Anne Landheim

• Clausen, Hanne Kristin; Ruud, Torleif; Odden, Sigrun; Saltyte Benth, Jurate; Heiervang, Kristin S.; Stuen, Hanne Kilen & Landheim, Anne (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.  ISSN 1664-0640.  11 . doi: 10.3389/fpsyt.2020.607071 Full text in Research Archive. Show summary

  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.  ISSN 1472-6963.  20(1) . doi: 10.1186/s12913-020-05949-1 Full text in Research Archive. Show summary

  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.

• Hjemsæter, Arne Jan; Bramness, Jørgen Gustav; Drake, Robert; Skeie, Ivar; Monsbakken, Bent Berntsen; Saltyte Benth, Jurate & Landheim, Anne (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.  ISSN 1455-0725.  37(4), s 352- 364 . doi: 10.1177/1455072520947249 Full text in Research Archive. Show summary

  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.

• 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 Full text in Research Archive. Show summary

  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; Saltyte Benth, Jurate & Landheim, Anne (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.  ISSN 1471-244X.  19(101) . doi: 10.1186/s12888-019-2077-8 Full text in Research Archive. Show summary

  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.

• Hjemsæter, Arne Jan; Bramness, Jørgen Gustav; Drake, Robert; Skeie, Ivar; Monsbakken, Bent Berntsen; Thoresen, Magne & Landheim, Anne (2019). Predictors of problematic substance use 18 years after treatment: a longitudinal cohort study of persons with substance use disorders. Cogent Psychology.  ISSN 2331-1908.  6:1634325, s 1- 13 . doi: 10.1080/23311908.2019.1634325 Full text in Research Archive. Show summary

  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.

• Kvam, Elisabeth Adams; Oddli, Hanne & Landheim, Anne (2019). Anker i normalitet. Betringsprosessar hjå menneske med rus- og psykisk liding. Tidsskrift for Norsk Psykologforening.  ISSN 0332-6470.  56(3), s 167- 177
• 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.  ISSN 1752-4458.  13(65), s 1- 12 . doi: 10.1186/s13033-019-0321-8 Full text in Research Archive. Show summary

  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

• 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 Full text in Research Archive. Show summary

  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 & Davidson, Larry (2019). Helpful Ingredients in the Treatment of Long-Term Substance Use Disorders: A Collaborative Narrative Study. Substance Abuse: Research and Treatment.  ISSN 1178-2218.  13, s 1- 9 . doi: 10.1177/1178221819844996 Full text in Research Archive. Show summary

  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.

• Pettersen, Henning; Landheim, Anne; Skeie, Ivar; Biong, Stian; Brodahl, Morten; Hansen, Jeppe Oute & Davidson, Larry (2019). How Social Relationships Influence Substance Use Disorder Recovery : A Collaborative Narrative Study. Substance Abuse: Research and Treatment.  ISSN 1178-2218.  13, s 1- 8 . doi: 10.1177/1178221819833379 Full text in Research Archive. Show summary

  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.  ISSN 1472-6963.  18(71) . doi: 10.1186/s12913-018-2862-y Full text in Research Archive. Show summary

  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

• 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 Full text in Research Archive. Show summary

  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.

• Pettersen, Henning; Landheim, Anne; Skeie, Ivar; Biong, Stian; Brodahl, Morten; Benson, Victoria & Davidson, Larry (2018). Why do those with long-term substance use disorders stop abusing substances: A qualitative study. Substance Abuse: Research and Treatment.  ISSN 1178-2218.  12, s 1- 8 . doi: 10.1177/1178221817752678 Full text in Research Archive. Show summary

  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.  ISSN 1752-4458.  12:51, s 1- 10 . doi: 10.1186/s13033-018-0230-2 Full text in Research Archive. Show summary

  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.

