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  • 1.
    Andersson, Claes
    Malmö högskola, Faculty of Health and Society (HS), Department of Criminology (KR).
    Comparison of WEB and Interactive Voice Response (IVR) Methods for Delivering Brief Alcohol Interventions to Hazardous-Drinking University Students: A Randomized Controlled Trial2015In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 21, no 5, p. 240-252Article in journal (Refereed)
    Abstract [en]

    This study evaluated automated techniques including personalized normative feedback and protective behavioral strategies, for brief interventions intended to reduce peak alcohol concentrations in university students. After completing baseline assessment, a total of 1,678 hazardous-drinking consumers were randomized to a single or a repeated Internet (WEB) or Interactive Voice Response (IVR) intervention, or to a control group (Single WEB: 323; Single IVR: 329; Repeated WEB: 318; Repeated IVR: 334; Control group: 374). At follow-up, six weeks after baseline, questionnaires were returned by 1,422 participants (Single WEB: 277; Single IVR: 286; Repeated WEB: 259; Repeated IVR: 279; Control group: 321). It was found that peak estimated BAC was reduced in the total group (b -0.14, 95% confidence interval (CI) -0.023; -0.005), in the total (b -0.17, 95% CI -0.027; -0.007) and single (b -0.021, 95% CI -0.032; -0.011) WEB group, and in the total (b -0.011, 95% CI -0.021; -0.015) and repeated (b -0.012, 95% CI -0.023; -0.000) IVR groups, compared to controls. The reduction in peak estimated BAC was greater in the single WEB group compared to the single IVR group (b -0.011, 95% CI -0.022; -0.000). This study concluded that both WEB and IVR interventions have a small but significant effect in reducing heavy episodic drinking, which may be due to the relatively large sample size. Repeated intervention may be needed if delivered by IVR.

  • 2. Bloomfield, K.
    et al.
    Rossow, I.
    Norström, Thor
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Changes in Alcohol-Related Harm after Alcohol Policy Changes in Denmark2009In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 15, no 4, p. 224-231Article in journal (Refereed)
    Abstract [en]

    Objectives: This paper examines changes in alcohol-related harm in Denmark between 2003 and 2005 after changes in alcohol policies were introduced between 2003 and 2005. Methods: Interrupted time series analysis was performed with data on violent assaults and hospitalisations for acute alcohol intoxication from 2003 through 2005. Results: A 26% increase in the number of acute alcohol intoxication hospitalisations among people aged 15 years and younger was detected after the tax reduction on spirits. No significant increase in violent assaults and acute intoxication among adults was found. Conclusions: Even modest alcohol price policies can affect more vulnerable population sub-groups such as under-age youth. Policy makers should consider such consequences when forming economic policies that also have public health implications.

  • 3. Bramness, Jorgen G.
    et al.
    Henriksen, Beate
    Persson, Olle
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Mann, Karl
    A Bibliometric Analysis of European versus USA Research in the Field of Addiction. Research on Alcohol, Narcotics, Prescription Drug Abuse, Tobacco and Steroids 2001-20112014In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 20, no 1, p. 16-22Article in journal (Refereed)
    Abstract [en]

    Background: To compare the publication and citation rate within the areas of drug abuse and dependence research in Europe with that in the USA. Methods: This is a bibliometric study using the Thomson Reuters Web of Knowledge as data source, 40 key words were used as search terms, but certain scientific publications not concerning the issue were excluded. Scientific publications from Denmark, England, Finland, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the USA were studied. The number of publications in each country and in each year in addition to the citation indices for these publications was retrieved. Results: Approximately two thirds of the publications came from the USA. Both in absolute and relative figures, Europe lagged behind. The trend over the last decade was a greater gap between the amount of research performed in Europe versus the USA. There were thematic differences. Smaller European countries had a greater relative publication rate. The citations were relatively evenly distributed. Conclusions: It has been claimed that 85% of the world's research within the field of drug abuse and dependence is carried out in the USA. This study challenges this figure, but European research within this field is lagging behind. Copyright (C) 2013 S. Karger AG, Basel

