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.

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.