Affiliations
- Unit for Clinical Research on Addictions, Oslo University Hospital Health Trust, www.rusforsk.no
- Norwegian Centre for Addiction Research, University of Oslo, www.seraf.uio.no
- Research Centre for Elimination of Hepatitis, Lovisenberg Diaconal Hospital, www.selihep.no
Education
- MD, PhD
- Psychiatrist
- Community Medicine specialist
Research interests
- Comorbidity of substance use disorders and somatic illnesses
- Comorbidity of substance use disorders and psychiatric illnesses
- Harm reduction health services for people with substance use disorders
Relevant links
Projects
Publications
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Leonhardt, Marja; Ellefsen, Rune; Haukland, Vegard Kokabzadeh & Wüsthoff, Linda Elise Couëssurel
(2026).
Providers’ perspectives on what heroin-assisted treatment ought to be: a qualitative study.
BMC Health Services Research.
26(1),
p. 1–14.
doi:
10.1186/s12913-026-14746-1.
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Heroin-assisted treatment (HAT) is an option for opioid use disorder (OUD), particularly for individuals not adequately served by standard therapies like methadone. Studies indicate that HAT can reduce criminal activity and enhance integration into society, as evidenced by significant long-term benefits in employment and health outcomes for marginalised populations. The Norwegian HAT program, launched in 2022, aims to complement existing opioid agonist treatments and improve health outcomes for those with OUD. This study seeks to explore clinicians’ perspectives on the ideal structure of HAT and identify challenges that may affect its implementation. This qualitative study employed an explorative design, conducting 21 semi-structured individual interviews with clinicians from the Norwegian HAT, including one interview with two clinicians. Individual interviews were chosen to facilitate open discussions about their experiences and views on HAT. Analysis was performed using Braun and Clarke’s reflexive thematic analysis framework to identify key themes and patterns from the transcripts. Four overarching themes were identified, whereof the first three were interrelated. The themes reflect clinicians’ ideal treatment philosophy and perspectives on what heroin assisted treatment ought to be: (1) An individualised and patient-centred treatment, (2) A holistic approach with an interdisciplinary collaboration, (3) A flexible service, and (4) Incorporating substance use as a reality. The clinicians’ insights outlined a comprehensive vision of HAT grounded in the principles of individualisation, holistic care, flexibility, and a realistic understanding of substance use. They found it essential to integrate medical, psychological, and social support while fostering collaboration among healthcare professionals. This framework not only responds to the complex realities of addiction but may also support pathways toward recovery, according to clinicians. These insights indicate a need for policy changes within the Norwegian HAT and resources that empower comprehensive care strategies within opioid agonist treatment frameworks.
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Auestad, Nina; Jørgenrud, Benedicte Marie; Bogstrand, Stig Tore; Vallersnes, Odd Martin; Lerdal, Anners & Wüsthoff, Linda Elise Couessurel
(2026).
Using PEth and AUDIT-4 to Detect Harmful Alcohol Use Among People with Severe Substance Use.
Substance Use & Misuse.
ISSN 1082-6084.
61(11),
p. 1984–1993.
doi:
10.1080/10826084.2026.2634253.
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Ellefsen, Rune; Pirro, Silvana De & Wüsthoff, Linda Elise Couëssurel
(2025).
Relational hope and despair: Heroin-assisted treatment as experienced by the patients’ family members.
Drugs: education prevention and policy.
ISSN 0968-7637.
doi:
10.1080/09687637.2025.2594495.
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Background: Limited research exists on how family members of adults with opioid use disorder (OUD) are affected by their relatives’ entry into treatment. This is the first study to solely examine the experiences of family members following a relative’s enrollment in heroin-assisted treatment (HAT).
Methods: The study explored how participants’ situations and those of their relatives, including their relational dynamics were impacted by HAT enrollment. We conducted 18 in-depth qualitative interviews with ten family members of individuals in HAT, conducting a thematic analysis of the data.
Results: Three main areas of impact were identified: effects on family members, on their relatives, and on their relationships. Participants reported reduced emotional and financial burdens, although many expressed ambivalence about the medical heroin treatment. They saw benefits for their relatives in HAT, such as increased stability and improvements in daily life, but noted that the treatment's demands limited family activities. While the stabilization of their relatives positively influenced relationships, participants struggled to include them in family gatherings due to treatment restrictions.
Conclusion: The findings emphasize how treatment impacts both the individual receiving care and their family members, highlighting the interconnectedness of their well-being, which has crucial implications for clinical practice, research, and policy
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Myklebust, Lars Henrik; Eide, Desiree; Wüsthoff, Linda Elise Couessurel; Melis, Francesca; Oldervoll, Ann & Pirro, Silvana De
[Show all 7 contributors for this article]
(2025).
Changes in self-reported mental health, anxiety and depression among patients in heroin-assisted treatment: Findings from a Norwegian trial project.