  • 4. Bramness, Jørgen G.
    et al.
    Henriksen, Beate
    Person, Olle
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Mann, Karl
    Bibliographic searches for a bibliometric analysis on drug addiction reply2015In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 21, no 1, p. 32-32Article in journal (Refereed)
  • 5. Broekaert, E.
    et al.
    Haack, M-J.
    Kaplan, C.
    Oberg, D.
    Stockholm University, Faculty of Social Sciences, Department of Social Work. National Board of Institutional Care [SIS], Sweden.
    Sallmén, B.
    National Board of Institutional Care [SIS], Sweden.
    Segraeus, Vera
    National Board of Institutional Care [SIS], Sweden.
    Soyez, V.
    Wilson, J.
    The Biomed II IPTRP Project: Implementation of Diagnostic Instruments2002In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 8, no 4, p. 201-203Article in journal (Refereed)
  • 6. Czobor, Pal
    et al.
    Bacskai, Erika
    Öberg, David
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Haack, Marie-Jeanne
    Gerevich, Jozsef
    The European Adolescent Assessment Dialogue (EuroADAD): A Psychometric Evaluation2011In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 17, no 6, p. 302-315Article in journal (Refereed)
    Abstract [en]

    Background: The Adolescent Drug Abuse Diagnosis (ADAD) has been a gold standard for assessing drug use and associated problems in adolescents. Criticism of the instrument has been increasing. A new instrument, the European Adolescent Assessment Dialogue (EuroADAD) that builds on ADAD's strengths but seeks to address its limitations is now available, but has not been subjected to comprehensive psychometric evaluation. Objective: To examine the psychometric properties of the EuroADAD across various settings in adolescent populations who developed or were at a high risk of developing substance use and psychosocial adaptation problems. Participants and Settings: Three of the samples were collected in Hungary, including: institutionalized youths from juvenile residential facility (n = 295); adolescents from outpatient psychiatry facility (n = 278), and controls (n = 59). An additional sample was collected in the Netherlands, and consisted of adolescent boys from an independent residential institution for youth with severe behavioral problems (n = 51). Procedure: The EuroADAD was administered by trained interviewers. Data were collected through face-to-face interviews and self-report questionnaires. Results: Reliability: the intraclass correlation was high for all domains of the EuroADAD; reliability analyses indicated good test-retest reliability, and internal consistency. Validity: difference among study samples was significant (p < 0.05) for the majority of the domains, with juvenile institution and psychiatric outpatient subjects exhibiting higher severity in most areas compared to controls. The Hungarian and Dutch samples were comparable, expect for the legal domain, due to the higher severity of behavioral problems in the Dutch sample. Several domains of the instrument, including 'alcohol', 'drugs' and 'legal' showed an association with trait aggression as measured by the Buss-Perry Aggression Questionnaire and with Novelty Seeking on the Cloninger Temperament and Character Inventory. Conclusion: Based on the pattern and significance of group differences, and correlations with other measures, the scale has good criterion, and convergent and discriminant construct validity. The EuroADAD is a reliable and valid tool for the assessment of alcohol and drug use, and related psychosocial problems in adolescents.

  • 7. Frick, Ulrich
    et al.
    Gmel, Gerhard
    Rehm, Jürgen
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Average volume of alcohol consumption, drinking patterns and related burden of mortality in young people in established market economies in Europe2001In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 7, no 3, p. 148-151Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine the burden of mortality in young people (age 15-29) in established market economies in Europe in 1999, which is attributable to alcohol consumption. Two dimensions of alcohol consumption were considered: average volume of consumption, and patterns of drinking.

    METHODS:Mortality data were obtained from the WHO EIP data bank, average volume data from the WHO global databank on alcohol, pattern of drinking data from a questionnaire sent out to experts, from the published literature and from the WHO global databank. Methods are explained and discussed in detail in two other contributions to this volume.

    RESULTS:More than 8,000 deaths of people aged 15-29 in Europe in 1999 were attributable to alcohol. Young males show a higher proportion of alcohol-attributable deaths (12.8%) than females (8.3%). Both average volume and patterns of drinking contribute to alcohol-related death.

