn between different commitments, without the autonomy to act as process drivers or facilitators, and without taking the necessary leadership role. The potential impact of the use of audit and feedback may thus not be fully realized, in part, because of limited organisational support and capacity to respond effectively.

• Pettersen, Henning; Landheim, Anne; Skeie, Ivar; Biong, Stian; Brodahl, Morten & Benson, Victoria [Vis alle 7 forfattere av denne artikkelen] (2019). Helpful Ingredients in the Treatment of Long-Term Substance Use Disorders: A Collaborative Narrative Study. Substance Abuse: Research and Treatment. 13, s. 1–9. doi: 10.1177/1178221819844996. Fulltekst i vitenarkiv Vis sammendrag

  Background: HIV infection may result in neurocognitive deficits, but the effects of pulmonary tuberculosis (TB+), a common comorbid condition in HIV infection, on cognition in HIV infections are unknown. Accordingly, we examined the effects of TB+, on neurocognitive functioning in HIV-infected (HIV+) Zambian adults. Setting: All participants were drawn from HIV clinics in and around Lusaka, the capital of Zambia. Methods: Participants were 275 HIV+, of whom 237 were HIV+ and TB-negative (HIV+/TB−), and 38 also had pulmonary TB+ (HIV+/TB+). Controls were 324 HIV- and TB-uninfected (HIV−) healthy controls. All HIV+ participants were prescribed combination antiretroviral treatment (cART). Published, demographically corrected Zambian neuropsychological norms were used to correct for effects of age, education, sex, and urban/rural residence. Results: Neuropsychological deficits, assessed by global deficit scores, were more prevalent in this order: 14% (46 of 324) of HIV− controls, 34% (80 of 237) of HIV+/TB−, and 55% (21 of 38) of HIV+/TB+ group. Thus, both HIV-infected groups evidenced more impairment than HIV− controls, and the HIV+/TB+ group had a higher rate of neurocognitive impairment than the HIV+/TB− group. HIV+/TB+ patients were more likely to be male, younger, less-educated, and have lower CD4 counts and detectable HIV RNA in blood compared with the HIV+/TB− patients. Conclusions: In HIV infection, TB may contribute to cognitive impairment, even after controlling for lower CD4 counts and viral load. Thus, systemic inflammation from HIV and TB and more advanced immune deficiency at diagnosis of HIV may contribute to impaired cognition in HIV+/TB+ patients.

• Odden, Sigrun; Landheim, Anne; Clausen, Hanne Kristin; Stuen, Hanne Kilen; Heiervang, Kristin Sverdvik & Ruud, Torleif (2019). Model fidelity and team members' experiences of assertive community treatment in Norway: A sequential mixed-methods study. International Journal of Mental Health Systems. 13(65), s. 1–12. doi: 10.1186/s13033-019-0321-8. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background: Assertive community treatment (ACT) is an evidence-based treatment for people with severe mental illness, and this model is used widely throughout the world. Given the various adaptations in different contexts, we were interested in studying the implementation and adaptation of the ACT model in Norway. The first 12 Norwegian ACT teams were established between 2009 and 2011, and this study investigated the teams’ model fidelity and the team members’ experiences of working with ACT. Methods: To investigate implementation of the ACT model, fidelity assessments were performed 12 and 30 months after the teams started their work using the Tool for Measurement of Assertive Community Treatment (TMACT). Means and standard deviations were used to describe the ACT teams’ fidelity scores. Cohen’s effect size d was used to assess the changes in TMACT scores from the first to second assessment. Qualitative focus group interviews were conducted in the 12 teams after 30 months to investigate the team members’ experiences of working with the ACT model. Results: The fidelity assessments of the Norwegian teams showed high implementation of the structural and organizational parts of the ACT model. The newer parts of the model, the recovery and evidence-based practices, were less implemented. Four of the six subscales in TMACT improved from the first to the second assessment. The team members experienced the ACT model to be a good service model for the target population: people with severe mental illness, significant functional impairment, and continuous high service needs. Team members perceived some parts of the model difficult to implement and that it was challenging to find effective ways to collaborate with existing health and social services. Conclusion: The first 12 Norwegian ACT teams implemented the ACT model to a moderate degree. The ACT model could be implemented in Norway without extensive adaptations. Although the team members were satisfied with the ACT model, especially the results for their service users, inclusion of the ACT team to the existing service system was perceived as challenging. Keywords: Assertive community treatment, Model fidelity, Team members, Tool for Measurement of Assertive Community Treatment (TMACT), Implementation

• Bahl, Nina Kavita Heggen; Nafstad, Hilde Eileen; Blakar, Rolv Mikkel; Landheim, Anne & Brodahl, Morten (2019). Multiple senses of community and recovery processes. A pilot study for a national evaluation of the experiences of persons with substance use problems receiving help and services from Norwegian municipalities. Journal of Community Psychology. ISSN 0090-4392. 47, s. 1399–1418. doi: 10.1002/jcop.22194. Fulltekst i vitenarkiv Vis sammendrag

  Aims This pilot study uses a multifaceted concept of sense of community (SOC)—multiple senses of community (MPSOC)—to understand how the multiple communities of persons with substance use problems, including those with a positive, negative and neutral SOC, influence processes of substance use recovery. Methods Semi‐structured interviews were conducted with 16 informants from different Norwegian municipalities and regions. A collaborative research design and thematic analyses with a peer researcher were applied. Results The findings confirm prior findings of key ingredients related to recovery. However, they also illustrate that for communities to promote recovery, they need to fulfil individual needs, provide distance from pretreatment status, identity and roles and harmonise with individual meaning systems of an ideal community. Conclusion Experiences of positive and negative community connections within geographical, relational and ideal communities take part in recovery processes. Community participation is suggested to be included in individual outpatient treatment and posttreatment plans.

• Hjemsæter, Arne Jan; Bramness, Jørgen Gustav; Drake, Robert; Skeie, Ivar; Monsbakken, Bent Berntsen & Benth, Jurate Saltyte [Vis alle 7 forfattere av denne artikkelen] (2019). Mortality, cause of death and risk factors in patients with alcohol use disorder alone or poly-substance use disorders: A 19-year prospective cohort study. BMC Psychiatry. 19(101). doi: 10.1186/s12888-019-2077-8. Fulltekst i vitenarkiv Vis sammendrag

  Background This study investigated cause of death, mortality rates and explored if baseline characteristics were associated with risk of death in patients with alcohol use disorder alone or poly-substance use disorders. Methods This was a prospective, longitudinal study of patients followed for 19 years after entering specialized treatment for substance use disorders. At baseline 291 patients (mean age 38.3 years, standard deviation 11.4 years, 72% male) with high psychiatric co-morbidity were recruited; 130 (45%) had lifetime alcohol use disorder alone, while 161 (55%) had poly-substance use disorders. Time and causes of death were gathered from the Norwegian Cause of Death Registry. Lifetime psychiatric symptom disorders and substance use disorders at baseline were measured with The Composite International Diagnostic Interview and personality disorders at baseline were measured with The Millon Clinical Multiaxial Inventory II. Results Patients with alcohol use disorder alone more often died from somatic diseases (58% versus 28%, p = 0.004) and more seldom from overdoses (9% versus 33%, p = 0.002) compared with patients with poly-substance use disorders. The crude mortality rate per 100 person year was 2.2 (95% confidence interval: 1.8–2.7), and the standardized mortality rate was 3.8 (95% confidence interval: 3.2–4.6) in the entire cohort during 19 years after entering treatment. Having lifetime affective disorder at baseline was associated with lower risk of death (Hazard Ratio 0.58, 95% confidence interval: 0.37–0.91). Older age was associated to increased risk of death among men (p < 0.001) and non-significantly among patients with poly-substance use (p = 0.057). The difference in association between age and risk of death was significantly different between men and women (p = 0.011) and patients with alcohol use disorder alone and poly-substance use disorders (p = 0.041). Conclusions Patients with alcohol use disorder alone died more often from somatic disease than patients with poly-substance use disorders, and all subgroups of patients had an increased risk of death compared with the general population. Men with long-lasting substance use disorders are a priority group to approach with directed preventive measures for somatic health before they reach 50 years of age.

• Kvam, Elisabeth Adams; Oddli, Hanne & Landheim, Anne (2019). Anker i normalitet. Betringsprosessar hjå menneske med rus- og psykisk liding. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 56(3), s. 167–177. Fulltekst i vitenarkiv
• Pettersen, Henning; Landheim, Anne; Skeie, Ivar; Biong, Stian; Brodahl, Morten & Hansen, Jeppe Oute [Vis alle 7 forfattere av denne artikkelen] (2019). How Social Relationships Influence Substance Use Disorder Recovery : A Collaborative Narrative Study. Substance Abuse: Research and Treatment. 13, s. 1–8. doi: 10.1177/1178221819833379. Fulltekst i vitenarkiv Vis sammendrag

  Individuals with a substance use disorder (SUD) often have fewer social support network resources than those without SUDs. This qualitative study examined the role of social relationships in achieving and maintaining stable recovery after many years of SUD. Semistructured interviews were conducted with 18 participants, each of whom had been diagnosed with a SUD and each of whom had been abstinent for at least 5years. A resource group of peer consultants in long-term recovery from SUDs contributed to the study planning, preparation, and initial analyses. The relationship that most participants described as helpful for initiating abstinence was recognition by a peer or a caring relationship with a service provider or sibling. These findings suggest that, to reach and maintain abstinence, it is important to maintain positive relationships and to engage self-agency to protect oneself from the influences of negative relationships. Substance use disorder service providers should increase the extent to which they involve the social networks of clients when designing new treatment approaches. Service providers should also focus more on individualizing services to meet their clients on a personal level, without neglecting professionalism or treatment strategies.

