Understanding the Process of Drug Addiction Recovery Through First-Hand Experiences: A Qualitative Study in the Netherlands Using Lifeline Interviews.

Understandings of drug addiction recovery are still being debated. Research on perspectives from first-hand experiences with recovery is rare and often contains short-term experiences in the context of a treatment setting. We aim to gain further understanding of recovery by analyzing autobiographical data from persons in different stages of drug addiction recovery who are not linked to any specific treatment service. We conducted 30 in-depth qualitative interviews with participants from various parts of the Netherlands. Participants self-identified as being "in recovery" or "recovered" from drug addiction for at least 3 months. Men and women are equally represented, and the sample consists of an equal number of participants in early (<1 year, n = 10), sustained (1-5 years, n = 10), and stable (>5 years, n = 10) recovery. We undertook a data-driven thematic analysis. Participants described that recovery is a broad process of change because addiction is interwoven with everything (theme 1); that recovery is reconsidering identity, seeing things in a new light (theme 2); that recovery is a staged long-term process (theme 3); and that universal life processes are part of recovery (theme 4). Thus, Drug addiction recovery is experienced as an interwoven long-term process, including identity change and common or universal life processes. Policy and clinical practice should therefore be aimed at supporting long-term tailored recovery goals and disseminating first-hand recovery experiences to enhance long-term outcomes and reduce stigmatization.

Mental health issues and illness and substance use disorder (non-)disclosure to a supervisor: a cross-sectional study on beliefs, attitudes and needs of military personnel.

OBJECTIVES: Research suggests that military personnel frequently delay disclosing mental health issues and illness (MHI), including substance use disorder, to supervisors. This delay causes missed opportunities for support and workplace accommodations which may help to avoid adverse occupational outcomes. The current study aims to examine disclosure-related beliefs, attitudes and needs, to create a better understanding of personnel's disclosure decision making. DESIGN: A cross-sectional questionnaire study among military personnel with and without MHI. Beliefs, attitudes and needs regarding the (non-)disclosure decision to a supervisor were examined, including factors associated with (non-)disclosure intentions and decisions. Descriptive and regression (logistic and ordinal) analyses were performed. SETTING: The study took place within the Dutch military. PARTICIPANTS: Military personnel with MHI (n=324) and without MHI (n=554) were participated in this study. OUTCOME MEASURE: (Non-)disclosure intentions and decisions. RESULTS: Common beliefs and attitudes pro non-disclosure were the preference to solve one's own problems (68.3%), the preference for privacy (58.9%) and a variety of stigma-related concerns. Common beliefs and attitudes pro disclosure were that personnel wanted to be their true authentic selves (93.3%) and the desire to act responsibly towards work colleagues (84.5%). The most reported need for future disclosure (96.8%) was having a supervisor who shows an understanding for MHI. The following factors were associated both with non-disclosure intentions and decisions: higher preference for privacy (OR (95% CI))=(1.99 (1.50 to 2.65)intention, 2.05 (1.12 to 3.76)decision) and self-management (OR (95% CI))=(1.64 (1.20 to 2.23)intention, 1.79 (1.00 to 3.20)decision), higher stigma-related concerns (OR (95% CI))=(1.76 (1.12 to 2.77)intention, 2.21 (1.02 to 4.79)decision) and lower quality of supervisor-employee relationship (OR (95% CI))=(0.25 (0.15 to 0.42)intention, 0.47 (0.25 to 0.87)decision). CONCLUSION: To facilitate (early-)disclosure to a supervisor, creating opportunities for workplace support, interventions should focus on decreasing stigma and discrimination and align with personnels' preference for self-management. Furthermore, training is needed for supervisors on how to recognise, and effectively communicate with, personnel with MHI. Focus should also be on improving supervisor-employee relationships.

Concepts of health in different contexts: a scoping review.