    CONCLUSIONS:Alcohol-related deaths constitute a considerable burden in young people in Europe.

  • 8.
    Grittner, Ulrike
    et al.
    Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Institute for Medical Informatics, Biometrics & Epidemiology.
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Bloomfield, Kim
    Centre for Alcohol and Drug Research, University of Aarhus .
    Changes in Alcohol Consumption in Denmark after the Tax Reduction on Spirits2009In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 15, no 4, p. 216-223Article in journal (Refereed)
    Abstract [en]

    Aims: This paper examines changes in alcohol consumption in Denmark between 2003 and 2006 after the excise tax on spirits in Denmark was lowered by 45% on October 1, 2003 and travelers' allowances for the import of alcohol were increased on January 1, 2004. Methods: Cross-sectional and panel data from Denmark from 2003 to 2006 were analyzed. Samples were collected by telephone interviews using random digit dialing. Results: Panel data for Denmark revealed that alcohol consumption remained relatively stable. Similar results were found in the Danish cross-sectional data. It appears that 'substitution' rather than increased importation occurred. Conclusion: We found no evidence to support earlier research stating that decreased prices and increased availability is related to higher alcohol consumption. This could be partly because (1) Denmark has reached a 'saturation' level of consumption over the past 30 years and (2) the survey mode of data collection did not capture specific subpopulations who might have increased their consumption. It may be necessary to examine other indicators of alcohol use or alcohol-related harm in order to fully assess the consequences of such changes in alcohol availability.

  • 9.
    Gustafsson, Nina-Katri
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Alcohol consumption in southern Sweden after major decreases in Danish spirits tax and increases in Swedish traveller's quotas2010In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 16, no 4, p. 152-161Article in journal (Refereed)
    Abstract [en]

    Background. In 2003, Denmark lowered its tax on spirits, and in 2004, Sweden increased its traveller import quotas. Aim. The aim was to determine whether these two changes increased self-reported alcohol consumption in southern Sweden, which is located near to Denmark. Method. Data were collected through telephone interviews with the general population between 2003 and 2006. People aged 16-80 years were interviewed. Some lived in southern Sweden, others in the northern region, which was assumed to be unaffected by the policy changes and thus used as a control site. Analyses were performed for the total population as well as by sex, age, socio-economic group and by consumption pattern. Results. The expected results were not found; alcohol consumption in southern Sweden had not changed. The few statistically significant changes found in southern Sweden indicated decreases. In the north, however, consumption seemed to have increased. Conclusion. In addition to the two policy changes mentioned above, other changes seem to have affected alcohol consumption in Sweden. It is possible, however, that the policy changes have affected population groups not reached by surveys, and thus other types of data need to be analysed before drawing any far-reaching conclusions.

  • 10. Gyepesi, Aron
    et al.
    Urban, Robert
    Farkas, Judit
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Semmelweis University.
    Piontek, Daniela
    Paksi, Borbala
    Horvath, Gergely
    Magi, Anna
    Eisinger, Andrea
    Pilling, Janos
    Koekoenyei, Gyoengyi
    Kun, Bernadette
    Demetrovics, Zsolt
    Psychometric Properties of the Cannabis Abuse Screening Test in Hungarian Samples of Adolescents and Young Adults2014In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 20, no 3, p. 119-128Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of our study was to analyze psychometric properties of the Cannabis Abuse Screening Test (CAST). Methods: Our sample comprised Hungarian high school (n = 476; male 56.3%; mean age 19.0 years, SD = 0.65 years) and college students (n = 439; male 65.1%; mean age 23.9 years, SD = 1.56 years) who reported cannabis use in the past year. The sample covered the five biggest universities of Hungary. Besides the CAST, participants responded to the Munich-Composite International Diagnostic Interview. Factor structure was analyzed by a confirmatory factor analysis. Receiver operating characteristic curve analysis was made to assess cut-off scores. Data collection took place in 2010. Results: CAST proved to be a reliable (Cronbach's alpha 0.71 and 0.76) one-dimensional measure. Regarding both cannabis dependence and cannabis use disorders, a cut-off of 2 points proved to be ideal in both samples, resulting in optimal specificity, negative predictive values and accuracy, but less than optimal positive predictive values (dependence) and low sensitivity (cannabis use disorder). Discussion and Conclusions: In line with former results, the CAST proved to be an adequate measure for the screening of cannabis-related problems among adolescents and young adults in an Eastern European country where this scale has not been studied before. (C) 2013 S. Karger AG, Basel