• Pedersen, Monica Stolt; Landheim, Anne; Møller, Merete & Lien, Lars (2018). Acting on audit & feedback: a qualitative instrumental case study in mental health services in Norway. BMC Health Services Research. 18(71). doi: 10.1186/s12913-018-2862-y. Fulltekst i vitenarkiv Vis sammendrag

  Background The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014. Methods This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings. Results The discussions provided health professionals with insight into their own and their colleagues’ practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working. Conclusion Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups

• Pettersen, Henning; Landheim, Anne; Skeie, Ivar; Biong, Stian; Brodahl, Morten & Benson, Victoria [Vis alle 7 forfattere av denne artikkelen] (2018). Why do those with long-term substance use disorders stop abusing substances: A qualitative study. Substance Abuse: Research and Treatment. 12, s. 1–8. doi: 10.1177/1178221817752678. Fulltekst i vitenarkiv Vis sammendrag

  Although a significant proportion of adults recover from substance use disorders (SUDs), little is known about how they reach this turning point or why they stop using. The purpose of the study was to explore the factors that influence reasoning and decision making about quitting substance use after a long-term SUD. Semistructured interviews were conducted with 18 participants, each of whom had been diagnosed with a SUD and had been abstinent for at least 5 years. A resource group of peer consultants in long-term recovery from SUDs contributed to the study’s planning, preparation, and initial analyses. Participants recalled harmful consequences and significant events during their years of substance use. Pressure and concern from close family members were important in their initial efforts to abstain from substance use. Being able to imagine a different life, and the awareness of existing treatment options, promoted hope and further reinforced their motivation to quit. Greater focus on why those with SUDs want to quit may help direct treatment matching; treatment completion may be more likely if the person’s reasons for seeking help are addressed.

• Stuen, Hanne Kilen; Landheim, Anne; Rugkåsa, Jorun & Wynn, Rolf (2018). How clinicians make decisions about CTOs in ACT: a qualitative study. International Journal of Mental Health Systems. 12:51(51), s. 1–10. doi: 10.1186/s13033-018-0230-2. Fulltekst i vitenarkiv Vis sammendrag

  Background The first 12 Norwegian assertive community treatment (ACT) teams were piloted from 2009 to 2011. Of the 338 patients included during the teams’ first year of operation, 38% were subject to community treatment orders (CTOs). In Norway as in many other Western countries, the use of CTOs is relatively high despite lack of robust evidence for their effectiveness. The purpose of the present study was to explore how responsible clinicians reason and make decisions about the continued use of CTOs, recall to hospital and the discontinuation of CTOs within an ACT setting. Methods Semi-structured interviews with eight responsible clinicians combined with patient case files and observations of treatment planning meetings. The data were analysed using a modified grounded theory approach. Results The participants emphasized that being part of a multidisciplinary team with shared caseload responsibility that provides intensive services over long periods of time allowed for more nuanced assessments and more flexible treatment solutions on CTOs. The treatment criterion was typically used to justify the need for CTO. There was substantial variation in the responsible clinicians’ legal interpretation of dangerousness, and some clinicians applied the dangerousness criterion more than others. Conclusions According to the clinicians, many patients subject to CTOs were referred from hospitals and high security facilities, and decisions regarding the continuation of CTOs typically involved multiple and interacting risk factors. While patients’ need for treatment was most often applied to justify the need for CTOs, in some cases the use of CTOs was described as a tool to contain dangerousness and prevent harm.

• Pedersen, Monica Stolt; Landheim, Anne; Møller, Merete & Lien, Lars (2018). Audit and feedback in mental healthcare: staff experiences. International Journal of Health Care Quality Assurance. ISSN 0952-6862. 31(7), s. 822–833. doi: 10.1108/IJHCQA-08-2017-0142. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Audit and feedback (A&F) often underlie implementation projects, described as a circular process; i.e. an A&F cycle. They are widely used, but effect varies with no apparent explanation. We need to understand how A&F work in real-life situations. The purpose of this paper, therefore, is to describe and explore mental healthcare full A&F cycle experiences. Design/methodology/approach This is a naturalistic qualitative study that uses four focus groups and qualitative content analysis. Findings Staff accepted the initial A&F stages, perceiving it to enhance awareness and reassure them about good practice. They were willing to participate in the full cycle and implement changes, but experienced poor follow-up and prioritization, not giving them a chance to own to the process. An important finding is the need for an A&F cycle facilitator. Practical implications Research teams cannot be expected to be involved in implementing clinical care. Guidelines will keep being produced to improve service quality and will be expected to be practiced. This study gives insights into planning and tailoring A&F cycles. Originality/value Tools to ease implementation are not enough, and the key seems to lie with facilitating a process using A&F. This study underscores leadership, designated responsibility and facilitation throughout a full audit cycle.

• Stuen, Hanne Kilen; Landheim, Anne; Rugkåsa, Jorun & Wynn, Rolf (2018). Responsibilities with conflicting priorities: A qualitative study of ACT providers’ experiences with community treatment orders. BMC Health Services Research. 18(290). doi: 10.1186/s12913-018-3097-7. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patients with severe mental illness may be subjected to Community Treatment Orders (CTOs) in order to secure that the patients adhere to treatment. Few studies have investigated the use of CTOs within an Assertive Community Treatment (ACT) setting, and little is known about how the tension between the patients’ autonomy and the clinicians’ responsibility to act in the patients’ best interest are resolved in practice. The aim of this study was to explore the service providers’ experiences with CTOs within an ACT setting. Methods: The study was based on reviews of case files of 15 patients, eight individual qualitative in depth interviews and four focus group interviews with service providers involved in ACT and decisions related to CTOs. A modified grounded theory approach was used to analyze the data. Results: The main theme ‘responsibility with conflicting priorities’ emerged from data analysis (case file reviews, individual interviews and focus group interviews). The balance between coercive approaches and the emphasis on promoting patient autonomy was seen as problematic. The participants saw few alternatives to CTOs as long-term measures to secure ongoing treatment for some of the patients. However, participants perceived the ACT model’s comprehensive scope as an opportunity to build rapport with patients and thereby better meet their needs. The team approach, the ACT providers’ commitment to establish supportive relationships and the frequent meetings with patients in their home environment were highlighted. The ACT approach gave them insight into patients’ everyday lives and, in some cases a greater sense of security when considering whether to take patients off CTOs. Conclusions: Many of the participants viewed CTOs as helpful in securing long-term treatment for patients. CTO decision-making was described as challenging and complex and presented the providers with many dilemmas. The ACT approach was considered as helpful in that it afforded comprehensive, patient-centered support and opportunities to build rapport.

• Clausen, Hanne Kristin; Landheim, Anne; Odden, Sigrun; Benth, Jurate Saltyte; Heiervang, Kristin Sverdvik & Stuen, Hanne Kilen [Vis alle 8 forfattere av denne artikkelen] (2016). Hospitalization of high and low inpatient service users before and after enrollment into Assertive Community Treatment teams: a naturalistic observational study. International Journal of Mental Health Systems. 10(14). doi: 10.1186/s13033-016-0052-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Assertive Community Treatment (ACT) is more successful in reducing hospitalization when baseline use is high. However, with a growing recovery-focus, ACT may be useful for people with severe mental illness who are difficult to engage but not high users of inpatient services. This study investigated hospitalization 2 years before and 2 years after ACT enrollment amongst patients both with and without high inpatient services use before enrollment into ACT. Methods This naturalistic observational study included 142 patients from 12 different ACT teams throughout Norway. Of these, 74 (52 %) were high users of inpatient services before ACT. The teams assessed the patients upon enrollment using clinician-rated and self-reported questionnaires. Hospitalization data from 2 years before and 2 years after enrollment into ACT were obtained from the Norwegian Patient Registry. Linear mixed models were used to assess changes in hospitalization and to explore associations between these changes and patient characteristics. Results When the participants enrolled into the ACT teams, high users of inpatient care were younger, more often living alone and more often subject to involuntary outpatient treatment than low users. The participants spent significantly fewer days in hospital during the 2 years of ACT follow-up compared to the 2 years before enrollment. The reduction was more evident amongst high users, whereas low users had an initial increase in inpatient days in the first year of ACT and a subsequent decrease in the second year. More severe negative symptoms and previous high use of inpatient care were associated with a reduction in both total and involuntary inpatient days. Additionally, a reduction in involuntary inpatient days was associated with being subject to involuntary outpatient treatment upon enrollment into ACT. Conclusion The findings in this study may suggest that ACT contributes to more appropriate use of inpatient care, possibly by reducing the presumably avoidable hospitalization of high users and increasing the presumably needed inpatient care of low users.

