Table 3 Professionals’ reported barriers and facilitators

1. Limited agenda setting among professionals

1.1 Prioritizing other themes

1.2 Underestimating necessity

1.3 Perceived as extra work

1.4 Lack of personal affinity

1.5 Losing key persons

1. Agenda setting among professionals

1.1 Project champion(s)

1.2 Recognizing necessity

1.3 Motivation through personal affinity

1.4 Continuity in attention

1.5 Creating support

1.6 Agenda setting at general practitioners

2. Lack of knowledge and skills

2.1 Lack of knowledge

2.2 Professional hesitation

2.3 Rapid knowledge erosion

2.4 Limited training curriculum

2. Sufficient knowledge and skills

2.1 Having knowledge

2.2 Comprehensive training curriculum

2.3 Ongoing education on-the-job

2.4 Knowledge exchange between mental health and addiction services

3. Hindrance in professional attitude

3.1 Alcohol-related stigma and taboos

3.2 Lacking integrated treatment vision

3. Supportive professional attitude

3.1 Reducing alcohol-related stigma and taboos

3.2 Integrated treatment vision

3.3 Providing tailored care

4. Lack of action

4.1 Lacking alcohol assessment

4.2 Lacking follow-up actions after identification

4. Supportive actions

4.1 Adequate alcohol assessment

4.2 Using screening instrument(s)

4.3 Incorporating theme into mental health treatment

4.4 Involving “support system” of client during intake/treatment

5. Difficulties in client contact

5.1 Client resistance

5.2 Contact loss due to referral errors

5. Good client contact

5.1 Establishing good therapeutic relationship

6. Difficult collaboration

With addiction services

6.1 Poor contact and communication

6.2 Inadequate client referrals

6.3 Lack of awareness regarding available services

6.4 Differences in treatment approaches and vision

6.5 Overconfidence in own approach

6.6 Resistance to change

6.7 Disagreements over roles

6.8 Financial self-interest

6.9 Lack of shared responsibility

6.10 Bureaucracy

6.11 Inability to access each other’s electronic health records

6. Effective collaboration

With addiction services

6.1 Close contact and communication

6.2 Awareness of available services

6.3 Acceptance of each other’s expertise

6.4 Consultations

6.5 Seamless and coordinated client referrals

6.6 Integrated collaboration

6.7 Shared commitment

6.8 Joint evaluation of collaboration

6.9 Willingness to experiment

6.10 Establishing collaborative agreements

With other parties

6.11 Collaboration with social domain

6.12 Collaborative network with other healthcare organizations

7. Limiting organizational characteristics

7.1 Lack of appropriate treatments

7.2 Mental health care silos

7.3 Large, cumbersome organizations

7.4 Insufficient management support

7. Organizational characteristics

7.1 Management endorsement

7.2 Involving experts

7.3 Having an alcohol clinic

7.4 Having a dual diagnosis department

7.5 Offering integrated treatment

8. Limited organizational resources

8.1 Time constraints

8.2 Insufficient staffing

8.3 Funding constraints

8.4 Lengthy waiting lists

9. Governmental barriers

9.1 Inadequate health insurance reimbursement

9.2 Lack of alcohol theme in clinical guidelines

9. Governmental support

9.1 Incorporated in treatment guidelines

9.2 Legislation

9.3 Adequate health insurance reimbursement

9.4 Government campaigns for alcohol prevention