The rationale of our study was that the World Health Organization's (WHO) definition of health from 1947 which includes "… complete physical, mental and social wellbeing…" does not fit the current societal viewpoints anymore. The WHO's definition of health implies that many people with chronic illnesses or disabilities would be considered unhealthy and complete wellbeing would be utopian and unfeasible for them. This is no longer uniformly accepted. Many alternative concepts of health have been discussed in the last decades such as 'positive health', which focusses on someone's capability rather than incapability,. However, the question remains whether a general health concept can guide all healthcare practices. More likely, health concepts need to be specified for professions or settings. The objective of our study was to create a structured overview of published concepts of health from different perspectives by conducting a scoping review using the PRISMA-ScR guideline. A literature search was conducted in Pubmed and Cinahl. Articles eligible for inclusion focussed on the discussion or the conceptualisation of health or health-related concepts in different contexts (such as the perspective of care workers' or patients') published since 2009 (the Dutch Health Council raised the discussion about moving towards a more dynamic perspective on health in that year). Seventy-five articles could be included for thematic analyses. The results showed that most articles described a concept of health consisting of multiple subthemes; no consensus was found on one overall concept of health. This implies that healthcare consumers act based on different health concepts when seeking care than care workers when providing care. Having different understandings of the concepts of health can lead to misunderstandings in practice. In conclusion, from every perspective, and even for every individual, health may mean something different. This finding stresses the importance that care workers' and healthcare consumers' meaning of 'health' has to be clear to all actors involved. Our review supports a more uniform tuning of healthcare between healthcare providers (the organisations), care workers (the professionals) and healthcare consumers (the patients), by creating more awareness of the differences among these actors, which can be a guide in their communication.

The introduction of the practice nurse mental health in general practices in the Netherlands: effects on number of diagnoses of chronic and acute alcohol abuse.

BACKGROUND: Since 2008 mental health practice nurses have been gradually introduced in general practices in the Netherlands as part of health policy aiming to improve early identification and treatment of mental health problems in primary care. This study aims to investigate the effect of the introduction of the practice nurse mental health in general practices in the Netherlands on the number of diagnoses of chronic and acute alcohol abuse. METHODS: The Netherlands Institute for Health Services Research (NIVEL) retrieved data of a representative sample of general practices (n = 155) for this study. Data were aligned at the starting point of the implementation of the PN-MH to compare the practices on our outcome measures after implementation of the PN-MH. Multilevel regression analyses were conducted to investigate differences in average number of chronic and acute alcohol abuse diagnoses between practices with a practice nurse mental health and control practices (without a practice nurse mental health and without a primary care psychologists). RESULTS: A significant decrease over time of chronic alcohol abuse diagnoses was observed (ß = -.52, p < 0.05) as well as a significant decrease over time of acute alcohol abuse diagnoses (ß = -.06, p < 0.05). After adjustment for multiple comparisons, no significant differences were found between practices that implemented a practice nurse mental health or only have a primary care psychologist and control practices. Practices that implemented a practice nurse mental health and have a primary care psychologist, had a higher mean of chronic and acute alcohol abuse diagnoses than control practices during all periods, but the differences between these groups were not statistically significant. CONCLUSIONS: Based on the results of this study it seems that the introduction of practice nurses mental health in general practices is not associated with increased diagnoses of chronic or acute alcohol abuse. Potential explanations are barriers experienced by practice nurses to addressing alcohol use with patients and prioritization of other mental health issues over alcohol abuse. In order to improve the management of alcohol abuse by practice nurses, more research is needed on how practice nurses can be involved in diagnosing and treatment of patients with alcohol abuse.

Do general practitioners record alcohol abuse in the electronic medical records? A comparison of survey and medical record data.

OBJECTIVE: Primary care professionals are encouraged to screen patients for alcohol abuse. However, patients with alcohol abuse are often under-diagnosed as well as under-registered in medical records in general practices. This study aims to report on the registration rates of alcohol abuse diagnoses in general practices in comparison to patients' self-reported rates of alcohol use disorder. RESEARCH DESIGN AND METHODS: Data of a total number of 2,349 patients were analyzed from the SMILE study, a large prospective cohort study conducted in The Netherlands. Two data collection strategies were combined: (1) Patient self-report data on alcohol consumption as well as other sociodemographic characteristics; (2) Medical record (ICPC codes) data of diagnoses of chronic and acute alcohol abuse of the same patients. GPs' registrations of diagnoses were compared with the self-report data using descriptive statistics. RESULTS: Based on the results of the patient reported data, 179 (14.8%) male participants had an alcohol use disorder. Of the total number of female patients, 82 (7.2%) had an alcohol use disorder. One of the male and none of the female patients with an alcohol use disorder were registered as such by the GP. CONCLUSIONS: This study found that 11.1% of the total patient sample reported an alcohol use disorder, of which a strikingly low number of patients were recorded as such by their GP. It is likely that low recognition due to barriers related to alcohol screening as well as registration avoidance due to the stigma around alcohol abuse play a role in low registration.