• Stensrud, Bjørn; Høyer, Georg; Beston, Gro; Granerud, Arild & Landheim, Anne (2016). “Care or control?”: a qualitative study of staff experiences with outpatient commitment orders. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 51(5), s. 747–755. doi: 10.1007/s00127-016-1193-8. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Outpatient commitment orders are being increasingly used in many countries to ensure follow-up care of people with psychotic disorders after discharge from hospital. Several studies have examined outpatient commitment in relation to use of health care services, but there have been fewer studies of health professionals’ experiences with the scheme. The purpose of this study was to examine health professionals’ experiences with patients subject to outpatient commitment. Methods This was a focus group study using a descriptive and exploratory approach. The study was based on three focus group interviews with a total of 22 participants. Data were analysed using qualitative content analysis. Results The study showed that health professionals had a positive attitude towards outpatient commitment and considered it necessary for patients with psychosis who lacked insight and did not collaborate on treatment. At the same time their attention to patients’ lack of insight could lead to a paternalistic approach more than measures to enhance patient autonomy. This challenged their therapeutic relationship with the patient. Conclusion Health professionals found it difficult to combine control with therapeutic care, but gave greater emphasis to patients’ need for treatment and continuity of care than to their autonomy. This dilemma indicates a need to discuss whether increased attention to patients’ autonomy rather than insight into their illness would improve treatment cooperation and reduce the use of coercion.

• Clausen, Hanne Kristin; Ruud, Torleif; Odden, Sigrun; Benth, Jurate Saltyte; Heiervang, Kristin Sverdvik & Stuen, Hanne Kilen [Vis alle 9 forfattere av denne artikkelen] (2016). Hospitalisation of severely mentally ill patients with and without problematic substance use before and during Assertive Community Treatment: an observational cohort study. BMC Psychiatry. 16(125). doi: 10.1186/s12888-016-0826-5. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Co-occurring substance use increases the risk of hospitalisation in people with severe mental illness, whereas Assertive Community Treatment (ACT) generally reduces hospitalisation in patients with severe mental illness and high inpatient service use. Because the superiority of ACT over standard services amongst patients with problematic substance use is uncertain, the present study examined inpatient service use amongst patients with and without problematic substance use in the 2 years before and the 2 years after they enrolled into ACT teams. Methods This naturalistic observational study included 142 patients of 12 different ACT teams throughout Norway. The teams assessed the patients upon enrolment into ACT using clinician-rated and self-reported questionnaires. We obtained hospitalisation data from the Norwegian Patient Register for the 2 years before and the 2 years after enrolment into ACT. We used linear mixed models to assess changes in hospitalisation and to explore associations between problematic substance use and changes in hospitalisation, controlling for socio-demographic and clinical characteristics. Results A total of 84 (59 %) participants had problematic substance use upon enrolment into the ACT teams. In the 2 years after ACT enrolment both participants with and without problematic substance use experienced a reduction in total inpatient days. Those with problematic substance use also had fewer involuntary inpatient days. Exploratory analyses suggested that symptom severity and functioning level interacted with problematic substance use to influence change in total inpatient days. Conclusion These findings may suggest that ACT teams successfully support people with complex mental health problems in the community, including those with problematic substance use, and thereby contribute to a reduction in inpatient service use.

• Landheim, Anne (2016). Rusmiddelmisbruk-forekomst, forløp og faktorer for recovery. Hva viser forskningen? I Landheim, Anne; Wiig, Frøy Lode; Brendbekken, Marit; Brodahl, Morten & Biong, Stian (Red.), Et bedre liv : historier, erfaringer og forskning om recovery ved rusmiddelmisbruk og psykiske helseproblemer. Gyldendal Akademisk. ISSN 9788205480322. s. 30–44. Fulltekst i vitenarkiv
• Stensrud, Bjørn; Høyer, Georg; Granerud, Arild & Landheim, Anne (2015). ‘Responsible, but Still not a Real Treatment Partner’: A Qualitative Study of the Experiences of Relatives of Patients on Outpatient Commitment Orders. Issues in Mental Health Nursing. ISSN 0161-2840. 36(8), s. 583–591. doi: 10.3109/01612840.2015.1021939. Fulltekst i vitenarkiv Vis sammendrag

  The aim of this study was to explore relatives’ experiences when their family member is under an outpatient commitment order. A descriptive and exploratory approach was used based on qualitative interviews with 11 relatives. The relatives felt they had responsibility for the patient, but experienced a lack of recognition for their contribution to the treatment. Relatives paid little attention to coercion, but were more concerned about whether the follow-up care improved the patient’s social functioning. They further reported an unmet need for information and guidance from healthcare staff to improve cooperation in the patient’s care and treatment.

• Stuen, Hanne Kilen; Rugkåsa, Jorun; Landheim, Anne & Wynn, Rolf (2015). Increased influence and collaboration: A qualitative study of patients' experiences of community treatment orders within an assertive community treatment setting. BMC Health Services Research. 15(409). doi: 10.1186/s12913-015-1083-x. Fulltekst i vitenarkiv Vis sammendrag

  <p><i>Background - </i>Since 2009, 14 assertive community treatment (ACT) teams have started up in Norway. Over 30 % of the patients treated by the ACT teams were subject to community treatment orders (CTOs) at intake. CTOs are legal mechanisms to secure treatment adherence for patients with severe mental illness. Little is known about patients’ views and experiences of CTOs within an ACT context. <p><i>Methods - </i>The study was based on qualitative in depth interviews with 15 patients that were followed up by ACT teams and that were currently subjected to CTOs. The data were analyzed by using a modified grounded theory approach. <p><i>Results - </i>While some participants experienced the CTO as a security net and as an important factor for staying well, others described the CTO as a social control mechanism and as a violation of their autonomy. Although experiencing difficulties and tensions, many participants described the ACT team as a different mental health arena from what they had known before, with another frame of interaction. Despite being legally compelled to receive treatment, many participants talked about how the ACT teams focused on addressing unmet needs, the management of future crises, and finding solutions to daily life problems. Assistance with housing and finances, reduced social isolation, and being able to seek help voluntarily were positive outcomes emphasized by many patients. <p><i>Discussion - </i>The participants had different views of being on a CTO within an ACT setting. While some remained clearly negative to the CTO, others described a gradual transition toward regarding the CTO as an acceptablesolution as they gained experience of ACT. Many of the participants valued the supportive relationship withthe ACT team, and communication with the care providers and the care providers’ attitudes could make a significant difference. The study shows that the perception of coercion is context dependent, and that the relationship between care providers and patients is of importance to how patients interpret the providers’ behavior and the restrictive interventions. <p><i>Conclusions - </i>Although some patients focused on loss of autonomy and being compelled to take medications, other patients emphasised the supportive relationships they had with the ACT teams and that they had received help with housing, finances, and other daily life problems. Thus, being on mandated community treatment could be acceptable in the opinion of several of the patients, provided that they received other services that they found beneficial.

• Årstad, Janne; Nesvåg, Sverre & Landheim, Anne (2015). Kartleggingsverktøy i rusbehandling - nyttig for bruker og behandler? Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 52(9), s. 762–773. Fulltekst i vitenarkiv
• Stensrud, Bjørn; Høyer, Georg; Granerud, Arild & Landheim, Anne (2015). "Life on Hold": A Qualitative Study of Patient Experiences with Outpatient Commitment in Two Norwegian Counties. Issues in Mental Health Nursing. ISSN 0161-2840. 36(3), s. 209–216. doi: 10.3109/01612840.2014.955933. Fulltekst i vitenarkiv Vis sammendrag

  In recent decades, outpatient commitment orders have been increasingly used in the follow-up of persons with serious mental disorders. Most studies on outpatient commitment orders have focused on compliance and consumption of health care services; there is little research on the content of outpatient commitment orders from a patient perspective. The aim of this study is to examine patients’ experiences of living with outpatient commitment orders, and is based on qualitative interviews with 16 persons in two Norwegian counties. The data were analysed using a constructivist, interpretive approach to the grounded theory method. The main finding was that patients with outpatient commitment orders felt that their lives were on hold. The feeling of being seen only as patients prevented them from taking responsibility for their own lives. The medical context was perceived as an obstacle to recovery and transition to a more normal life. Patients’ daily lives were dominated by the agenda set by health care providers and many said they were subjected to control measures that resulted in a reduced quality of life. However, informants also spoke of positive experiences as outpatient commitment order patients, such as feeling safe and secure and having easy access to health care staff and services.