• 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.  ISSN 1472-6963.  18(290) . doi: 10.1186/s12913-018-3097-7 Full text in Research Archive. Show summary

  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; Saltyte Benth, Jurate; Heiervang, Kristin Sverdvik; Kilen Stuen, Hanne; Killaspy, Helen & Ruud, Torleif (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.  ISSN 1752-4458.  10(14) . doi: 10.1186/s13033-016-0052-z
• Clausen, Hanne Kristin; Ruud, Torleif; Odden, Sigrun; Saltyte Benth, Jurate; Heiervang, Kristin Sverdvik; Stuen, Hanne Kilen; Killaspy, Helen; Drake, Robert E. & Landheim, Anne (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.  ISSN 1471-244X.  16(125) . doi: 10.1186/s12888-016-0826-5 Show summary

  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: Anne Landheim; Frøy Lode Wiig; Marit Brendbekken; Morten Brodahl & Stian Biong (red.),  Et bedre liv : historier, erfaringer og forskning om recovery ved rusmiddelmisbruk og psykiske helseproblemer.  Gyldendal Akademisk.  ISBN 9788205480322.  Del I: kapittel 2.  s 30 - 44
• 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 Show summary

  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; Landheim, Anne; Odden, Sigrun; Heiervang, Kristin Sverdvik; Kilen Stuen, Hanne; Killaspy, Helen; Saltyte Benth, Jurate & Ruud, Torleif (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 Show summary

  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.

• Kilen Stuen, Hanne; 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.  ISSN 1472-6963.  15(409) . doi: 10.1186/s12913-015-1083-x Full text in Research Archive.
• 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 Show summary

  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.

• 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 Show summary

  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.

• 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.  ISSN 2077-1444.  6(1), s 92- 106 . doi: 10.3390/rel6010092 Show summary

  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

• Årstad, Janne; Nesvåg, Sverre & Landheim, Anne (2015). Kartleggingsverktøy i rusbehandling - nyttig for bruker og behandler?. Tidsskrift for Norsk Psykologforening.  ISSN 0332-6470.  52(9), s 762- 773
• 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.  ISSN 1471-2458.  14(316) . doi: 10.1186/1471-2458-14-316 Show summary

  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; 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.  ISSN 1752-4458.  8(40) . doi: 10.1186/1752-4458-8-40 Show summary

  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.

• 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
• 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 Full text in Research Archive.
• Wynn, Rolf; Landheim, Anne & Hoxmark, Ellen Margrethe (2013). Which factors influence psychiatric diagnosing in substance abuse treatment?. International Journal of Mental Health Systems.  ISSN 1752-4458.  7 . doi: 10.1186/1752-4458-7-17 Full text in Research Archive.
• 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
• 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.  ISSN 1471-244X.  7:29 . doi: 10.1186/1471-244X-7-29
• 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.  ISSN 1471-244X.  6:44 . doi: 10.1186/1471-244X-6-44
• 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
• 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
• 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
• 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
• 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
• 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

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

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• 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.
• Landheim, Anne; Hoxmark, Ellen Margrethe; Aakerholt, Amund & Aasbrenn, Kristian (2017). Potensialet for Assertive Community Treatment (ACT) og Fleksibel ACT (FACT) i Norge. Full text in Research Archive. Show summary

