Reducing substance misuse and related problems: How can unhealthy alcohol users and problem drug users be effectively intervened with in general hospital settings?

Background: There is a high prevalence of unhealthy alcohol use and problem drug use among patients presenting to general hospital settings. However, many unhealthy alcohol users and problem drug users in these settings are not even aware, or do not acknowledge that they have such problems. Their presentation to hospital for the treatment of other conditions offers an opportunity to engage with them. However, there is uncertainty over how best to identify, assess and intervene with this population. Aim: To investigate how unhealthy alcohol users or problem drug users can be effectively identified, assessed and intervened with when they present to general hospital settings for the treatment of other conditions. Methods: This thesis is based on six published papers that used systematic review, meta-regression and Delphi methods. Main findings: To date, research on interventions for unhealthy alcohol use in general hospital settings has focused on brief interventions (BIs). Multiple session BIs are likely to be beneficial for unhealthy alcohol use in these settings. Where targeted screening and intervention is the strategy of choice, a focus on gastroenterology and emergency medicine is a promising way to target resources for unhealthy alcohol use. There is lack of evidence on how to effectively identify and intervene with problem drug users. The available evidence favours the ASSIST as the problem drug use screening instrument of choice. There is also lack of evidence to inform which comprehensive substance misuse assessment package to use in these settings. Conclusions: There is still need for robustly designed research on how to effectively identify, assess and intervene with unhealthy alcohol users and problem drug users within general hospital settings. It is to be hoped that the body of work presented in this thesis will, effectively, contribute to the development stage for other primary research in the future.