Cross-sectional associations between maternal parenting styles, physical activity and screen sedentary time in children.

BACKGROUND: Children's activity level, including physical activity (PA) and screen sedentary time (SST), is influenced by environmental factors in which parents play a critical role. Different types of parenting styles may influence children's activity level. Inconsistent results were found on the association between parenting styles and PA, and few studies tested the association between parenting styles and SST. This study examined the association between parenting styles, PA and SST and the modifying effect of children's gender and maternal educational level on these associations. METHODS: Cross-sectional data were collected from parents of children aged 8-11 years old who completed a web-based non-standardized questionnaire (N = 4047). Since 85% of the questionnaires were filled in by mothers, parenting styles are mainly reported by mothers. Multiple linear regression techniques were used to assess the associations between parenting styles (authoritative, permissive, authoritarian and neglectful), and PA and SST (mean min/day). The modifying effect of children's gender and maternal educational level on these associations was explored. P values ≤.0125 were considered as statistically significant based on the Bonferroni correction for four primary analyses. RESULTS: The neglectful parenting style was most widely used (35.3%), while the authoritarian style was least common (14.8%). No significant association was found between parenting styles and PA level. As regards SST, an authoritative parenting style was significantly associated with lower SST in boys while a neglectful parenting style was significantly associated with higher SST in both boys and girls. When the mother had a medium educational level, an authoritative parenting style was significantly associated with lower SST while neglectful parenting was significantly associated with higher SST. CONCLUSIONS: No association was found between parenting styles and PA. However, an authoritative parenting style was associated with a reduction in SST and a neglectful parenting style with an increase in SST, especially in boys and in children whose mother had a medium education level. Future studies of parenting practices are needed to gain more insight into the role of parents in children's PA and SST levels, as a basis for the development of interventions tailored to support parents in stimulating PA and reducing SST in children.

A theory-based implementation program for alcohol screening and brief intervention (ASBI) in general practices: Planned development and study protocol of a cluster randomised controlled trial.

BACKGROUND: Previous studies have shown that alcohol screening and brief intervention (ASBI) in general practices can lead to significant reductions in alcohol consumption among patients, yet ASBI is rarely implemented into routine clinical practice. The aim of this paper is to describe the development and evaluation of an ASBI implementation program aimed at increasing ASBI delivery rates of general practitioners (GPs) and decreasing patients' alcohol consumption. METHODS/DESIGN: This study protocol describes the step-wise development and evaluation of an ASBI implementation program. A four-step method is used to identify relevant determinants of change and intervention components based on the Behaviour Change Wheel and the Theoretical Domains Framework. The program will be evaluated in general practices in The Netherlands in a two-arm cluster randomised controlled trial which investigates the effect of the program on GPs' ASBI delivery behaviour as well as on patients' alcohol consumption. DISCUSSION: Effective theory- and practice-based strategies to implement ASBI in general practices are highly needed. Using a stepwise method we described the development of a program consisting of an e-learning module, a tailored feedback module and environmental support and materials. We hypothesize that this program will result in an increase of GPs' ASBI delivery behaviour. Secondly, we expect an overall decrease in percentage of patients with excessive or problematic alcohol use and a higher proportion of patients from GPs receiving the ASBI implementation program decreasing their alcohol consumption, compared to patients from GPs in the control group. TRIAL REGISTRATION: NTR5539.

Strategies to Overcome Barriers to Implementation of Alcohol Screening and Brief Intervention in General Practice: a Delphi Study Among Healthcare Professionals and Addiction Prevention Experts.

Despite the evidence base, alcohol screening and brief intervention (ASBI) have rarely been integrated into routine clinical practice. The aim of this study is to identify strategies that could tackle barriers to ASBI implementation in general practice by involving primary healthcare professionals and addiction prevention experts. A three-round online Delphi study was carried out in the Netherlands. The first-round questionnaire consisted of open-ended questions to generate ideas about strategies to overcome barriers. In the second round, participants were asked to indicate how applicable they found each strategy. Items without consensus were systematically fed back with group median ratings and interquartile range (IQR) scores in the third-round questionnaire. In total, 39 out of 69 (57 %) invited participants enrolled in the first round, 214 participants completed the second round, and 144 of these (67 %) completed the third-round questionnaire. Results show that participants reached consensus on 59 of 81 strategies, such as the following: (1) use of E-learning technology, (2) symptom-specific screening by general practitioners (GPs) and/or universal screening by practice nurses, (3) reimbursement incentives, (4) supportive materials, (5) clear guidelines, (6) service provision of addiction care centers, and (7) more publicity in the media. This exploratory study identified a broad set of strategies that could potentially be used for overcoming barriers to ASBI implementation in general practice and paves the way for future research to experimentally test the identified implementation strategies using multifaceted approaches.