European Addiction Research.
ISSN 1022-6877.
31,
p. 286–296.
doi:
10.1159/000547375.
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Introduction: Norway’s heroin-assisted treatment (HAT) project started in 2022, aimed at targeting individuals with severe opioid use disorder (OUD) who did not benefit from first-line, conventional opioid agonist treatment. The use of pharmaceutical diacetylmorphine in HAT may particularly benefit patients with comorbid psychiatric disorders due to its structured nature, which includes daily contact with outpatient clinics. However, previous findings on mental health outcomes in HAT have been inconclusive. The main aim of this study was to explore changes in patients’ self-rated mental health and anxiety and depression over the first 12 months of HAT in Norway. Methods: We used data from 2 questions about patients’ self-rated mental health and anxiety and depression collected from 79 patients at the start of treatment (baseline) and at 3, 6, and 12 months into treatment. Ordinal logistic regression models were used to examine the changes in the responses over the observational period and to explore the potential effects of predictors such as gender and age, self-reported substance use, and clinic site. Results: We found a gradual improvement in self-rated mental health from baseline over the observational period, with a statistically significant shift in response distribution at the 12-month mark (p = 0.017). The distribution of responses indicating “good” mental health increased with a 35% improvement at 12 months, with a corresponding decline of 48% in “bad” mental health. For self-rated anxiety and depression, we found no change in severity of self-rated symptoms. A decline of 48% in the proportion of responses reporting severe symptoms at 12 months was aligned with a simultaneous increase of 17% reporting moderate symptoms. Age and previous suicide attempts were significant predictors of both outcomes; gender influenced anxiety and depression only, whereas clinic site influenced only mental health ratings. Conclusion: HAT appears to gradually improve patients’ self-rated mental health over time, possibly by enhancing overall psychological well-being. Self-rated symptoms of anxiety and depression may not be affected by this treatment, indicating that psychiatric conditions can persist in HAT for those struggling with them. This highlights the importance of specific psychiatric assessments and targeted interventions for at least a subset of patients, underscoring the need for integrated treatment approaches within HAT programs that address both substance use and co-occurring psychiatric disorders.
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Auestad, Nina; Bogstrand, Stig Tore; Vallersnes, Odd Martin; Lerdal, Anners & Wüsthoff, Linda Elise Couëssurel
(2025).
Cognitive Function among People with Severe Substance Use.
European Addiction Research.
ISSN 1022-6877.
31(2),
p. 133–144.
doi:
10.1159/000543755.
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Introduction: Studies report a high variability of cognitive impairment in people who use drugs, ranging from 20% to 80%. Most research focuses on individuals who use drugs who are either admitted to treatment facilities or incarcerated and being abstinent from substances. The present study aimed to assess cognitive function among populations with ongoing, severe, habitual substance use, mimicking a real-world day-to-day situation. Methods: Cross-sectional design with 171 participants (70.2% male) with severe substance use, recruited from two sites in Oslo, Norway. All participants were screened for cognitive function using the Montreal Cognitive Assessment (MoCA). A cutoff of <26 points was used to classify possible cognitive impairment. Participants also provided information on their alcohol and substance use, as well as demographic data. Results: 74.9% of the participants scored below the MoCA cutoff for possible cognitive impairment. We did not find any associations between scoring below the MoCA cutoff <26 and the substance use variables (substance use, number of substances used, history of overdoses, injection drug use, and past substance use treatment). Conclusion: A high proportion of people with severe substance use may experience a functional cognitive impairment. This study provides novel insights into cognitive function within a population actively engaged in habitual substance use, offering a real-world perspective with high external validity. This knowledge is highly relevant for service providers who aim to deliver tailored follow-up services to this population outside of traditional treatment settings.
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Melis, Francesca; Clausen, Thomas; Castel, Charlotte Jocelyne Yvonne; Dadras, Omid; Pirro, Silvana De & Myklebust, Lars Henrik Ryther
[Show all 9 contributors for this article]
(2024).
Patient Characteristics From Norway’s First Heroin-Assisted Treatment Clinics.
Substance use & addiction journal.
46(1),
p. 13–24.
doi:
10.1177/29767342241271991.