  • 11. Haasen, C.
    et al.
    Prinzleve, M.
    Zurhold, H.
    Rehm, J.
    Guettinger, F.
    Fischer, G.
    Jagsch, R.
    Olsson, Börje
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Ekendahl, M.
    Verster, A.
    Composeragna, A.
    Pezous, A.-M.
    Gossop, M.
    Manning, V.
    Cox, G.
    Ryder, N.
    Gerevich, J.
    Bacskai, E.
    Casas, M.
    Matali, J.L.
    Krausz, M.
    Cocaine use in Europe - a multi-centre study: Methodology and prevalence estimates2004In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 10, no 4, p. 139-146Article in journal (Refereed)
    Abstract [en]

    An increase in the use of cocaine and crack in several parts of Europe has raised the question whether this trend is similar to that of the USA in the 1980s. However, research in the field of cocaine use in Europe has been only sporadic. Therefore, a European multi-centre and multi-modal project was designed to study specific aspects of cocaine and crack use in Europe, in order to develop guidelines for public health strategies. Data on prevalence rates were analysed for the general population and for specific subgroups. Despite large differences between countries in the prevalence of cocaine use in the general population, most countries show an increase in the last few years. The highest rate with a lifetime prevalence of 5.2% was found for the United Kingdom, although with a plateau effect around the year 2000. With regard to specific subgroups, three groups seem to show a higher prevalence than the general population: (1) youth, especially in the party scene; (2) socially marginalized groups, such as homeless and prostitutes or those found in open drug scenes; (3) opiate-dependent patients in maintenance treatment who additionally use cocaine. Specific strategies need to be developed to address problematic cocaine use in these subgroups.

  • 12. Hansagi, Helen
    et al.
    Engdahl, Barbro
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Romelsjo, Anders
    Predictors of Repeated Emergency Department Visits among Persons Treated for Addiction2012In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 18, no 2, p. 47-53Article in journal (Refereed)
    Abstract [en]

    Background/Aims: To determine whether frequent emergency department (ED) users who enter specialized treatment programs for alcohol and/or drug problems have any characteristics that predict their future ED use. Methods: Adult patients (783 alcohol users, 405 illicit drug users) were interviewed. Data from the medical database on utilization of ED and the emergency departments' specific units for addictive diseases (EDAD) 12 months before and 12 months after the interview were linked with patient characteristics in logistic regression models. Results: Among alcohol users, prior ED/EDAD visits predicted repeat future visits to these sites (OR 11.6; 95% CI 6.5-20.5). Prior inpatient hospital care with addiction diagnosis was a predictor of future multiple visits to the EDAD only (OR 3.1; 95% CI 1.5-6.5). Among drug users, predictors of future ED/EDAD visits were use of heroin (OR 2.7; 95% CI 1.4-5.4) and prior ED/EDAD visits (OR 27.3; 95% CI 12.7-58.4). Drug users' EDAD utilization was also predicted by inpatient hospital care with addiction diagnosis. Conclusion: The strongest predictive factors of visiting ED repeatedly were previous repeat emergency care use and hospitalization with addiction diagnosis. Entering regular addiction treatment does not appear to alter the pattern of ED utilization.

