Very Integrated Program (VIP): health promotion for patients with alcohol and drug use disorders

Sammanfattning: Treatment of patients with alcohol or drug use disorders is a complex multistage process addressing the substance addiction and co-morbidities. The risky lifestyles, including tobacco smoking, insufficient physical activity and unhealthy diet, which can aggravate health condition as well as addiction treatment itself, are very common among these patients. The complex health promotion (Very Integrated Program, VIP), addressing both the risky lifestyle and educating about the chronic diseases, can be promising for achieving better outcomes foraddiction treatment.This thesis aims to explore the health status and lifestyle risk factors in patients with alcohol or drug use disorders in Sweden (study 1), to investigate the effect of the VIP in patients with alcohol or drug use disorders (study 2). In addition, the thesis aims to explore the factors of interest associated with this intervention, such as the compliance of these patients to the VIP (study 3) and the characteristics of the patients that were successful in changing their lifestyle (study 4). The thesis consists of a comprehensive survey (study 1), two quantitative studies (studies 2 and 4), and a mix methods study (study 3).The screening of the patients with alcohol or drug use disorders revealed that most of them had at least one lifestyle risk factor (93%) and suffer from at least one chronic disease (70%). The VIP intervention garnered no significant effect on harm reduction among these patients, their health status or quality of life (QoL), as well as on the addiction treatment outcomes, such as days in treatment or time to relapse. Surprisingly, the patients that did not receive the program had significantly more substance-free days after 12 months. The patients with highereducation, better QoL, and several lifestyle risk factors had higher chances of changing their lifestyle. The patients’ higher self-efficacy was positively associated with their compliance with the health promotion program. The patients displayed willingness for a change but also showed strong emotions associated with the process of change.