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Background: Heroin-assisted treatment (HAT) is an evidence-based treatment option for opioid use disorder (OUD), available in a limited number of countries. Norway implemented a 5-year HAT project in 2022, aiming to assess its effectiveness and its potential integration into the country’s OUD treatment system. This study describes and compares patients’ baseline characteristics from the Oslo and Bergen HAT clinics, providing a comprehensive picture of the unique population and the real-world application of HAT. Methods: This cross-sectional study examines the baseline characteristics of consenting HAT patients within the first 2 years of operation (n = 86). Self-reported questionnaires gathered sociodemographics, previous treatment experiences, self-reported crime, and substance use, as well as motivations and expectations for treatment. Comparisons between the clinics were carried out using t-tests, Mann–Whitney U tests, Chi-square, and Fisher’s exact test. Results: The majority of the patients were enrolled at the Oslo clinic (76%) and were male (80%). At admission, the average age was 45.9, with a significantly younger group in Bergen (42.5 vs 47.3, P < .05). While no patients reported being unhoused, 17% noted unstable housing within the preceding month. Unemployment was prevalent (91%) alongside previous treatment experiences (95%), with a median of 2 prior medication types. In the 3 months preceding HAT initiation, 78% of patients reported being victims of crime, and 44% committed at least one crime. Over their lifetime, 2 in 5 participants (41%) had experienced an unwanted overdose and 43% had shared syringes and equipment. Conclusion: This study reveals a cohort experiencing societal marginalization, including unstable housing, unsatisfactory prior OUD treatment, high-risk behaviors, and frequent interactions with criminal activities, predominantly as victims. While the Oslo and Bergen clinics serve a similar patient profile, notable differences emerged in the reasons for discontinuing past OUD treatment and crime-related factors.
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Wüsthoff, Linda Elise Couëssurel; Lund-Johansen, Fridtjof; Henriksen, Kathleen; Wildendahl, Gull; Jacobsen, Jon-Aksel & Gomes, Leni
[Show all 11 contributors for this article]
(2024).
Seroprevalence of SARS-CoV-2 and humoral immune responses to COVID-19 mRNA vaccines among people who use drugs - in the light of tailored mitigating strategies.
Harm Reduction Journal.
21(1).
doi:
10.1186/s12954-024-01023-9.
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Background During the initial wave of the COVID-19 pandemic, there was a surprisingly low incidence of SARS-CoV-2 among People Who Use Drugs (PWUD) in Oslo, Norway, despite their heightened vulnerability regarding risk of infection and severe courses of the disease.This study aims to investigate the seroprevalence of SARS-CoV-2 antibodies among PWUD, their antibody responses to relevant virus infections and COVID-19 mRNA vaccines, and their vaccination coverage compared to the general population. Methods Conducted as a prospective cohort study, data was collected from residents in six institutions for homeless PWUD and users of a low-threshold clinic for opioid agonist treatment. Ninety-seven participants were recruited for SARS-CoV-2 seroprevalence analysis. Additional two participants with known positive SARS-CoV-2 test results were recruited for further analyses. Twenty-five participants completed follow-up. Data included questionnaires, nasal swabs and blood samples. Data on vaccination coverage was obtained from the National Vaccine Register. Serologic methods included detection of antibodies to relevant virus proteins, neutralizing antibodies to SARS-CoV-2, antibodies to the full-length spike protein, and receptor-binding domain from SARS-CoV-2. Results Among PWUD, antibodies to SARS-CoV-2 were detected in 2 out of 97 samples before vaccines against SARS-CoV-2 were available, comparable to a 2.8% frequency in population-based screening. Levels of serum antibodies to seasonal coronaviruses and Epstein-Barr-Virus (EBV) in PWUD were similar to population-based levels. After the second vaccine dose, binding and neutralizing antibody levels to SARS-CoV-2 in PWUD were comparable to controls. Eighty-four of PWUD received at least one dose of COVID-19 mRNA vaccine, compared to 89% in the general population. Conclusion Results indicate that PWUD did not exhibit increased SARS-CoV-2 seroprevalence or elevated serum antibodies to seasonal coronaviruses and EBV. Moreover, vaccine responses in PWUD were comparable to controls, suggesting that vaccination is effective in conferring protection against SARS-CoV-2 also in this population.
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Ellefsen, Rune; Pirro, Silvana De; Haukland, Vegard; Wüsthoff, Linda Elise Couëssurel & Arnevik, Espen Kristian Ajo
(2024).
“It’s a delicate balance”: clinicians’ experiences of providing heroin-assisted treatment.
Harm Reduction Journal.
21(1),
p. 1–11.
doi:
10.1186/s12954-024-01135-2.
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Background
Little attention has been paid to the experiences of clinicians and health personnel who provide heroin-assisted treatment (HAT). This study provides the first empirical findings about the clinicians’ experiences of providing HAT in the Norwegian context.
Methods
23 qualitative interviews were conducted with 31 clinicians shortly after HAT clinics opened in Norway’s two largest cities: Oslo and Bergen. By inductive thematic analysis of interview transcripts, we identified what research participants experienced and viewed as the chief rewards and challenges of providing HAT. The study aimed to offer an overview of these key rewards and challenges, with insights potentially transferable to HAT programs internationally.