• Clausen, Hanne Kristin; Landheim, Anne; Odden, Sigrun; Heiervang, Kristin Sverdvik; Stuen, Hanne Kilen & Killaspy, Helen [Vis alle 8 forfattere av denne artikkelen] (2015). Associations Between Quality of Life and Functioning in an Assertive Community Treatment Population. Psychiatric Services. ISSN 1075-2730. 66(11), s. 1249–1252. doi: 10.1176/appi.ps.201400376. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Level of functioning is positively associated with subjective quality of life for people with severe mental illness, but a detailed relationship between functioning and satisfaction with various life domains is largely unknown, and this gap prompted this study. Methods: Demographic and clinical data were obtained from 149 patients engaged with 12 assertive community treatment teams in Norway. Multivariate regression analyses were used to explore associations between subjective quality of life and patient characteristics. Results: Analyses confirmed positive associations between quality of life and age, functioning, and weekly contact with family and friends and a negative association with anxiety and depressive symptoms. Positive associations between several areas of practical and social functioning and satisfaction with related life domains also were found. Conclusions: Although a causal direction of the associations between functioning and life satisfaction has not been determined in this study, the positive findings might indicate that programs aiming to improve functioning could affect patients’ quality of life.

• Sørensen, Torgeir; Lien, Lars; Landheim, Anne & Danbolt, Lars Johan (2015). Meaning-Making, Religiousness and Spirituality in Religiously Founded Substance Misuse Services—A Qualitative Study of Staff and Patients’ Experiences. Religions. 6(1), s. 92–106. doi: 10.3390/rel6010092. Fulltekst i vitenarkiv Vis sammendrag

  The Norwegian health authorities buy one third of their addiction treatment from private institutions run by organizations and trusts. Several of these are founded on religious values. The aim of the study was to investigate such value-based treatment and the patients’ experiences of spirituality and religiousness as factors of meaning-making in rehabilitation. The study was performed in an explorative qualitative design. Data were collected through focus-group interviews among therapists and in-patients at a religiously founded substance misuse service institution. The analysis was carried out by content analysis through systematic text-condensation. Through different activities and a basic attitude founded on religious values, the selected institution and the therapists facilitated a treatment framework which included a spiritual dimension and religious activity. The patients appreciated their free choice regarding treatment approaches, which helped them to make meaning of life in various collective and individual settings. Rituals and sacred spaces gave peace of mind and confidence in a situation that up to now had been chaotic and difficult. Sermons and wording in rituals contributed to themes of reflection and helped patients to revise attitudes and how other people were met. Private confessions functioned for several patients as turning point experiences influencing patients’ relations to themselves and their surroundings. Spirituality and religious activity contributed to meaning-making among patients with substance use disorder and had significance for their rehabilitation

• Martinez, Priscilla; Lien, Lars; Landheim, Anne; Kowal, Paul & Clausen, Thomas (2014). Quality of life and social engagement of alcohol abstainers and users among older adults in South Africa. BMC Public Health. 14(316). doi: 10.1186/1471-2458-14-316. Fulltekst i vitenarkiv Vis sammendrag

  Background: The literature from developed countries suggests a relationship between alcohol use and quality of life and social engagement, where harmful drinkers have lower quality of life and less social engagement. Despite the high rates of harmful alcohol use in South Africa, little is known about the association between drinking pattern and quality of life and social engagement in this context. We aimed to determine if quality of life and social engagement varied across different drinking patterns among older South African adults, contributed to drinking pattern when controlling for socio-demographic factors, and varied differentially between genders. Methods: This is a secondary analysis of data from the Survey on Global Ageing and Adult Health (SAGE). Alcohol use was measured as self-reports of use over the previous seven days, and we constructed gender-specific alcohol variables. The WHO Quality of Life-scale was used to measure quality of life, and social engagement was measured by frequency of participation in social activities. We used ANOVA to observe differences in quality of life and social engagement scores across drinking patterns, and regression models were used to identify factors independently associated with drinking pattern. Results: There were 2572 (84.4%) lifetime abstainers, and 475 (15.6%) persons who had a drink in the last 7 days. In bivariate analysis, quality of life was lowest among at risk drinking men compared to abstainers (OR = 0.21, p = 0.02), although this association was not significant in adjusted analysis. Social engagement did not vary statistically significantly across the drinking patterns in the total sample or within gender. Conclusions: Quality of life and social engagement were not independently associated with drinking pattern among older adults in South Africa in this sample. In order to better understand their alcohol use, further exploratory research is warranted to identify other potentially relevant subjective factors of alcohol use among older adults in South Africa.

• Pettersen, Henning; Ruud, Torleif; Ravndal, Edle & Landheim, Anne (2014). Searching for Sobriety: How Persons With Severe Mental Illness Experience Abstaining from Substance Use. Journal of Addiction Research & Therapy. ISSN 2155-6105. 5(3). doi: 10.4172/2155-6105.1000193. Fulltekst i vitenarkiv Vis sammendrag

  Individuals diagnosed with severe mental illness (SMI) are more vulnerable to substances than are other people. Many people with SMI tend to attain full remission of their substance use, but others relapse frequently. There is more research on the reasons for substance use than on the reasons for abstaining among these individuals. Information from the latter may contribute to a better understanding of how individuals with SMI experience abstaining from substance use. Objective: The aim of this explorative study was to examine experiences of abstaining from substances of persons diagnosed with SMI. We examined both the reasons given and the requirements and strategies used when abstaining. Methods: A qualitative study with semi-structured interviews was conducted, and a descriptive and explorative design was applied. This study included a purposeful sample of 11 patients with SMI and substance use being treated by assertive community treatment teams. Results: The main reasons for quitting substance use were social relationships and meaningful activities. The stated requirements and strategies used in the search for sobriety were detachment towards people and places, positive thinking, controlling feelings and emotions, and fear of dependency. Conclusion: Our results are consistent with those from other qualitative studies on the importance of social relationships and meaningful activities as expressed reasons for abstaining. The strategy of actively avoiding a former adverse milieu to reach sobriety is consistent with findings from one similar study. The strategies of fear of adverse consequences, positive thinking, and controlling feelings and emotions found in the present study have not been reported by other qualitative studies. © 2014 Pettersen H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

• Pettersen, Henning; Ruud, Torleif; Ravndal, Edle; Havnes, Ingrid Amalia & Landheim, Anne (2014). Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use. International Journal of Mental Health Systems. 8(40). doi: 10.1186/1752-4458-8-40. Fulltekst i vitenarkiv Vis sammendrag

  Background: Clients with severe mental illness (SMI) who use substances are less engaged in treatment than those who do not use substances, and assertive community treatment (ACT) engages and retains clients with SMI and concurrent substance use at a higher rate compared with traditional treatment. This qualitative study aimed to explore the experiences of being recruited to, and remaining in, ACT among recovering clients diagnosed with SMI and concurrent substance use. Methods: Twenty semi-structured interviews were undertaken among 11 clients with SMI and concurrent substance use who were included in ACT teams. The inclusion criteria were SMI and concurrent substance use and improvement after a minimum of 12 months in treatment regarding one or several of the following parameters: quality of life, general functioning and substance use. Systematic text condensation was applied in the analyses. Results: The experiences of building trust through enduring involvement and receiving benefits were most important for the acceptance of ACT by clients. A feeling of exclusiveness, perceiving ACT as a safety net and the clients’ own personal responsibility for taking part in the treatment were stated as the most important factors for remaining in treatment. Conclusions: The implications of the results of the present study are that service providers have to prove that they can be trusted in the initial phase of the clients’ contact with the team. The feeling by clients with SMI and concurrent substance use that service providers in ACT believe they can improve their client’s quality of life, is of importance for feeling exclusive, having hope for the future and remaining in treatment.

• Wynn, Rolf; Landheim, Anne & Hoxmark, Ellen Margrethe (2013). Which factors influence psychiatric diagnosing in substance abuse treatment? International Journal of Mental Health Systems. 7. doi: 10.1186/1752-4458-7-17. Fulltekst i vitenarkiv Vis sammendrag

  The importance of diagnosing and treating co-occurring psychiatric disorders among substance abusers in treatment has received much attention. The aim of this study was to investigate to which extent co-occurring psychiatric disorders are diagnosed in a clinical population of substance abusers, and which factors (including the use of MINI-Plus) that influence the diagnosing of co-occurring psychiatric disorders. Patients (N = 275) who received inpatient substance use treatment in five different units in Northern Norway participated in the study. The patients’ clinicians gave information on diagnoses given during the stay in the units, and whether a systematic diagnostic tool was used for the diagnosing (MINI-Plus). Predictors of independent co-occurring psychiatric disorders were examined utilizing hierarchical regression analysis. One third of the patients were given an independent psychiatric diagnosis. Less than half of the patients were assessed using a diagnostic tool. The main predictor of diagnosing of independent psychiatric disorders was the use of the diagnostic tool MINI-Plus. Younger patients and patients that used less alcohol, were given independent psychiatric diagnoses more frequently. The number of co-occurring independent psychiatric diagnoses was lower compared to other studies using standardized diagnostic tools. The low number of patients assessed by such a tool, and the strong relationship between the use of such a tool and the diagnosing of co-occurring psychiatric disorders, suggest that the implementation of standardized diagnostic tools should be addressed in the units. Generally, patients suffering from substance use disorders should be systematically screened for other psychiatric disorders, in order to improve their treatment and health.