  • 13.
    Israelsson, Magnus
    Mid Sweden University, Faculty of Human Sciences, Department of Social Work.
    Welfare, temperance and compulsory commitment to care for persons with substance misuse problems: a comparative study of 38 European countries2011In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 17, no 6, p. 329-341Article in journal (Refereed)
    Abstract [en]

    Aims: The study explores the existence and types of law on compulsory commitment to care (CCC) of adult substance misusers in Europe and how such laws are related to variations in demographics, alcohol consumption and epidemiology in misuse of opiates, cocaine, amphetamines, temperance culture heritage, health and welfare expenditure, and involvement and role of the state in welfare distribution. Material and Methods: Legal information on laws on CCC of misusers was obtained primarily through a survey of 38 European countries. Predictors of laws on CCC, and types of such, were analyzed from country descriptors in multivariate models. Results: A majority (74%) of the explored countries have a law concerning CCC. The most common type of CCC law is within criminal justice legislation (45%), but civil CCC is almost as frequent (37%). These two models of CCC legislation are related to differences in cultural heritage and welfare distribution models. Conclusions: Temperance cultures, i.e. countries with a history of a strong temperance movement, and countries with a Beveridgean distribution of welfare, i.e. through the state, tend to favor civil CCC, while countries with a Bismarckian distribution of welfare, i.e. through insurance with less state interference, tend to favor CCC within criminal justice legislation.

  • 14.
    Israelsson, Magnus
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Work.
    Gerdner, Arne
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Forskningsplattformen socialt arbete.
    Compulsory commitment to care of substance misusers - international trends during 25 years2012In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 6, no 18, p. 302-321Article in journal (Refereed)
    Abstract [en]

    Purpose:The study explores international trends in law on compulsory commitment to care of substance misusers (CCC), and two subtypes – civil CCC and CCC within criminal justice legislation – as well as maximum length and amount of applications of such care. Method: The time period covers more than 25 years, and a total of 104 countries and territories. The study is based on available data in three times of observation (1986, 1999 and 2009). Applications of CCC in number of cases are studied on European level for the years 2002–2006. Trends are analyzed using nonparametric tests and general linear models for repeated measures. Findings are discussed from contextual analysis. Result:  There is a trend towards decrease in the number of countries worldwide having civil CCC legislation after the millennium, while CCC under criminal law has increased since the mid-1980s, resulting in some total net decrease. The shift results in longer mean duration of CCC and an increase in the number of cases sentenced. Conclusion:  There is a risk that the shift from civil CCC to penal CCC implies more focus on young outacting males in compulsory treatment and that the societal responsibility for more vulnerable persons might be neglected.

  • 15.
    Israelsson, Magnus
    et al.
    Institutionen för socialt arbete, Mittuniversitetet, Östersund.
    Gerdner, Arne
    Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work.
    Compulsory commitment to care of substance misusers: international trends during 25 years2012In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 18, no 6, p. 302-321Article in journal (Refereed)
    Abstract [en]

    Purpose: The study explores international trends in law on compulsory commitment to care of substance misusers (CCC), and two subtypes – civil CCC and CCC within criminal justice legislation – as well as maximum length and amount of applications of such care. Method: The time period covers more than 25 years, and a total of 104 countries and territories. The study is based on available data in three times of observation (1986, 1999 and 2009). Applications of CCC in number of cases are studied on European level for the years 2002–2006. Trends are analyzed using nonparametric tests and general linear models for repeated measures. Findings are discussed from contextual analysis. Result: There is a trend towards decrease in the number of countries worldwide having civil CCC legislation after the millennium, while CCC under criminal law has increased since the mid-1980s, resulting in some total net decrease. The shift results in longer mean duration of CCC and an increase in the number of cases sentenced. Conclusion: There is a risk that the shift from civil CCC to penal CCC implies more focus on young out-acting males in compulsory treatment and that the societal responsibility for more vulnerable persons might be neglected.

  • 16. Jenner, H.
    et al.
    Segraeus, Vera
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The Swedish DOC-system: an attempt to combine documentation and selfevaluation2005In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 11, no 4, p. 186-192Article in journal (Refereed)
    Abstract [en]

    This article addresses the issue of how documentation can become a regular and competence-raising activity in treatment settings. A documentation system in Sweden (the DOC system) is used as an illustrative example. Two propositions are put forward and discussed: it is important that (1) the documentation be in accordance with the interests of the practitioners, and (2) that the documentation be used for self-evaluation, in order to enhance the practitioners' competence. Based on experiences using the DOC system, some general observations about how to implement the forms and self-evaluation are presented. Finally, some research prospects are outlined.