Results
Participants experienced three aspects of providing HAT as particularly rewarding, and three as most challenging. The rewarding aspects were observing harm reduction outcomes; providing holistic care; and having a positive clinic milieu and patient–clinician relationships. The challenging aspects were dosing and overdose risk; rule enforcement and aggression management; and the difficulty of initiating treatments beyond medication and harm reduction. The rewarding and challenging aspects of providing HAT overlapped and were at times contradictory, thus reflecting the duality and tensions in clinicians’ work to provide HAT. The challenges were reported to vary between patient subgroups, according to their degree of instability. The most unstable patients were seen as involving more difficulties as regards the challenging aspects of HAT. Participants expressed uncertainty about HAT’s utility for a small group of the most unstable patients.
Conclusion
While studies about clinical experiences of HAT have usually examined individual or limited aspects of treatment provision, this study provided an overview of the main aspects of the rewards and challenges of providing HAT. Importantly, it also showed the tensions between these overlapping and sometimes contradictory aspects of HAT provision. Because a positive patient–clinician relationship is crucial to patient satisfaction and treatment outcomes in HAT, the provision of training for clinicians on navigating the inherent tensions of HAT provision, nurturing therapeutic alliances with patients, and managing their role as gatekeepers to medical heroin and valuable services, seem particularly important for ensuring that care is patient-centered and staff are adequately supported.
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Tjelta, Thomas; Bogstrand, Stig Tore; Lerdal, Anners; Wüsthoff, Linda Elise Couëssurel; Edvardsen, Hilde Marie Erøy & Johannessen, Aud
(2024).
Screening and Following Up Harmful Alcohol Use “… is Not Necessarily Your Primary Focus”: A Qualitative Study Exploring Health Professionals’ Experiences Addressing Harmful Alcohol Use in a Norwegian Hospital.
Journal of Multidisciplinary Healthcare.
17,
p. 5189–5198.
doi:
10.2147/JMDH.S475750.
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Introduction: Alcohol use remains a leading cause of excess mortality and morbidity worldwide, and identifying and following up
harmful alcohol use represents a key component of alcohol harm reduction policies. This article explores health professionals’
experiences implementing these policies in a Norwegian hospital.
Aim: To explore health professionals’ views and experiences of systematic screening and tailored follow-up of harmful and hazardous
alcohol use in a Norwegian hospital.
Methods: We conducted semi-structured interviews with 13 specialty registrars and nurses working in the emergency department and
observation ward of a hospital in Oslo, Norway. Interviews were carried out between May and December 2022, coded using NVivo
v.14 and analyzed thematically.
Results: We identified three themes: (i) standardized and clinical assessment, referring to tensions between standardized and clinical
alcohol risk assessment; (ii) formal and informal treatment guidelines, encompassing the informal patient care practices enacted in the emergency department and on the wards, and; (iii) training delivery and barriers to implementation, referring to the training
penetration rate and identified need for “clear and simple” alcohol treatment guidelines.
Conclusion: This study highlights tensions between alcohol-related harm and alcohol-related norms as these pertain to screening and
following up harmful and hazardous alcohol use in a Norwegian hospital. Results suggest training should focus on zero alcohol
recommendations, the use of assessment tools, the acceptability of screening to patients and “clear and simple” patient follow-up
procedures
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Ellefsen, Rune; Wüsthoff, Linda Elise & Arnevik, Espen Kristian Ajo
(2023).
Patients’ satisfaction with heroin-assisted treatment: a qualitative study.
Harm Reduction Journal.
20.
doi:
10.1186/s12954-023-00808-8.
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Background Heroin-assisted treatment (HAT) involves supervised dispensing of medical heroin (diacetylmorphine) for people with opioid use disorder. Clinical evidence has demonstrated the effectiveness of HAT, but little is known about the self-reported satisfaction among the patients who receive this treatment. This study presents the first empirical findings about the patients’ experiences of, and satisfaction with, HAT in the Norwegian context. Methods Qualitative in-depth interviews with 26 patients in HAT were carried out one to two months after their enrollment. Analysis sought to identify the main benefits and challenges that the research participants experienced with this treatment. An inductive thematic analysis was conducted to identify the main areas of benefits and challenges. The benefits were weighed against the challenges in order to assess the participants’ overall level of treatment satisfaction. Results Analysis identified three different areas of experienced benefits and three areas of challenges of being in this treatment. It outlines how the participants’ everyday lives are impacted by being in the treatment and how this, respectively, results from the treatment’s medical, relational, or configurational dimensions. We found an overall high level of treatment satisfaction among the participants. The identification of experienced challenges reveals factors that reduce satisfaction and thus may hinder treatment retention and positive treatment outcomes. Conclusions The study demonstrates a novel approach to qualitatively investigate patients’ treatment satisfaction across different treatment dimensions. The findings have implications for clinical practice by pointing out key factors that inhibit and facilitate patients’ satisfaction with HAT. The identified importance of the socio-environmental factors and relational aspect of the treatment has further implications for the provision of opioid agonist treatment in general.
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Rognli, Eline B.; Dalsrud, Martine Kihle; Wüsthoff, Linda Elise & Arnevik, Espen Kristian Ajo
(2023).