• Pettersen, Henning; Ruud, Torleif; Ravndal, Edle & Landheim, Anne (2013). Walking the fine line: Self-reported reasons for substance use in persons with severe mental illness. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 8. doi: 10.3402/qhw.v8i0.21968. Fulltekst i vitenarkiv Vis sammendrag

  Many theoretical models have been proposed to explain the relationship between severe mental illness (SMI) and substance use. Because many of these are contradictory quantitative American studies, a qualitative, exploratory study of a Scandinavian sample may offer a new perspective. The aim of the study is to explore reasons for substance use through analysis of the participants’ experiences. A qualitative study with semistructured interviews was used. Purposeful sampling (N=11) of patients with substance use disorder (SUD) and SMI, who were included in assertive community treatment teams, was completed. Inclusion criteria are increased quality of life or increased general functioning, and decreased substance use, after a minimum of 12 months in treatment. Reasons given for using substances were categorized as (a) controlling the symptoms of mental illness, (b) counteracting medication side effects, or (c) balancing the ambiguity. The conclusion is that the study findings mainly support secondary substance use models in explaining the comorbidity of SMI and substance use. However, there is some support for the traditional self-medication hypothesis (SMH), iatrogenic vulnerability, and the supersensitivity model. This may be because the majority of the study participants reported having a mental illness with subsequent substance use. The expressed ambivalence to substance use also lends some support to bidirectional models.

• Martinez, Priscilla; Landheim, Anne; Clausen, Thomas & Lien, Lars (2011). A comparison of alcohol use and correlates of drinking patterns among men and women aged 50 and above in Ghana and South Africa. African Journal of Drug and Alcohol Studies. ISSN 1531-4065. 10(2), s. 75–87. Fulltekst i vitenarkiv
• Bakken, Kjell; Landheim, Anne & Vaglum, Per Jørgen Wiggen (2007). Axis I and II disorders as long-term predictors of mental distress: a six-year prospective follow-up of substance-dependent patients. BMC Psychiatry. 7:29. doi: 10.1186/1471-244X-7-29. Fulltekst i vitenarkiv Vis sammendrag

  Background A high prevalence of lifetime psychiatric disorders among help-seeking substance abusers has been clearly established. However, the long-term course of psychiatric disorders and mental distress among help-seeking substance abusers is still unclear. The aim of this research was to examine the course of mental distress using a six-year follow-up study of treatment-seeking substance-dependent patients, and to explore whether lifetime Axis I and II disorders measured at admission predict the level of mental distress at follow-up, when age, sex, and substance-use variables measured both at baseline and at follow-up are controlled for. Methods A consecutive sample of substance dependent in- and outpatients (n = 287) from two counties of Norway were assessed at baseline (T1) with the Composite International Diagnostic Interview (Axis I), Millon's Clinical Multiaxial Inventory (Axis II), and the Hopkins Symptom Checklist (HSCL-25 (mental distress)). At follow-up (T2), 48% (137/287 subjects, 29% women) were assessed with the HSCL-25, the Alcohol Use Disorders Identification Test, and the Drug Use Disorders Identification Test. Results The stability of mental distress is a main finding and the level of mental distress remained high after six years, but was significantly lower among abstainers at T2, especially among female abstainers. Both the number of and specific lifetime Axis I disorders (social anxiety disorder, generalized anxiety disorder, and somatization disorder), the number of and specific Axis II disorders (anxious and impulsive personality disorders), and the severity of substance-use disorder at the index admission were all independent predictors of a high level of mental distress at follow-up, even when we controlled for age, sex, and substance use at follow-up. Conclusion These results underscore the importance of diagnosing and treating both substance-use disorder and non-substance-use disorder Axis I and Axis II disorders in the same programme.

• Landheim, Anne; Bakken, Kjell & Vaglum, Per Jørgen Wiggen (2006). What characterizes substance abusers who commit suicide attempts? Factors related to Axis I disorders and patterns of substance use disorders - A study of treatment-seeking substance abusers in Norway. European Addiction Research. ISSN 1022-6877. 12, s. 102–108. doi: 10.1159/000090430. Fulltekst i vitenarkiv
• Landheim, Anne; Bakken, Kjell & Vaglum, Per Jørgen Wiggen (2006). Impact of comorbid psychiatric disorders on the outcome of substance abusers: a six year prospective follow-up in two Norwegian counties. BMC Psychiatry. 6:44. doi: 10.1186/1471-244X-6-44. Fulltekst i vitenarkiv Vis sammendrag

  Background Most help-seeking substance abusers have comorbid psychiatric disorders. The importance of such disorders for the long-term course of substance abuse is, however, still unclear. The aim of this paper is to describe six-year outcomes regarding death and relapse among alcoholics and poly-substance abusers and to analyse the predictive value of lifetime psychiatric disorders on relapse. Methods A consecutive sample of substance-dependent patients who received treatment in two counties in Norway (n = 287) was followed up after approximately six years. Information on socio-demographics, Axis I (CIDI) and II disorders (MCMI-II) and mental distress (HSCL-25) was gathered at baseline. At follow-up, detailed information regarding socio-demographics, use of substances (AUDIT and DUDIT) and mental distress (HSCL-25) was recorded (response rate: 63%). Results At six-year follow-up, 11% had died, most often male alcoholics (18%). Among the surviving patients, 70% had drug or alcohol related problems the year prior to follow-up. These patients were, classified as "relapsers". There were no significant differences in the relapse rate between women and men and among poly-substance abusers and alcoholics. The relapsers had an earlier onset of a substance use disorder, and more frequently major depression and agoraphobia. Multivariate analysis indicated that both psychiatric disorders (major depression) and substance use factors (early onset of a substance use disorder) were independent predictors of relapse. Conclusion For reducing the risk of long-term relapse, assessment and treatment of major depression (and agoraphobia) are important. In addition, we are in need of a comprehensive treatment and rehabilitation program that also focuses on the addictive behaviour.

• Bakken, Kjell; Landheim, Anne & Vaglum, Per Jørgen Wiggen (2005). Substance-dependent patients with and without social anxiety disorder: Occurence and clinical differences. A study of a consecutive sample of alcohol-dependent and poly-substance-dependent patients treated in two counties in Norway. Drug and Alcohol Dependence. ISSN 0376-8716. 80(3), s. 321–328. doi: 10.1016/j.drugalcdep.2005.04.011. Fulltekst i vitenarkiv
• Bakken, Kjell; Landheim, Anne & Vaglum, Per (2004). Early and late onset groups of substance misusers: Differences in primary and secoandary psychiatric disorders. Journal of Substance Use. ISSN 1465-9891. 9(5), s. 224–234. doi: 10.1080/14659890410001711706. Fulltekst i vitenarkiv
• Bakken, Kjell E.; Landheim, Anne & Vaglum, Per (2003). Primary and secondary substance misusers: do they differ in substance induced and substance-independent mental disorders? Alcohol and Alcoholism. ISSN 0735-0414. 38(1), s. 54–59. Fulltekst i vitenarkiv
• Landheim, Anne; Bakken, Kjell E. & Vaglum, Per (2003). Gender Differences in the Prevalence of Symptom Disorders and Personality Disorders among Poly-Substance Abusers and Pure Alcoholics. Substance Abusers Treated in Two Countries in Norway. European Addiction Research. ISSN 1022-6877. 9(1), s. 8–17. Fulltekst i vitenarkiv
• Landheim, Anne; Bakken, Kjell E. & Vaglum, Per (2002). Sammensatte problemer og separate systemer. Psykiske lidelser blant rusmisbrukere til behandling i russektoren. Norsk Epidemiologi. ISSN 0803-2491. 12(3), s. 309–318. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Landheim, Anne; Wiig, Frøy Lode; Brendbekken, Marit; Brodahl, Morten & Biong, Stian (2016). Et bedre liv : historier, erfaringer og forskning om recovery ved rusmiddelmisbruk og psykiske helseproblemer. Gyldendal Akademisk. ISBN 9788205480322. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Landheim, Anne Signe; Clausen, Hanne Kristin; Martinsen, Randi & Bronken, Berit Arnesveen (2026). Flexible Assertive Community Treatment (FACT): An Integrated Care Model Bridging Primary and Specialist Mental Health Services – Perspectives from Collaborating Partners and Relatives. Fulltekst i vitenarkiv Vis sammendrag

  Individuals with serious mental illness are among the most vulnerable groups in society, often experiencing marginalization and social exclusion. They face significant challenges such as disability, unemployment, social isolation, and poor health — all of which contribute to reduced quality of life and shortened life expectancy. Despite needing coordinated and continuous care, they frequently encounter a fragmented and complex service system. There is a growing need for holistic and integrated care approaches that ensure collaboration between municipal and specialist health services. The involvement of the voluntary sector and patients’ social networks is also essential. In Norway, Flexible Assertive Community Treatment (FACT) is an integrated care model that bridges primary and specialist mental health services, aiming to provide seamless, person-centred support. In this symposium, we will present findings from research exploring FACT in the Norwegian context, highlighting perspectives from collaborating partners and relatives.

