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Substance Use in Swedish Adolescents: The Importance of Co-occurring Psychiatric Symptoms and  Psychosocial Risk
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aims: Study I: Identify substance use disorders (SUDs), psychiatric disorders, and psychosocial risk (PSR) in adolescence, to predict SUD after 5 years in 147 adolescents who sought treatment at a misuse-clinic. Study II: Identify alcohol risk use (ARU) and its association with psychiatric symptoms and PSR in 960 adolescents who sought treatment in general psychiatric care. Study III: Examine the effect of antisocial behavior (ASB) on the association between inattention, hyperactivity, impulsivity, and alcohol use in 3,864 adolescent students. Study IV: Examine the veracity of drug use reports comparing responses in questionnaires, in-depth interview, and hair analysis in 200 adolescent students.

Results: Study I: SUDs in adolescence persisted into early adulthood. Predictors for SUD: girls who had mothers with alcohol use disorder, victimization, criminality, SUD, or SUD treatment. Study II: Prevalence of ARU was 20%. ARU increased with the number of psychiatric symptom domains. Probability of psychiatric symptoms increased with ARU. Most ARU was found in: ASB and sexual abuse. Most common in ARU: symptoms of ADHD, depression, and anxiety. Study III: ASB reduced association between inattention, hyperactivity, impulsivity, and alcohol use for boys, and hyperactivity and impulsivity for girls. Girls’ inattention continued to affect alcohol use despite the presence of ASB. Study IV: Twice as many participants reported drug use in interviews compared to questionnaires. Questionnaires and hair-analysis showed low sensitivity and high specificity. Responses from participants in less privileged socioeconomic circumstances were less reliable.

Conclusions: Study I: Treatment-as-usual experienced difficulties preventing the persistence of SUD. Participants’ comorbidity and PSR must be attended to. Study II: ARU in general psychiatric care is prevalent and associated with other psychiatric symptoms, and all symptoms must be attended to simultaneously. Study III: ASB should be screened for when symptoms of ADHD are present. Inattention in girls might require special attention to prevent alcohol use. Study IV: Interviews might be an alternative to questionnaires. Hair analysis was less useful in this population, but a physical measure might function as a pipeline procedure. Responses from participants in less privileged circumstances might be interpreted with caution.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. , 85 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1110
Keyword [en]
Alcohol, illicit drug, psychiatry, meassures, validity, ADHD, antisocial behaviors, depression, anxiety
National Category
Medical and Health Sciences
Research subject
Child and Youth Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-251558ISBN: 978-91-554-9263-2 (print)OAI: oai:DiVA.org:uu-251558DiVA: diva2:806551
Public defence
2015-06-12, Vårdskolans aula, ingång 21, Västmanlands sjukhus, Västerås, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2015-05-21 Created: 2015-04-20 Last updated: 2015-07-07
List of papers
1. A 5-year follow-up study of adolescents who sought treatment for substance misuse in Sweden
Open this publication in new window or tab >>A 5-year follow-up study of adolescents who sought treatment for substance misuse in Sweden
2014 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 23, no 5, 347-360 p.Article in journal (Refereed) Published
Abstract [en]

Previous studies have shown that substance misuse in adolescence is associated with increased risks of hospitalizations for mental and physical disorders, convictions for crimes, poverty, and premature death from age 21 to 50. The present study examined 180 adolescent boys and girls who sought treatment for substance misuse in Sweden. The adolescents and their parents were assessed independently when the adolescents first contacted the clinic to diagnose mental disorders and collect information on maltreatment and antisocial behavior. Official criminal files were obtained. Five years later, 147 of the ex-clients again completed similar assessments. The objectives were (1) to document the prevalence of alcohol use disorders (AUD) and drug use disorders (DUD) in early adulthood; and (2) to identify family and individual factors measured in adolescence that predicted these disorders, after taking account of AUD and DUD in adolescence and treatment. Results showed that AUD, DUD, and AUD + DUD present in mid-adolescence were in most cases also present in early adulthood. Prediction models detected no positive effect of treatment in limiting persistence of these disorders. Thus, treatment-as-usual provided by the only psychiatric service for adolescents with substance misuse in a large urban center in Sweden failed to prevent the persistence of substance misuse. Despite extensive clinical assessments of the ex-clients and their parents, few factors assessed in mid-adolescence were associated with substance misuse disorders 5 years later. It may be that family and individual factors in early life promote the mental disorders that precede adolescent substance misuse.

Keyword
Substance misuse, Adolescence, Outcomes
National Category
Pediatrics Psychology Psychiatry
Identifiers
urn:nbn:se:uu:diva-227266 (URN)10.1007/s00787-013-0456-0 (DOI)000335956400011 ()
Available from: 2014-07-02 Created: 2014-06-24 Last updated: 2017-12-05Bibliographically approved
2. Adolescent alcohol risk use co-occurrence with psychiatric symptoms in Swedish child and adolescent psychiatric care
Open this publication in new window or tab >>Adolescent alcohol risk use co-occurrence with psychiatric symptoms in Swedish child and adolescent psychiatric care
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences Psychiatry
Identifiers
urn:nbn:se:uu:diva-251554 (URN)
Available from: 2015-04-20 Created: 2015-04-20 Last updated: 2015-07-07
3. Antisocial behaviour reduces the association between subdimensions of ADHD symptoms and alcohol use in a large population-based sample of adolescents
Open this publication in new window or tab >>Antisocial behaviour reduces the association between subdimensions of ADHD symptoms and alcohol use in a large population-based sample of adolescents
(English)Manuscript (preprint) (Other academic)
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-251555 (URN)
Available from: 2015-04-20 Created: 2015-04-20 Last updated: 2015-07-07
4. Reports of adolescent illicit drug use -in what and whom can we trust?: Investigating the congruency of questionnaires, in-depth interviews, and hair analysis
Open this publication in new window or tab >>Reports of adolescent illicit drug use -in what and whom can we trust?: Investigating the congruency of questionnaires, in-depth interviews, and hair analysis
(English)Manuscript (preprint) (Other academic)
National Category
Substance Abuse
Identifiers
urn:nbn:se:uu:diva-251563 (URN)
Available from: 2015-04-20 Created: 2015-04-20 Last updated: 2015-07-07

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