Ubenyttet behandlingstilbud ved rusakuttmottak – en kvalitativ studie.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
143(5).
doi:
10.4045/tidsskr.22.0471.
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BAKGRUNN Nasjonalt pasientforløp (tidligere kalt pakkeforløp) for oppfølging etter rusmiddeloverdose er en viktig del av nasjonal overdosestrategi og trådte i kraft 1. januar 2022. Fire år forut for dette ble det innledet et samarbeid mellom ambulansetjenesten og rusakuttmottaket ved Oslo universitetssykehus, for å gjøre det samme som nå beskrives i nasjonalt pasientforløp: å gi et akutt oppfølgingstilbud i spesialisthelsetjenesten etter overdose. Tilbudet ble lite benyttet, og hensikten med denne studien var å undersøke hvorfor. MATERIALE OG METODE Vi benyttet et kasusstudiedesign og gjennomførte tolv kvalitative intervjuer med representanter fra ambulansetjenesten, rusakuttmottaket og brukergruppen. Intervjuene ble analysert med tematisk analyse. RESULTATER Analysen avdekket fem tematiske områder med ulike forklaringer på hvorfor tilbudet ikke ble benyttet. Det var utilstrekkelig informasjon om tilbudet, og inntakskriteriene var uklare. Omstendelig kommunikasjon mellom ambulansetjenesten og rusakuttmottaket gjorde at tilbudet ikke fungerte som akuttjeneste. Brukernes ønsker etter en overdose var bare delvis sammenfallende med tilbudet, og i tillegg kunne tilbudet være forbundet med sanksjoner. FORTOLKNING Resultatene viser at ting kunne ha vært gjort annerledes lokalt, men også at innholdet i det nasjonale pasientforløpet er uklart, og at overordnede føringer kan gjøre at tilbudet ikke oppleves trygt. Kunnskapen fra denne undersøkelsen vil kunne bidra til å avdekke områder for forbedring av det nasjonale pasientforløpet for oppfølging etter rusmiddeloverdose.
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Malme, Kristian Nødtvedt; Ulstein, Kjersti Anne; Finbråten, Ane-Kristine; Wüsthoff, Linda Elise; Kielland, Knut Boe & Hauge, Joakim
[Show all 8 contributors for this article]
(2023).
Hepatitis C treatment uptake among people who inject drugs in Oslo, Norway: A registry-based study.
International journal of drug policy.
ISSN 0955-3959.
116.
doi:
10.1016/j.drugpo.2023.104044.
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Background: Improving HCV treatment uptake among people who inject drugs (PWID) is crucial to achieving the WHO elimination targets. The aims were to evaluate HCV treatment uptake and HCV RNA prevalence in a large cohort of PWID in Norway.
Methods: Registry-based observational study where all users of the City of Oslo's low-threshold social and health services for PWID between 2010-2016 (n = 5330) were linked to HCV notifications (1990-2019) and dispensions of HCV treatment, opioid agonist treatment (OAT) and benzodiazepines (2004-2019). Cases were weighted to account for spontaneous HCV clearance. Treatment rates were calculated using person-time of observation, and factors associated with treatment uptake were analysed using logistic regression. HCV RNA prevalence was estimated among individuals alive by the end of 2019.
Results: Among 2436 participants with chronic HCV infection (mean age 46.8 years, 30.7% female, 73.3% OAT), 1118 (45.9%) had received HCV treatment between 2010-2019 (88.7% DAA-based). Treatment rates increased from 1.4/100 PY (95% CI 1.1-1.8) in the pre-DAA period (2010-2013) to 3.5/100 PY (95% CI 3.0-4.0) in the early DAA period (2014-2016; fibrosis restrictions) and 18.4/100 PY (95% CI 17.2-19.7) in the late DAA period (2017-2019; no restrictions). Treatment rates for 2018 and 2019 exceeded a previously modelled elimination threshold of 50/1000 PWID. Treatment uptake was less likely among women (aOR 0.74; 95% CI 0.62-0.89) and those aged 40-49 years (aOR 0.74; 95% CI 0.56-0.97), and more likely among participants with current OAT (aOR 1.21; 95% CI 1.01-1.45). The estimated HCV RNA prevalence by the end of 2019 was 23.6% (95% CI 22.3-24.9).
Conclusion: Although HCV treatment uptake among PWID increased, strategies to improve treatment among women and individuals not engaged in OAT should be addressed.
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Gainullin, Murat; Federico, Lorenzo; Osen, Julie Røkke; Chaban, Viktoriia; Kared, Hassen & Alirezaylavasani, Amin
[Show all 18 contributors for this article]
(2023).
People who use drugs show no increase in pre-existing T-cell cross-reactivity toward SARS-CoV-2 but develop a normal polyfunctional T-cell response after standard mRNA vaccination.
Frontiers in Immunology.
14:1235210,
p. 1–13.
doi:
10.3389/fimmu.2023.1235210.