• Trane, Kristin; Hoxmark, Ellen Margrethe; Landheim, Anne Signe; Clausen, Hanne Kristin; Haug, Thomas & storbækken, solveig (2025). Få FACT- team legges ned. Fulltekst i vitenarkiv
• Nord-Baade, Silje; Landheim, Anne Signe; Martinsen, Randi; Jensen, Camilla Bergsve; Bakmann, Anne Stine Mjelve & Kielland, Torhild (2025). Forskningsdagene 2025 - Ung voksen, psykisk helse, rus og utenforskap. Fulltekst i vitenarkiv
• Martinsen, Randi; Landheim, Anne Signe & Bronken, Berit Arnesveen (2025). Trygghet for pårørende til alvorlig psykisk syke. Fulltekst i vitenarkiv
• Martinsen, Randi; Landheim, Anne Signe & Bronken, Berit Arnesveen (2025). Trygghet for pårørende til alvorlig psykisk syke. Fulltekst i vitenarkiv
• Landheim, Anne Signe; Brekke, Eva; Nord-Baade, Silje & Clausen, Hanne Kristin (2025). Supporting social inclusion and citizenship for people with serious mental health and substance use problems in Norway. Fulltekst i vitenarkiv
• Bahl, Nina Kavita Heggen; Nafstad, Hilde Eileen; Blakar, Rolv Mikkel; Tømmervik, Kristin; Brodahl, Morten & Ness, Ottar [Vis alle 9 forfattere av denne artikkelen] (2024). Fellesskapsfølelser og “mattering” hos eldre med rusmiddelproblematikk. Fulltekst i vitenarkiv
• Høiland, Gry Cecilie Lunder; Obstfelder, Aud Uhlen & Landheim, Anne Signe (2024). Understanding mechanisms for coordinating healthcare - the case of mental healthcare services in rural Valdres, Norway. Fulltekst i vitenarkiv
• Storvik, Bjørn Steinar; Høiland, Gry Cecilie Lunder; Obstfelder, Aud Uhlen & Landheim, Anne Signe (2024). Understanding mechanisms for coordinating healthcare - the case of mental healthcare services in rural Valdres, Norway. Fulltekst i vitenarkiv
• Bahl, Nina Kavita Heggen; Øversveen, Emil Mortensrud; Brodahl, Morten; Nafstad, Hilde Eileen; Blakar, Rolv Mikkel & Landheim, Anne Signe [Vis alle 7 forfattere av denne artikkelen] (2023). På hvilke måter påvirker fellesskap og fellesskapsfølelser bedringsprosesser fra rusmiddelproblematikk hos eldre? Fulltekst i vitenarkiv
• Landheim, Anne Signe; Nord-Baade, Silje Louise; Johansen, Marthe; Jensen, Camilla Bergsve & Stuen, Hanne Kilen (2023). Research on Youth FACT in Norway. Fulltekst i vitenarkiv
• Nord-Baade, Silje Louise; Ness, Ottar; Rowe, Michael; Jensen, Camilla Bergsve & Landheim, Anne Signe (2023). How to matter: Promoting social inclusion and participation among young adults with complex problems in FACT teams. Fulltekst i vitenarkiv
• Landheim, Anne Signe; Odden, Sigrun & Clausen, Hanne Kristin (2022). Samhandlingsmodeller: ACT & FACT. I Lien, Lars & Lie, Tore Willy (Red.), Sammensatte problemer, sammenvevde tiltak: Integrert behandling av rus og psykiske lidelser. Fagbokforlaget. ISSN 9788245035599. s. 237–263. Fulltekst i vitenarkiv Vis sammendrag

  Samtidig rus og psykisk lidelse innebærer ofte et komplekst og mangefasettert tilstandsbilde, med mange potensielle problemområder. Ulike og ofte organisatorisk separate helse- og sosialtjenester er relevante i den sammenheng, periodevis eller langsiktig, hvor disse lidelsene må behandles samtidig på veien mot et bedre liv. Denne boken trekker veksler på forfattere med lang erfaring i ROP-feltet, både klinisk og akademisk, hvor blant annet følgende spørsmål belyses: Hvordan gi best mulig integrert og helhetlig behandling? Hvilke samhandlingsmodeller anbefales, og hvordan få til lokalt samarbeid mellom ulike tjenestenivåer? Hvilken basiskunnskap og kompetanse innen rus og psykiske lidelser burde alle ha uansett hvor de jobber? Hvordan kan du bistå i en annen persons bedringsprosess? Boken beskriver en rekke relevante fagområder for å få til et godt tjenestetilbud for personer med ROP-lidelser: Integrert behandling i praksis ACT og FACT Bolig og bo-oppfølging Vold og suicidalitet Kartlegging og utredning Rus og avhengighet IPS og arbeid Kriminalomsorgen og politi Oppfølging av somatisk (u)helse Fastlegens rolle Oppfølging og involvering av pårørende Brukermedvirkning Recovery-orienterte tjenester for personer med ROP-lidelser Boken er relevant i en rekke helse- og sosialfaglige utdanninger, og nyttig for alle som følger opp personer med rus og psykiske lidelser, uavhengig av profesjon, enten de jobber kommunalt, i spesialisthelsetjenesten, er fastlege eller jobber i somatikken.

• Brekke, Eva; Clausen, Hanne Kristin; Brodahl, Morten & Landheim, Anne Signe (2021). FLEXIBLE ASSERTIVE COMMUNITY TREATMENT AS A TOOL FOR SUPPORTING CITIZENSHIP. Fulltekst i vitenarkiv
• Stuen, Hanne Kilen; Landheim, Anne; Rugkåsa, Jorun & Wynn, Rolf (2017). Assessments of need for treatment and danger in decisions about community treatment orders. European psychiatry. ISSN 0924-9338. 41, s. S154–S155. doi: 10.1016/j.eurpsy.2017.01.2017. Fulltekst i vitenarkiv
• Odden, Sigrun; Landheim, Anne & Kvam, Elisabeth Adams (2017). Evaluation of ROP Vestfold. Fulltekst i vitenarkiv
• Odden, Sigrun & Landheim, Anne (2017). Evaluation of ACT teams in Norway. Fulltekst i vitenarkiv
• Rognli, Eline Borger; Krajci, Peter; Lie, Tore Willy; Linderoth, Lars; Lien, Lars & Bramness, Jørgen Gustav [Vis alle 7 forfattere av denne artikkelen] (2016). Å skille rus og psykopatologi. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 53(12), s. 1000–1005. Fulltekst i vitenarkiv
• Landheim, Anne & Rognli, Eline Borger (2016). 1. Eline Borger Rognli, Peter Krajci, Tore Willy Lie, Lars Linderoth,Lars Lien, Jørgen G.Bramness og Anne Signe Landheim (2016): «Å skille rus og psykopatologi». Fagessay i Psykologforeningens tidsskrift. Tidsskrift for Norsk psykologforening. Supplement. ISSN 0333-1857. Fulltekst i vitenarkiv
• Kielland, Knut Boe; Sandnes, Rolf-Arne & Landheim, Anne (2016). Does chronic hepatitis C cause fatigue? Fulltekst i vitenarkiv
• Biong, Stian & Landheim, Anne (2016). Recovery sett fra brukere, fagfolk og forskning. I Landheim, Anne; Wiig, Frøy Lode; Brendbekken, Marit; Brodahl, Morten & Biong, Stian (Red.), Et bedre liv : historier, erfaringer og forskning om recovery ved rusmiddelmisbruk og psykiske helseproblemer. Gyldendal Akademisk. ISSN 9788205480322. s. 13–16. Fulltekst i vitenarkiv
• Thorberg, Fred Arne; Young, Ross McD; Lyvers, Michael; Connor, Jason P; Tyssen, Reidar & Landheim, Anne [Vis alle 8 forfattere av denne artikkelen] (2015). Loss of self-control over drinking and the relationship of alexithymia to quality of life in alcohol-dependent patients. Drug and Alcohol Dependence. ISSN 0376-8716. 146, s. e4–e4. doi: 10.1016/j.drugalcdep.2014.09.693. Fulltekst i vitenarkiv
• Pedersen, Monica Stolt; Landheim, Anne & Lien, Lars (2015). Clinical audit as a basis for improvement in mental health services, a qualitative study. Fulltekst i vitenarkiv
• Ruud, Torleif & Landheim, Anne (2015). Assertive outreach in Norway. I Veldhuizen, Remmers van; Polhuis, Diana; Bahler, Michiel; Mulder, Niels & Kroon, Hans (Red.), Handboek (Flexible) ACT. Herstelondersteunende zorg en behandeling in de eigen omgeving voor mensen met ernstige psychiatrische aandoeningen. De Tijdstroom Uitgevrij B.V.. ISSN 9789058982797. s. 489–494. Fulltekst i vitenarkiv
• Pedersen, Monica Stolt; Landheim, Anne & Lien, Lars (2015). How are clinical audits used in mental health services to implement a national guideline in diual diagnosis: a qualitative study. Fulltekst i vitenarkiv
• Thorberg, Fred Arne; Young, R; Lyvers, Michael; Connor, Jason; Tyssen, Reidar & Landheim, Anne [Vis alle 8 forfattere av denne artikkelen] (2014). A prospective study of alexithymia and craving among alcohol-dependent treatment seekers. Drug and Alcohol Dependence. ISSN 0376-8716. 140, s. e225–e225. Fulltekst i vitenarkiv
• Thorberg, Fred Arne; Young, Ross McD; Lyvers, Michael; Connor, Jason P; Tyssen, Reidar & Landheim, Anne [Vis alle 8 forfattere av denne artikkelen] (2014). Loss of self-control over drinking and the relationship of alexithymia to quality of life in alcohol-dependent patients. Fulltekst i vitenarkiv
• Skeie, Ivar & Landheim, Anne (2014). Rus – psykiatri – somatikk. Forskningsprosjekt Hedmark og Oppland. Fulltekst i vitenarkiv
• Pedersen, Monica Stolt; Landheim, Anne & Lien, Lars (2014). Bridging the gap between current practice and recommendations in national guidelines, a qualitative study of mental health services. Fulltekst i vitenarkiv Vis sammendrag