  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 (2017). Evaluation of ACT teams in Norway..
• Odden, Sigrun; Landheim, Anne & Kvam, Elisabeth Adams (2017). Evaluation of ROP Vestfold.
• 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
• Biong, Stian & Landheim, Anne (2016). Recovery sett fra brukere, fagfolk og forskning, I: Anne Landheim; Frøy Lode Wiig; Marit Brendbekken; Morten Brodahl & Stian Biong (red.),  Et bedre liv : historier, erfaringer og forskning om recovery ved rusmiddelmisbruk og psykiske helseproblemer.  Gyldendal Akademisk.  ISBN 9788205480322.  Innledning.  s 13 - 16
• Kielland, Knut Boe; Sandnes, Rolf-Arne & Landheim, Anne (2016). Does chronic hepatitis C cause fatigue?.
• Landheim, Anne & Borger Rognli, Eline (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.
• Odden, Sigrun & Landheim, Anne (2016). Evaluering av ROP Vestfold - et samhandlingsteam for personer med alvorlig rusmisbruk og psykiske lidelser.
• Odden, Sigrun; Kogstad, Ragnfrid Eline; Brodahl, Morten & Landheim, Anne (2015). Opplærings- og veiledningsbehov hos erfaringskonsulenter.
• Odden, Sigrun; Kogstad, Ragnfrid Eline; Brodahl, Morten & Landheim, Anne (2015). Opplærings- og veiledningsbehov hos erfaringskonsulenter..
• Pedersen, Monica Stolt; Landheim, Anne & Lien, Lars (2015). Clinical audit as a basis for improvement in mental health services, a qualitative study.
• 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.
• Ruud, Torleif & Landheim, Anne (2015). Assertive outreach in Norway, In Remmers van Veldhuizen; Diana Polhuis; Michiel Bahler; Niels Mulder & Hans Kroon (ed.),  Handboek (Flexible) ACT. Herstelondersteunende zorg en behandeling in de eigen omgeving voor mensen met ernstige psychiatrische aandoeningen.  De Tijdstroom Uitgevrij B.V..  ISBN 9789058982797.  Hoofdstuk 40.  s 489 - 494
• Thorberg, Fred Arne; Young, Ross McD; Lyvers, Michael; Connor, Jason P; Tyssen, Reidar; Landheim, Anne; Edythe, London & Feeney, Gerald F.X. (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 . doi: 10.1016/j.drugalcdep.2014.09.693
• Kilen Stuen, Hanne; 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 Show summary

  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.

• 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?.
• 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. Show summary

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

• Skeie, Ivar & Landheim, Anne (2014). Rus – psykiatri – somatikk. Forskningsprosjekt Hedmark og Oppland.
• Thorberg, Fred Arne; Young, R; Lyvers, Michael; Connor, Jason; Tyssen, Reidar; Landheim, Anne; London, Edyth & Feeney, Gerald F.X. (2014). A prospective study of alexithymia and craving among alcohol-dependent treatment seekers. Drug and Alcohol Dependence.  ISSN 0376-8716.  140, s e225
• Thorberg, Fred Arne; Young, Ross McD; Lyvers, Michael; Connor, Jason P; Tyssen, Reidar; Landheim, Anne; London Danick, Edythe & Feeney, Gerald F.X. (2014). Loss of self-control over drinking and the relationship of alexithymia to quality of life in alcohol-dependent patients.
• Kilen Stuen, Hanne; Wynn, Rolf; Landheim, Anne & Ruud, Torleif (2013). Committed treatment orders in Norwegian assertive community treatment (ACT) teams, seen from the patients' views and experience.
• 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.
• Thorberg, Fred Arne; Young, Ross McD; Sullivan, Karen; Lyvers, Michael; Connor, Jason; Landheim, Anne; Tyssen, Reidar & Feeney, GFX (2012). Alexithymia in alcohol dependent patients: Gender differences, associations with craving and dependence severity.
• Thorberg, Fred Arne; Young, Ross McD; Sullivan, Karen; Lyvers, Michael; Connor, Jason; Landheim, Anne; Tyssen, Reidar & Feeney, GFX (2012). Alexithymia in alcoholics is mediated by alcohol expectancy, but only for males.
• Kirkehei, Ingvild; Leiknes, Kari Ann; Larun, Lillebeth; Hammerstrøm, Karianne Thune; Bramness, Jørgen; Gråwe, Rolf W; Haugerud, Helge; Helseth, Valborg Helene; Landheim, Anne; Lossius, Kari & Waal, Helge (2008). Dobbeldiagnose – alvorlig psykisk lidelse og ruslidelse. Del 2 Effekt av psykososial behandling. Rapport fra Kunnskapssenteret. 25/2008. Full text in Research Archive. Show summary

  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; Kornør, Hege; Landheim, Anne; Lossius, Kari; Hammerstrøm, Karianne Thune & Waal, Helge (2007). Dobbeldiagnose – alvorlig psykisk lidelse og ruslidelse: del 1 Screening og diagnoseinstrumenter. Rapport fra Kunnskapssenteret. 21/2007. Full text in Research Archive. Show summary

  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.

• Landheim, Anne; Bakken, Kjell E. & Vaglum, Per (2000). Addicts with personality disorders -are they coming to the ''right'' treatment?.

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