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People who use drugs (PWUD) are at a high risk of contracting and developing severe coronavirus disease 2019 (COVID-19) and other infectious diseases due to their lifestyle, comorbidities, and the detrimental effects of opioids on cellular immunity. However, there is limited research on vaccine responses in PWUD, particularly regarding the role that T cells play in the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we show that before vaccination, PWUD did not exhibit an increased frequency of preexisting cross-reactive T cells to SARS-CoV-2 and that, despite the inhibitory effects that opioids have on T-cell immunity, standard vaccination can elicit robust polyfunctional CD4 + and CD8 + T-cell responses that were similar to those found in controls. Our findings indicate that vaccination stimulates an effective immune response in PWUD and highlight targeted vaccination as an essential public health instrument for the control of COVID-19 and other infectious diseases in this group of high-risk patients.
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Wüsthoff, Linda Elise; Waal, Helge & Gråwe, Rolf W.
(2014).
The effectiveness of integrated treatment in patients with substance use disorders co-occurring with anxiety and/or depression - a group randomized trial.
BMC Psychiatry.
14(67).
doi:
10.1186/1471-244X-14-67.
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Wüsthoff, Linda Elise; Waal, Helge & Gråwe, Rolf W.
(2012).
When Research Meets Reality—Lessons Learned From a Pragmatic Multisite Group-Randomized Clinical Trial on Psychosocial Interventions in the Psychiatric and Addiction Field.
Substance Abuse: Research and Treatment.
6,
p. 95–106.
doi:
10.4137/SART.S9245.
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Research on treatments for patients with co-occurring psychiatric and substance use disorders is of core importance and at the same time highly challenging as it includes patients that are normally excluded from clinical studies. Such research may require methodological adaptations which in turn create new challenges. However, the challenges that arise in such studies are insufficiently discussed in the literature. The aim of this methodology paper is, firstly, to discuss the methodological adaptations that may be required in such research; secondly, to describe how such adaptations created new challenges in a group-randomized clinical trial on Integrated Treatment amongst patients with co-occurring psychiatric and substance use disorders. We also discuss how these challenges might be understood and highlight lessons for future research in this field.
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Wüsthoff, Linda Elise; Waal, Helge; Ruud, Torleif & Gråwe, Rolf W
(2011).
A cross-sectional study of patients with and without substance use disorders in Community Mental Health Centres.
BMC Psychiatry.
11.
doi:
10.1186/1471-244X-11-93.
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Background Epidemiological studies have consistently established high comorbidity between psychiatric disorders and substance use disorders (SUD). This comorbidity is even more prominent when psychiatric populations are studied. Previous studies have focused on inpatient populations dominated by psychotic disorders, whereas this paper presents findings on patients in Community Mental Health Centres (CMHCs) where affective and anxiety disorders are most prominent. The purpose of this study is to compare patients in CMHCs with and without SUD in regard to differences in socio-demographic characteristics, level of morbidity, prevalence of different diagnostic categories, health services provided and the level of improvement in psychiatric symptoms. Methods As part of the evaluation of the National Plan for Mental Health, all patients seen in eight CMHCs during a 4-week period in 2007 were studied (n = 2154). The CMHCs were located in rural and urban areas of Norway. The patients were diagnosed according to the ICD-10 diagnoses and assessed with the Health of the Nation Outcome Scales, the Alcohol Use Scale and the Drug Use Scale. Results Patients with SUD in CMHCs are more frequently male, single and living alone, have more severe morbidity, less anxiety and mood disorders, less outpatient treatment and less improvement in regard to recovery from psychological symptoms compared to patients with no SUD. Conclusion CMHCs need to implement systematic screening and diagnostic procedures in order to detect the special needs of these patients and improve their treatment.
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Wüsthoff, Linda Elise; Waal, Helge; Ruud, Torleif; Røislien, Jo & Gråwe, Rolf W
(2011).
Identifying co-occurring substance use disorders in community mental health centres. Tailored approaches are needed.
Nordic Journal of Psychiatry.
ISSN 0803-9488.
65(1),
p. 58–64.
doi:
10.3109/08039488.2010.489954.
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Haugen, Kine; Fauske, Ingvill; Wüsthoff, Linda Elise & Kleppa-Schau, Jarle
(2014).
Metodebok for etablering og drift av sprøyterom.
Velferdsetaten, Oslo kommune.
ISBN 9788293361008.
98 p.
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Wüsthoff, Linda Elise & Hauge, Joakim
(2014).
Metodebok for etablering og drift av sprøyterom.
Velferdsetaten, Oslo kommune.
ISBN 9788293361008.
98 p.
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Bogstrand, Stig Tore; Auestad, Nina; Vallersnes, Odd Martin; Lerdal, Anners & Wüsthoff, Linda Elise Couëssurel
(2024).
COGNITIVE FUNCTION IN PEOPLE WITH SEVERE SUBSTANCE USE.