  Pedersen et al. BMC Health Services Research 2014, 14(Suppl 2):P94

• Stuen, Hanne Kilen; Wynn, Rolf; Landheim, Anne & Rugkåsa, Jorun (2014). Use of committed treatment orders in norwegian assertive community treatment (act) teams, seen from the service users‘perspective. European psychiatry. ISSN 0924-9338. 29. doi: 10.1016/S0924-9338(14)77852-6. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Since 2007 14 ACT-teams have been established in Norway. Despite the lack of clear evidence for efficacy, CTOs are used as a tool for supporting patients with severe mental illness that are difficult to engage to promote medication adherence and early identification of relapse. There is not much literature about the use of CTOs in ACT-teams. Objectives This study explores the perceptions and experiences of users in Norwegian ACT-teams with recent experience of CTOs. According to the ACT-model establishing trust and a treatment alliance is of significant importance Beside exploring how CTOs influence upon the users‘life-situation and the relationship to the team-members, the study will also focus on the service users‘experience of whether their opinions and whishes are of importance to the treatment planning process. Methodology In-depth interviews with 18 selected users from three ACT-teams will be analyzed by using a modified grounded theory approach, based upon initial, focused and theoretical coding and constant comparison. Results The users perceive the uncertainty of the length of the CTO and the threat of being recalled to hospital if they don‘t comply with treatment difficult to accept. To receive support and respect from the ACT team has been important to increase their sense of safety and stability. Conclusions The results from this study can give useful information about how users‘perceive community treatment orders, which is important for how health personnel encounter ethical dilemmas and ambivalences that may accompany the use of committed community treatment.

• Stuen, Hanne Kilen; Wynn, Rolf; Landheim, Anne & Ruud, Torleif (2013). Committed treatment orders in Norwegian assertive community treatment (ACT) teams, seen from the patients' views and experience. Fulltekst i vitenarkiv
• Thorberg, Fred Arne; Young, Ross McD; Sullivan, Karen; Lyvers, Michael; Connor, Jason & Landheim, Anne [Vis alle 8 forfattere av denne artikkelen] (2012). Alexithymia in alcoholics is mediated by alcohol expectancy, but only for males. Fulltekst i vitenarkiv
• Thorberg, Fred Arne; Young, Ross McD; Sullivan, Karen; Lyvers, Michael; Connor, Jason & Landheim, Anne [Vis alle 8 forfattere av denne artikkelen] (2012). Alexithymia in alcohol dependent patients: Gender differences, associations with craving and dependence severity. Fulltekst i vitenarkiv
• Landheim, Anne; Bakken, Kjell E. & Vaglum, Per (2000). Addicts with personality disorders -are they coming to the ''right'' treatment? Fulltekst i vitenarkiv
• Bakken, Regine; Landheim, Anne Signe; Lien, Lars & Fauske, Halvor (2025). Young adults in SUD treatment: Characteristics and long-term course of service utilization, criminality, and socioeconomic factors. Universitetet i Innlandet. ISSN 9788283805345. Fulltekst i vitenarkiv Vis sammendrag

  Denne studien har oppmerksomheten på en populasjon som er spesielt utsatt for sammensatte og langvarige problemer: unge voksne som er i døgnbehandling for rusbrukslidelse (inkludert skadelig bruk og avhengighet). Fra før av finnes det få langtidsstudier av denne kliniske gruppen. Det overordnede formålet med avhandlingen var å undersøke kjennetegn, langtids forløp og utfall hos unge voksne som kommer i døgnbasert behandling i TSB i perioden 2011 til 2016. Tre artikler er publisert for å fokusere på ulike aspekter ved formålet, inkludert hva som kjennetegner de unge ved innleggelse i døgnbehandling (Artikkel 1), langtids bruk av spesialisthelsetjenester og tjenestebrukens sammenheng med sosiodemografiske faktorer (Artikkel 2), i tillegg til utfall knyttet til utdanning, sysselsetting og dødelighet tre år etter behandling (Artikkel 3). Utvalget besto av tidligere pasienter som mottok behandling for rusbrukslidelse i døgninstitusjoner tilknyttet Stiftelsen Fossumkollektivet mellom 2011 og 2016. Studien var en kombinasjon av en tverrsnittsdesign (Artikkel 1) og en historisk prospektiv kohortstudie med flere målepunkter over en observasjonsperiode på 6 år (Artikkel 2 og 3). Det ble funnet indikasjoner på store psykososiale vansker, inkludert lav samfunnsdeltakelse og betydelige psykiske helseproblemer hos de unge som kom til behandling ved Fossumkollektivet i perioden 2011 til 2016. Tidlig debut av rusmiddelbruk og blandingsbruk var utbredt hos denne gruppen. Resultatene viste stor variasjon i bruk av spesialisthelsetjenester. Kvinnene rapporterte mer alvorlig rusmiddelbruk, mer alvorlige psykiske helseproblemer og hadde en høyere bruk av spesialisthelsetjenester. Mennene hadde en høyere sannsynlighet for å rapportere domfellelser og prosentandel individer som døde i løpet av de tre første årene etter inntak i døgnbehandling. Denne studien antyder at ressursene til disse unge menneskene er forskjellige. Bare to femtedeler var i utdanning og/eller arbeid tre år etter innleggelse i behandling av rusbrukslidelse. Oppsummert tyder hovedfunnene i avhandlingen på at mange av de unge fortsatt strever tre år etter døgnbasert rusbehandling. Fortsatt vansker med rusbruk og redusert sosial fungering kan indikere at helse- og velferdstjenestene ikke klarte å tilby nødvendig støtte og hjelp for denne gruppen unge pasienter.

• Landheim, Anne Signe & Martinsen, Randi (2024). Evaluering av Valdres-modellen. Midtveisrapport. Sykehuset Innlandet HF. Fulltekst i vitenarkiv
• Nord-Baade, Silje Louise; Marthe, Johansen; Stuen, Hanne Kilen; Jensen, Camilla Bergsve & Landheim, Anne Signe (2022). Evaluering av FACT ung-piloter. Nasjonal kompetansesenter for samtidig rusmisbruk og psykisk lidelse. Fulltekst i vitenarkiv
• Wynn, Rolf; Stuen, Hanne Kilen; Landheim, Anne & Rugkåsa, Jorun (2019). Community treatment orders in an Assertive Community Treatment setting: a qualitative study of experiences of patients, care providers and responsible clinicians. UiT Norges arktiske universitet. ISSN 9788275896498. Fulltekst i vitenarkiv
• Landheim, Anne; Hoxmark, Ellen Margrethe; Aakerholt, Amund & Aasbrenn, Kristian (2017). Potensialet for Assertive Community Treatment (ACT) og Fleksibel ACT (FACT) i Norge. Norges teknisk-naturvitenskapelige universitet. ISSN 9788275705288. Fulltekst i vitenarkiv Vis sammendrag

  Denne rapporten anbefaler:​​​​​ 1. Etablering ACT-team og/eller FACT-team i DPS-regioner med minst 40 000 innbyggere over 18 år og maksimum én times reisevei fra DPS-et til regionens ytterkanter. ACT-team bør opprettes når det er befolkningsgrunnlag for det. Befolkningsgrunnlaget i slike regioner utgjør 67 prosent av befolkningen. Et FACT-team i et område med 40 000 innbyggere vil ha ca. 250 potensielle brukere. 2. Etablering av FACT-team i DPS-regioner med minst 15 000 innbyggere og maksimum reisevei på én time fra DPS-et til regionens ytterkanter. Et FACT-team i et område med 15 000 innbyggere vil ha ca. 100 potensielle brukere. 3. Etablering av modifiserte FACT-team i DPSregioner med minst 15 000 innbyggere og reisevei på over en time fra DPS-et til regionens ytterkanter. Former for modifisering beskrives i rapporten. 94 prosent av Norges befolkning bor slik at de kan nås av et ACT og/eller FACT-team. 4. I DPS-regioner som har færre enn 15 000 innbyggere, anbefales det å etablere samarbeid rundt de enkelte brukerne med utgangspunkt i prinsippene for FACT. 6 prosent av befolkningen bor i slike regioner, de fleste i Nord-Norge og på Vestlandet. Etablering av team i det omfanget rapporten foreslår, forutsetter at dagens ressurser omdisponeres. Vellykket implementering av ACT- og FACT-modellene er imidlertid avhengig av stimulering både til utdanning av teammedarbeidere, til oppfølging av teamene og i noen tilfeller til opprettelse av team.​