  • 17. Kallmen, Hakan
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Leifman, Hakan
    Bergman, Hans
    Berman, Anne H.
    Alcohol Habits in Sweden during 1997-2009 with Particular Focus on 2005 and 2009, Assessed with the AUDIT: A Repeated Cross-Sectional Study2011In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 17, no 2, p. 90-96Article in journal (Refereed)
    Abstract [en]

    Aim: This study aimed to survey the changes in alcohol habits during a period with the European Union legal practices. Methods: Alcohol habits in Sweden were surveyed in the general Swedish population at four timepoints, in 1997, 2001, 2005 and 2009, using the 10-item AUDIT questionnaire. Design: Four separate randomly drawn cross-sectional samples of 1,250 individuals were surveyed at each timepoint. Results: An average of 70% of the sampled individuals responded to the AUDIT questionnaire. Men had higher total AUDIT scores than women in 2005 and 2009, but scores increased among women 61-71 years old and decreased among men 61-71 years old. Younger men and women 17-27 years old decreased their AUDIT-C consumption scores by almost 20% between 2005 and 2009. An analysis of problem drinkers (+8 for men/+6 for women) indicated that a larger proportion of elderly women drank moderately in 2009 compared with 2005, but fewer elderly women drank hazardously. Conclusions: Earlier increases in drinking levels between 1997 and 2001 may reflect a latent high demand that was restricted by low availability. When availability due to European Union harmonization increased, alcohol consumption followed suit. After a period of adaptation, alcohol consumption appears to have stabilized.

  • 18.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, München, Germany.
    Pabst, Alexander
    Piontek, Daniela
    Gmel, Gerrit
    Shield, Kevin D.
    Frick, Hannah
    Rehm, Juergen
    Temporal Changes in Alcohol-Related Morbidity and Mortality in Germany2015In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 21, no 5, p. 262-272Article in journal (Refereed)
    Abstract [en]

    Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18-64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

  • 19.
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Population drinking and fatal injuries in Eastern Europe: A time-series analysis of six countries2010In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 16, no 1, p. 43-52Article in journal (Refereed)
    Abstract [en]

    Aims: To estimate to what extent injury mortality rates in 6 Eastern European countries are affected by changes in population drinking during the post-war period. Data and Methods: The analysis included injury mortality rates and per capita alcohol consumption in Russia, Belarus, Poland, Hungary, Bulgaria and the former Czechoslovakia. Total population and gender-specific models were estimated using auto regressive integrated moving average time-series modelling. Results: The estimates for the total population were generally positive and significant. For Russia and Belarus, a 1-litre increase in per capita consumption was associated with an increase in injury mortality of 7.5 and 5.5 per 100,000 inhabitants, respectively. The estimates for the remaining countries ranged between 1.4 and 2.0. The gender-specific estimates displayed national variations similar to the total population estimates although the estimates for males were higher than for females in all countries. Conclusions: The results suggest that changes in per capita consumption have a significant impact on injury mortality in these countries, but the strength of the association tends to be stronger in countries where intoxication-oriented drinking is more common.

  • 20.
    Landberg, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Hemmingsson, Tomas
    Sydén, Lovisa
    Ramstedt, Mats
    The Contribution of Alcohol Use, Other Lifestyle Factors and Working Conditions to Socioeconomic Differences in Sickness Absence2020In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 26, no 1, p. 40-51Article in journal (Refereed)
    Abstract [en]

    Introduction: This study investigates how alcohol use contributes to the social gradient in sickness absence. Other factors assessed include lifestyle factors (smoking, physical activity and body mass index), physical and psychosocial working conditions. Methods: The study used baseline data from the Stockholm public health cohort 2006, with an analytical sample of 17,008 respondents aged 25-64 years. Outcome variables included self-reported short-term (<14 days) and register-based long-term (>14 days) sickness absence. Socioeconomic position (SEP) was measured by occupational class. Alcohol use was measured by average weekly volume and frequency of heavy episodic drinking. Negative binominal regression was used to estimate sex-specific SEP differences in sickness absence, before and after adjusting for alcohol use and the additional explanatory factors. Results: Adjusting for alcohol use attenuated the SEP differences in long-term sickness absence by 20% for men and 14% for women. Alcohol use explained a smaller proportion of the differences in short-term sickness absence. Alcohol use in combination with other lifestyle factors attenuated the SEP differences (20-35%) for both outcomes. Physical working conditions explained more than half of the gradient in long-term sickness absence, whereas psychosocial conditions had greater impact on short-term sickness absence among men. Discussion/Conclusion: Alcohol use explains a substantial proportion of the SEP disparities in long-term sickness absence among men. The effect is smaller among women and for short-term sickness absence. Our findings support the notion that physical working conditions constitute the key explanatory variable for SEP differences in long-term sickness absence, but add that psychosocial working conditions have greater impact on the gradient in short-term sickness absence among men.

