In the complex landscape of psychiatric care, alcohol use disorders (AUD) frequently overlap with mental health conditions, posing significant challenges to treatment. Recent research emerging from Sweden dives deep into patient experiences with a novel approach known as the 15-method—a structured framework designed to screen and treat AUD within psychiatric settings. This qualitative study, conducted in psychiatric outpatient units across Region Stockholm, provides a rare patient-centered perspective on integrating alcohol interventions into mental health care.
The study is grounded in the recognition that comorbidity between psychiatric disorders and alcohol use is both prevalent and complicates treatment frameworks. Swedish national guidelines advocate for integrated treatment models targeting both conditions simultaneously. Yet, in practice, adherence to these guidelines remains insufficient, creating gaps in effective care delivery. To address this shortfall, psychiatric health care staff were trained in the 15-method, an approach intended to simplify and standardize alcohol intervention protocols within psychiatric services.
Employing a qualitative design, the researchers conducted individual interviews with 15 adult patients who had elevated scores on the Alcohol Use Disorder Identification Test (AUDIT), indicating hazardous drinking. Participants were receiving care from psychiatric units where the 15-method had been implemented, positioning them uniquely to reflect on its real-world application. The interview data was then analyzed using reflexive thematic analysis, guided by the Normalization Process Theory—a conceptual framework exploring how new interventions become routinely embedded in healthcare practice through constructs such as coherence, cognitive participation, collective action, and reflexive monitoring.
Findings revealed that all participants underwent alcohol screening, a pivotal first step of the 15-method. However, only a subset proceeded to more formal assessment or received pharmacological treatments targeting alcohol use, and notably, none reported receiving psychological treatment components of the intervention. This points to a significant gap between screening and comprehensive intervention, raising critical questions about the implementation fidelity and resource allocation within psychiatric services.
An encouraging insight was the general acceptance among patients of discussing alcohol use in psychiatric settings. Many described these conversations as enlightening, fostering greater awareness of their hazardous drinking patterns. This reflects the “coherence” component of the Normalization Process Theory, where patients integrate understanding of the intervention into their health narrative. Despite alcohol use being regarded as a sensitive and potentially stigmatizing topic, the attitudes and interpersonal skills of healthcare staff were instrumental to establishing trust and willingness to engage, aligning with “cognitive participation”—the relational work that sustains involvement in the treatment process.
Behavioral change, a central goal of alcohol interventions, was sometimes triggered by conversations about drinking. Nonetheless, most participants indicated that beyond initial screening, few opportunities for structured support or intervention had been offered. This highlighted a disconnect in “collective action,” revealing that systemic and operational factors might be constraining the effective delivery of the full 15-method protocol.
A striking theme was the conditioning of psychiatric treatment on the patients’ alcohol consumption levels. Many participants reported that access to treatment for their psychiatric symptoms was contingent on reducing hazardous drinking. This condition fostered pragmatic short-term attempts to modify drinking behavior in order to qualify for mental health care—a dynamic captured under both “coherence” and “cognitive participation.” While this gatekeeping could motivate immediate change, patients perceived such shifts as transient rather than sustainable, pointing to potential shortcomings in long-term support and follow-up.
The study’s nuanced application of the Normalization Process Theory allowed for detailed mapping of individual and systemic challenges in integrating alcohol interventions into psychiatric care. Patients’ reflections illuminated a landscape where initial engagement is promising, but where institutional barriers and insufficient treatment breadth undermine progress. The findings underscore the need for tailored training programs that address unique psychiatric care complexities, such as stigma, motivation, and structural conditioning, to enhance the normalizing of these interventions.
This research stands out because it centers the patients’ lived experiences, often overlooked in implementation science. Their perspectives reveal both opportunities and pitfalls in everyday clinical practice, emphasizing that interventions must go beyond protocols to consider relational dynamics and system-level enablers. Crucially, psychiatric care presents a valuable window to address AUD comorbidity, but realizing this potential demands deeper commitment to comprehensive intervention deployment.
Moreover, the absence of reported psychological treatments among participants flags an urgent area for quality improvement. Psychological therapies are cornerstone elements in effective AUD management, and their omission could reflect workforce limitations, time constraints, or gaps in practitioner confidence. Addressing these barriers is essential for bridging the divide between screening and sustained treatment engagement.
The Swedish context of national guidelines and regional implementation offers a notable example of how top-down policy directives interface with front-line practice realities. This study exemplifies the complexity of translating clinical recommendations into routine care, where patient voices provide critical feedback loops for optimizing strategies. As psychiatric units strive to balance addressing mental health and substance use concurrently, insights from such qualitative work can drive innovations toward integrated, patient-centered care models.
Overall, this qualitative inquiry highlights that alcohol interventions within psychiatric outpatient settings are both feasible and welcome by patients, provided staff attitudes foster respectful, empathetic dialogue. Future research should explore scalable methods to embed psychological and behavioral treatments fully within psychiatric frameworks, ensuring comprehensive support for those grappling with dual diagnoses. As the field advances, the 15-method could be refined to better navigate the intricacies of psychiatric care, ultimately improving health outcomes for individuals caught at this challenging intersection.
The findings should galvanize policymakers, clinicians, and implementation scientists to prioritize investments that enhance training, resources, and structural adjustments in psychiatric settings. By aligning intervention delivery with patient perspectives and systemic realities, it is possible to harness psychiatric care encounters as powerful moments for meaningful change in addressing alcohol misuse. As awareness grows about the burden of comorbid AUD and mental illness, integrated approaches like the 15-method hold promise as transformative tools—if adapted with fidelity and sensitivity to patient and contextual nuances.
In conclusion, this study contributes a vital qualitative lens on the lived experiences of patients receiving alcohol interventions via the 15-method within psychiatric care. It affirms the receptivity of this population to integrated care while illuminating gaps and conditioning that can hinder progress. Strategies to strengthen implementation should embrace the complexity of psychiatric settings and prioritize holistic, empathic treatment engagement to realize the full benefits of reducing hazardous alcohol use alongside psychiatric symptom management.
Subject of Research: Patient experiences with alcohol interventions using the 15-method in psychiatric outpatient care.
Article Title: A qualitative study of patient’s experiences of receiving alcohol interventions according to the 15-method in psychiatric care.
Article References: Sundbye, J., Hammarberg, A., Guterstam, J. et al. A qualitative study of patient’s experiences of receiving alcohol interventions according to the 15-method in psychiatric care. BMC Psychiatry 25, 1031 (2025). https://doi.org/10.1186/s12888-025-07553-1
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