[How much alcohol is too much and why? Comments on socially accepted but excessive alcohol drinking patterns]. / Hoeveel alcohol is te veel en waarom? Kanttekeningen bij sociaal geaccepteerd overmatig alcoholgebruik.

Many modern societies increasingly seem to accept drinking patterns that should be qualified as excessive from a health care point of view. This does not concern alcoholism or alcohol addiction but a daily intake of three to eight glasses and the pattern of binge drinking. Although a lot of data are available on the physical consequences of alcohol abuse, little is known about the impact of these drinking patterns on peoples' health. According to the J-shaped curve between alcohol consumption and mortality, an increase in morbidity and mortality can be noticed from two to three drinks a day. This is largely caused by an increase in accidents, malignancies, cardiovascular diseases and neurological disorders. However, data on pathophysiological mechanisms and on the contribution of these drinking patterns in medical consumption are scarce. Because of the estimated extent of the problem and societies' interest, more support should be given to scientific programs and research into this matter. This may not only contribute to a better monitoring of the problem but also guide the development of strategies for education and prevention.

Educational differences in excessive alcohol consumption: the role of psychosocial and material stressors.

BACKGROUND: Socioeconomic differences in health are determined mainly by socioeconomic differences in unhealthy behavior. Little is known, however, about the mechanisms that account for socioeconomic differences in unhealthy behavior, such as excessive alcohol consumption. In this paper we examined educational differences in excessive alcohol consumption in The Netherlands and whether these may be explained by educational differences in experienced stress and stress-moderating factors. METHODS: Data were obtained from the baseline survey of the Longitudinal Study on Socio Economic Health Differences in 1991. Excessive drinking was defined as drinking more than six glasses on 3 or more days a week or more than four glasses on 5 or more days a week. Socioeconomic status was indicated by educational level. Stressors were divided into psychosocial and material factors. Analyses were performed for women (n = 756) and men (n = 1,006) separately, among drinkers only. RESULTS: Excessive alcohol consumption was more common among lower educational groups. Material stressors, such as financial problems, deprivation, and income, were related to part of the educational gradient in excessive alcohol consumption. Differences in stress-moderating factors were not related to the educational gradient in excessive drinking. CONCLUSIONS: Our results suggest that improvement of material conditions among the lower educational groups could result in a reduction of socioeconomic differences in excessive alcohol consumption.

Validation of cancer prevalence data from a postal survey by comparison with cancer registry records.

Data on self-reported cancer from a health interview survey carried out in 1991 in the southeastern Netherlands by means of a postal questionnaire (n = 17,940) were validated against records from a population-based cancer registry. The sensitivity of the questionnaire was 0.552 (95% confidence interval (CI) 0.507-0.597), and the specificity was 0.995 (95% CI 0.994-0.996). The survey underestimated cancer prevalence in the population by 25%. Of the 212 false negative cases, 46% were registered with non-melanoma skin cancer. After the exclusion of nonmelanoma skin cancer from cancer registry records, cancer prevalence was overestimated by the survey by a negligible 2%. The misclassification of cancer by the postal survey was differential according to age, sex, education, and degree of urbanization. The survey overestimated cancer prevalence ratios for men versus women, old respondents versus young respondents, and urban residents versus rural residents. The prevalence ratios for respondents with a low educational level versus those with a high level were underestimated using survey data. These patterns remained essentially the same after exclusion of nonmelanoma skin cancer from the cancer registry records. This study shows that both overall cancer prevalence and differences in cancer prevalence between subgroups of the population may be biased when health interview survey data are used. If explicit attention is paid to nonmelanoma skin cancer in survey questions, this might improve the validity of overall cancer prevalence estimates, but not that of comparisons between subgroups of the population.