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Myklebust, Lars Henrik Ryther; Eide, Desiree; Arnevik, Espen Ajo; Dadras, Omid; Pirro, Silvana De & Ellefsen, Rune
[Show all 14 contributors for this article]
(2024).
Evaluation of heroin-assisted treatment in Norway: protocol for a mixed methods study.
BMC Health Services Research.
24(1).
doi:
10.1186/s12913-024-10767-w.
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Background
Opioid agonist treatment (OAT) for patients with opioid use disorder (OUD) has a convincing evidence base, although variable retention rates suggest that it may not be beneficial for all. One of the options to include more patients is the introduction of heroin-assisted treatment (HAT), which involves the prescribing of pharmaceutical heroin in a clinical supervised setting. Clinical trials suggest that HAT positively affects illicit drug use, criminal behavior, quality of life, and health. The results are less clear for longer-term outcomes such as mortality, level of function and social integration. This protocol describes a longitudinal evaluation of the introduction of HAT into the OAT services in Norway over a 5-year period. The main aim of the project is to study the individual, organizational and societal effects of implementing HAT in the specialized healthcare services for OUD.
Methods
The project adopts a multidisciplinary approach, where the primary cohort for analysis will consist of approximately 250 patients in Norway, observed during the period of 2022–2026. Cohorts for comparative analysis will include all HAT-patients in Denmark from 2010 to 2022 (N = 500) and all Norwegian patients in conventional OAT (N = 8300). Data comes from individual in-depth and semi-structured interviews, self-report questionnaires, clinical records, and national registries, collected at several time points throughout patients’ courses of treatment. Qualitative analyses will use a flexible inductive thematic approach. Quantitative analyses will employ a wide array of methods including bi-variate parametric and non-parametric tests, and various forms of multivariate modeling.
Discussion
The project’s primary strength lies in its comprehensive and longitudinal approach. It has the potential to reveal new insights on whether pharmaceutical heroin should be an integral part of integrated conventional OAT services to individually tailor treatments for patients with OUD. This could affect considerations about drug treatment even beyond HAT-specific topics, where an expanded understanding of why some do not succeed with conventional OAT will strengthen the knowledge base for drug treatment in general. Results will be disseminated to the scientific community, clinicians, and policy makers.
Trial registration
The study was approved by the Norwegian Regional Committee for Medical and Health Research Ethics (REK), ref.nr.:195733.
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Razavi-Shearer, D; Dalgard, Olav; Midgard, Håvard; Razavi, H; Wüsthoff, Linda Elise & Kielland, Knut Boe
(2016).
Aggressive treatment of hepatitis C in People who inject drugs in Norway: an integral step to eradicate the infection in this population.
Full text in Research Archive
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Havnes, Ingrid Amalia & Wüsthoff, Linda Elise
(2014).
Hest eller Sebra - Rusmiddelavhengige sitt møte med helsevesenet.
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Wüsthoff, Linda Elise
(2014).
Kommunal strategi mot åpne russcener - fra midlertidighet til varige, stabile tiltak i bydel.
Full text in Research Archive
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Havnes, Ingrid Amalia & Wüsthoff, Linda Elise
(2014).
Hest eller Sebra - Rusmiddelavhengige sitt møte med helsevesenet.
Full text in Research Archive
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Havnes, Ingrid Amalia & Wüsthoff, Linda Elise
(2013).
Hest eller Sebra - Rusmiddelavhengiges møte med helsevesenet.
Full text in Research Archive
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Havnes, Ingrid Amalia & Wüsthoff, Linda Elise
(2013).
Hest eller Sebra - Rusmiddelavhengiges møte med helsevesenet.
Full text in Research Archive
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Wüsthoff, Linda Elise; Rognli, Eline Borger; Waal, Helge & Clausen, Thomas
(2013).
Lost in Downtown Oslo - How did they get there and how do they get out? - A Project presentation.
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Wüsthoff, Linda Elise; Waal, Helge & Gråwe, Rolf W.
(2012).
When research meets reality - Lessons learned from a pragmatic multi-site group-randomized clinical trial on psychosocial interventions in the psychiatric and addiction field.
Full text in Research Archive
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Wüsthoff, Linda Elise
(2012).
Teorier om Avhengighetsutvikling. Mestre jobben - Mestre livet, Mestringskurs for personer med rusproblemer.
Full text in Research Archive
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Wüsthoff, Linda Elise
(2012).
Teorier om Avhengighetsutvikling. Mestre jobben - Mestre livet, Mestringskurs for personer med rusproblemer.
Full text in Research Archive
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Wüsthoff, Linda Elise
(2012).
Teorier om Avhengighetsutvikling. Mestre jobben - Mestre livet, Mestringskurs for personer med rusproblemer.
Full text in Research Archive
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Wüsthoff, Linda Elise
(2012).