  • 21. Legleye, Stephane
    et al.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Piontek, Daniela
    Phan, Olivier
    Jouanne, Celine
    Validation of the cannabis abuse screening test in a sample of cannabis inpatients2012In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 18, no 4, p. 193-200Article in journal (Refereed)
    Abstract [en]

    The present study aims at validating the Cannabis Abuse Screening Test (CAST) in a clinical sample of adolescent and young adult cannabis users seeking treatment. Applying a classical test theory approach using DSM-IV diagnoses as gold standard, two versions of the CAST questionnaire are compared. The sample consisted of 140 subjects aged 15-26 years (mean 18.9) recruited from two cannabis treatment centers. Gold standard diagnoses were assessed using the Adolescent Diagnostic Interview-Light. Internal structure and consistency of the CAST were assessed by principal component analysis and Cronbach's alpha. Optimal thresholds were defined using receiver operating characteristic analysis. Both the binary and the full test version revealed unidimensional structures with moderate to satisfactory internal consistency (alpha = 0.66 and 0.73). Screening properties were unsatisfactory when the CAST was compared against cannabis dependence. With regard to cannabis use disorders, both test versions yielded comparable and good sensitivity and specificity at cut-off 3 (binary: 92.2%, 66.7%) and 6 (full: 93.0%, 66.7%). Overall, the full CAST may be used for screening cannabis use disorders in clinical settings. Further research may use validation methods that do without gold standard.

  • 22.
    Palm, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Sweden: integrated compulsory treatment2002In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 8, no 2, p. 69-77Article in journal (Other academic)
    Abstract [en]

    In the year 2000, 804 adults were in coercive care for a maximum of 6 months under the Swedish Act on Care of Addicts in Certain Cases, which has both paternalistic and utilitarian motives. The extensive rights of the state to intervene in the private lives of its citizens seem to have a solid support in society. The article describes the present system and offers some explanations for its acceptance by looking at history. The fact that compulsory decisions have been made within the social administration has meant that such measures grew with the welfare system and could benefit from its goodwill. The medical profession provided motivation for preventive compulsory measures for social or individual reasons and gave hope for a cure. The crucial involvement of laypersons and non-governmental organisations in decision-making and provision of compulsory treatment has given compulsory treatment a high political legitimacy. Compulsion became ‘internalised’ in the Swedish society. The economic and political liberalisation of today may pose a threat to the Swedish compulsory treatment of substance misusers.

  • 23.
    Philips, Björn
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Stockholm County Council, Sweden; Karolinska Institutet, Sweden.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Konradsson, Per
    Franck, Johan
    Mentalization-Based Treatment for Concurrent Borderline Personality Disorder and Substance Use Disorder: A Randomized Controlled Feasibility Study2018In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 24, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Aims: There is a scarcity of clinical trials on psychological treatments for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Mentalization-based treatment (MBT) have shown efficacy in several trials on BPD. The aim of the present study was to examine the feasibility and effectiveness of MBT for concurrent BPD and SUD. Methods: Patients (n = 46) with concurrent BPD and SUD were randomized either to MBT in combination with SUD treatment (n = 24) or to SUD treatment alone (n = 22). Outcome was measured after 18 months using objective data, as well as interview and self-report measures. Results: There was no significant difference between the groups on any outcome variable. No suicide attempts occurred in the MBT group in contrast to 4 suicide attempts that occurred in the control group - a difference that did not reach statistical significance (p = 0.06). A majority of the therapists did not show sufficient MBT adherence and quality. Conclusion: MBT for patients with concurrent BPD and SD does not appear to be harmful; on the other hand, it is possibly helpful in reducing the risk involved in suicide attempts.