• Odden, Sigrun & Landheim, Anne (2016). Evaluering av ROP Vestfold - et samhandlingsteam for personer med alvorlig rusmisbruk og psykiske lidelser. Nasjonal kompetansetjeneste ROP. ISSN 9788299952125. Fulltekst i vitenarkiv
• Odden, Sigrun; Kogstad, Ragnfrid Eline; Brodahl, Morten & Landheim, Anne (2015). Opplærings- og veiledningsbehov hos erfaringskonsulenter. Erfaringskompetanse. Fulltekst i vitenarkiv
• Odden, Sigrun; Kogstad, Ragnfrid Eline; Brodahl, Morten & Landheim, Anne (2015). Opplærings- og veiledningsbehov hos erfaringskonsulenter. Nasjonalt senter for erfaringskompetanse. ISSN 9788293171270. Fulltekst i vitenarkiv
• Landheim, Anne; Odden, Sigrun; Clausen, Hanne K.; Heiervang, Kristin Sverdvik; Stuen, Hanne Kilen & Ruud, Torleif (2014). Utprøving av ACT-team i Norge. Hva viste resultatene? Sykehuset Innlandet HF. Fulltekst i vitenarkiv
• Martinez, Priscilla; Lien, Lars; Clausen, Thomas & Landheim, Anne (2013). Alcohol use in special populations in Africa. Data from the World Health Survey and Study on global AGEing and adult health. Universitetet i Oslo. Fulltekst i vitenarkiv Vis sammendrag

  Background Alcohol use is an important factor in a population’s risk for disease and mortality. Alcohol has a long history of use in Africa, and changes in drinking behavior are underway in many African states. Women and older adults are two special populations that comprise sizable proportions of the general population and whose use of alcohol will have important consequences for public health in Africa. There is limited information about the drinking behavior of women and older adults, what factors are associated with different drinking patterns and how these populations compare to one another across African nations. Such information is necessary for the development of effective public health policies and for advancing our understanding alcohol epidemiology in Africa.<br><br> Aims We aimed to determine the prevalence of various types of drinking patterns, correlates of these patterns and cross-national similarities and differences of both drinking patterns and associated correlates among African women and older adults.<br><br> Methods This work is a secondary analysis of publicly available data from the World Health Organization. We used material from two nationally representative population-based surveys, the World Health Survey (WHS) and the Study on global AGEing and adult health (SAGE). The WHS was conducted in 20 African countries and SAGE in Ghana and South Africa. Both surveys collected data through face-to-face interviews using standardized instruments on alcohol use and a variety of measures of socio-demographics, health behaviors and well-being. We constructed alcohol measures based on self-reported use over the previous week.<br><br> Results A total of 40,739 African women were included in the WHS, and 4289 adults aged 50 and above in Ghana and 3666 in South Africa in the SAGE Survey. Overall, lifetime abstention rates ranged from 56% in Mauritius to 99% in Comoros among women. Among older adults, lifetime abstention was 42% in Ghana and 75% in South Africa. Among currently drinking women, rates of risky single-occasion drinking varied from 0.5% to 58% in Mauritius and Chad, respectively. Among current drinking older adults, at risk drinkers comprised 26% in Ghana and 37% in South Africa. Socio-demographic correlates of current drinking among women included increasing age, having any education, working for pay, being married/cohabitating and living in an urban setting. Increasing age was the most common and consistent correlate, and few other correlates were consistent across states. Among older adults in Ghana and South Africa, the most common correlates of drinking pattern included ethnic group, religion and smoking. Among women, 4 clusters of countries were identified based on the prevalence rates of the different drinking patterns and few correlates were common by cluster or geography, save the high rates of lifetime abstention among Muslim states in northern Africa. The older adult populations in Ghana and South Africa differed on all alcohol measures, while smoking was a common correlate of drinking behavior between the two countries. Discussion and Conclusion The high rates of lifetime abstention among African women are consistent with historical and current reports, and rates of risky single-occasion drinking are cause for concern and action. Drinking patterns among older adults in Ghana and South Africa mirror that of the general populations. The correlates identified suggest socio-cultural factors such as religion and tribal association are important factors in drinking behavior, as well as lifestyle factors such as smoking. The variety of drinking patterns and associated correlates across the states among both women and older adults suggests nations would benefit from tailored national alcohol policies that take into account alcohol use among women and older adults, and that continued monitoring of drinking patterns and associated correlates among these groups would be an important piece for understanding alcohol epidemiology in a dynamic African context.

• Kirkehei, Ingvild; Leiknes, Kari Ann; Larun, Lillebeth; Hammerstrøm, Karianne Thune; Bramness, Jørgen & Gråwe, Rolf W [Vis alle 11 forfattere av denne artikkelen] (2008). Dobbeldiagnose – alvorlig psykisk lidelse og ruslidelse. Del 2 Effekt av psykososial behandling. Folkehelseinstituttet. ISSN 9788281212220. Fulltekst i vitenarkiv Vis sammendrag

  Problemstilling: Rapporten oppsummerer effekten av ti psykososiale behandlingstiltak for personer med dobbeldiagnose (samtidig alvorlig psykisk lidelse og ruslidelse). De til behandlingstiltakene er integrert behandling, case management, aktivt oppsøkende behandling, kognitiv atferdsterapi, motiverende intervju, familieterapi, sosial ferdighetstrening, selvhjelpsgrupper, boligtiltak og sysselsettingstiltak. Rapporten oppsummerer hvordan behandlingstiltakene virker sammenlignet med andre psykososiale tiltak eller behandling som vanlig og rapporterer følgende utfallsmål: bruk av stoff, medikamenter og alkohol, psykisk symptombelastning, funksjonsnivå og livskvalitet. Metode: Vi søkte etter systematiske oversikter over randomiserte kontrollerte studier på personer over 15 år med alvorlig psykisk lidelse og ruslidelse. De systematiske oversiktene ble inkludert i henhold til våre inklusjonskriterier og kvalitetsvurderinger. Vi oppsummerte resultatene som var rapportert i de systematiske oversiktene og brukte GRADE for å vurdere dokumentasjonsstyrken for resultatene. Resultat: To systematiske oversikter utgjorde kunnskapsgrunnlaget i rapporten. Oversiktene rapporterte resultater fra studier på syv av behandlingstiltakene. Enkelte resultater var statistisk signifikante: Motiverende intervju hadde positiv effekt på alkoholkonsum sammenlignet med psykoedukasjon. Kognitiv atferdsterapi kombinert med motiverende intervju hadde positiv effekt på henholdsvis funksjonsnivå og livstilfredshet sammenlignet med bl.a. psykoedukasjon og gruppesamtaler. Studier på de andre tiltakene hadde enten meget lav dokumentasjonsstyrke eller viste ingen statistisk signifikante resultater. Resultatene var imidlertid basert på enkeltstående studier, ofte med få deltakere og metodiske svakheter. De fleste resultatene fikk derfor en dokumentasjonsstyrke på middels, lav eller meget lav og gjorde det vanskelig å trekke klare konklusjoner. Vi fant ingen studier på effekten av boligtiltak, sysselsettingstiltak eller familietiltak. Konklusjon: De to systematiske oversiktene ga lite støtte for at de inkluderte psykososiale tiltakene har bedre eller dårligere effekt enn andre tiltak. Oversiktene indikerte mulige positive effekter for motiverende intervju alene eller i kombinasjon med kognitiv atferdsterapi. Det er behov for ytterlige forskning på dette området.

• Larun, Lillebeth; Helseth, Valborg Helene; Bramness, Jørgen G; Haugerud, Helge; Høie, Bjørg & Gråwe, Rolf W [Vis alle 11 forfattere av denne artikkelen] (2007). Dobbeldiagnose – alvorlig psykisk lidelse og ruslidelse: del 1 Screening og diagnoseinstrumenter. Folkehelseinstituttet. ISSN 9788281211827. Fulltekst i vitenarkiv Vis sammendrag

  Personer med ruslidelser og personer med psykiske lidelser har tradisjonelt fått behandling i parallelle tiltak. Imidlertid har personer som er til behandling ved tverrfaglige, spesialiserte rustjenester, ofte psykiske lidelser, og personer som er til behandling i psykisk helsevern, har ofte en ruslidelse (komorbiditet). Befolkningsstudier fra Europa og USA viser at psykiske lidelser og ruslidelser ofte opptrer sammen. Jo mer alvorlig ruslidelsen er, desto høyere er forekomsten av psykiske lidelser. Denne rapporten oppsummerer forskning om nøyaktighet av screening- og diagnoseverktøy for ruslidelser og psykiske lidelser. Rapporten inkluderer studier som tilfredsstiller kravene om bruk av referansestandard, og forskningsmetoder som tillater beregning av verktøyets egenskaper. Dette gir rimelig god sikkerhet i funnene som presenteres i denne rapporten. Det kan imidlertid finnes verktøy som er klinisk relevante, men der det mangler metodisk god forskning.

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