Presentasjon av Oslo kommunes erfaringer med å dele ut folie til røyking av heroin og litteraturoppsummering vedr helseskader ved røyking av heroin.
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Wüsthoff, Linda Elise
(2012).
Teorier om Avhengighetsutvikling. Mestre jobben - Mestre livet, Mestringskurs for personer med rusproblemer.
Full text in Research Archive
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Wüsthoff, Linda Elise
(2012).
Lavterskel tiltak for dårlig fungerende rusbrukere i Oslo. Injiserende rusbrukeres helsetilstand, Kommunens strategi for å få bukt med åpne russcener. Samhandling.
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Wüsthoff, Linda Elise; Waal, Helge; Gråwe, Rolf W. & Ruud, Torleif
(2011).
A cross-sectional study of patients with and without substance use disorders in Community Mental Health Centres.
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Wüsthoff, Linda Elise; Waal, Helge; Ruud, Torleif & Gråwe, Rolf W.
(2011).
A cross-sectional study of patients with and without substance use disorders in Community Mental Health Centres.
Full text in Research Archive
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Wüsthoff, Linda Elise; Waal, Helge; Ruud, Torleif & Gråwe, Rolf W
(2011).
A cross-sectional study of patients with and without substance use disorders in Community Mental Health Centres.
Full text in Research Archive
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Eide, Desiree; Bjørnestad, Ronny; Brummer, Julie Elizabeth; Dadras, Omid; Pirro, Silvana De & Ellefsen, Rune
[Show all 17 contributors for this article]
(2024).
Midtveisrapport om heroinassistert behandling fra 2022-2023 (SERAF rapport 4/2024).
Senter for rus- og avhengighetsforskning.
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Show summary
Denne midtveisrapporten tar for seg de to første årene av Norges første heroinassisterte behandlingsprogram (HAB) som er planlagt å vare ut 2026 som et tidsavgrenset klinisk forsøksprosjekt. Forsøksprosjektet HAB ble etablert som del av legemiddelassistert rehabilitering (LAR) i Oslo og Bergen. Fra 1. januar 2022 til 31. desember 2023 ble 92 av totalt 97 pasienter inkludert i forskningsprosjektet som skal evaluere de to nyetablerte HABklinikkene. Denne rapporten beskriver etableringen av klinikkene, pasienterfaringer og pasientrapporterte resultater mens de var i heroinassistert behandling. Denne rapporten gir en midtveisevaluering av forsøksprosjektet. En endelig og utvidet evalueringsrapport vil bli levert i løpet av første halvdel av 2026.
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Whittaker, Robert; Kløvstad, Hilde; Blindheim, Martin Ingvald; Skullerud, Kristin Helene; Dalgard, Olav & Midgard, Håvard
[Show all 9 contributors for this article]
(2023).
Statusrapport om eliminasjon av hepatitt B og C som folkehelseproblem i Norge.
Folkehelseinstituttet.
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Show summary
Helse- og omsorgsdepartementet lanserte en nasjonal strategi mot virale hepatitter i 2016, som ble videreutviklet i 2018. Hepatitt B virus- (HBV) og hepatitt C virus- (HCV) infeksjon er globalt ledende årsaker til leverkreft og leversvikt. I Norge anses prevalensen av kronisk HBV- og HCV-infeksjon for å være lav i den generelle befolkningen, men forekomsten har vært høy i risikoutsatte grupper, særlig blant personer som har injisert rusmidler og innvandrere fra land med høy prevalens av hepatitt B eller C. I tråd med FNs globale bærekraftsmål og WHO sin globale helsestrategi har Norge som mål å eliminere hepatitt B og C som folkehelseproblem. Med ‘eliminasjon’ menes reduksjon av smitte og sykdom til et så lavt nivå at det ikke lenger utgjør et problem for folkehelsen. Eliminasjon defineres for flere områder, inkludert insidens av nye tilfeller, insidens av alvorlig sykdom og dødsfall og dekningsmål i helsetjenesten. Dekningsmål omfatter oppfølgning i helsetjenesten, behandlingsopptak, vaksinasjonsdekning, trygge blodprodukter og injeksjoner, og skadereduserende tiltak. Formålet med denne rapporten er å: • Presentere oppdatert kunnskap om forekomst av hepatitt B og C i Norge. • Vurdere status for de igangsatte tiltakene i hepatittstrategiene opp mot nasjonale og internasjonale mål. • Gi råd for videreføring av arbeidet mot eliminasjon av hepatitt B og C som folkehelseproblem i Norge.
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Wüsthoff, Linda Elise
(2015).
Patients with anxiety and/or depression co-occurring with substance use disorders in psychiatric outpatient clinics. Detection of co-occurring substance use disorders, patient characteristics and the effectiveness of integrated treatment.
Universitetet i Oslo.
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Published
Oct. 14, 2020 1:46 PM
- Last modified
Nov. 14, 2025 11:52 AM