  • 24. Prinzleve, M.
    et al.
    Haasen, C.
    Zurhold, H.
    Matali, J.L.
    Bruguera, E.
    Gerevich, J.
    Bacskai, E.
    Ryder, N.
    Butler, S.
    Manning, V.
    Gossop, M.
    Pezous, A.-M.
    Verster, A.
    Camposeragna, A.
    Andersson, P.
    Olsson, Börje
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Primorac, A.
    Fischer, G.
    Guettinger, F.
    Rehm, J.
    Krausz, M.
    Cocaine use in Europe - a multi-centre study: Patterns of use in different groups2004In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 10, no 4, p. 147-155Article in journal (Refereed)
    Abstract [en]

    AIM:

    The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities.

    DESIGN, SETTING, PARTICIPANTS:

    Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment.

    MEASUREMENTS:

    Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. Findings: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days.

    CONCLUSIONS:

    The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.

  • 25. Rehm, J.
    et al.
    Rehn, N.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Monteiro, M.
    Gmel, G.
    Jernigan, D.
    Frick, U.
    The global distribution of average volume of alcohol consumption and patterns of drinking2003In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 9, no 4, p. 147-156Article in journal (Refereed)
    Abstract [en]

    AIMS:To make quantitative estimates on a global basis of exposure of disease-relevant dimensions of alcohol consumption, i.e. average volume of alcohol consumption and patterns of drinking.

    DESIGN:Secondary data analysis.

    MEASUREMENTS:Level of average volume of drinking was estimated by a triangulation of data on per capita consumption and from general population surveys. Patterns of drinking were measured by an index composed of several indicators for heavy drinking occasions, an indicator of drinking with meals and an indicator of public drinking. Average volume of consumption was assessed by sex and age within each country, and patterns of drinking only by country; estimates for the global subregions were derived from the population-weighted average of the countries. For more than 90% of the world population, per capita consumption was known, and for more than 80% of the world population, survey data were available.

    FINDINGS:On the country level, average volume of alcohol consumption and patterns of drinking were independent. There was marked variation between WHO subregions on both dimensions. Average volume of drinking was highest in established market economies in Western Europe and the former Socialist economies in the Eastern part of Europe and in North America, and lowest in the Eastern Mediterranean region and parts of Southeast Asia including India. Patterns were most detrimental in the former Socialist economies in the Eastern part of Europe, in Middle and South America and parts of Africa. Patterns were least detrimental in Western Europe and in developed countries in the Western Pacific region (e.g., Japan).

    CONCLUSIONS:Although exposure to alcohol varies considerably between regions, the overall exposure by volume is quite high and patterns are relatively detrimental. The predictions for the future are not favorable, both with respect to average volume and to patterns of drinking.

  • 26. Rehm, J.
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Monteiro, M.
    Gmel, G.
    Graham, K.
    Rhen, N.
    Sempos, C.T.
    Jernigan, D.
    Alcohol as a risk factor for global burden of disease2003In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 9, no 4, p. 157-164Article in journal (Refereed)
    Abstract [en]

    AIM:To make quantitative estimates of the burden of disease attributable to alcohol in the year 2000 on a global basis.

    DESIGN:Secondary data analysis.

    MEASUREMENTS:Two dimensions of alcohol exposure were included: average volume of alcohol consumption and patterns of drinking. There were also two main outcome measures: mortality, i.e. the number of deaths, and disability-adjusted life years (DALYs), i.e. the number of years of life lost to premature mortality or to disability. All estimates were prepared separately by sex, age group and WHO region.

    FINDINGS:Alcohol causes a considerable disease burden: 3.2% of the global deaths and 4.0% of the global DALYs in the year 2000 could be attributed to this exposure. There were marked differences by sex and region for both outcomes. In addition, there were differences by disease category and type of outcome; in particular, unintentional injuries contributed most to alcohol-attributable mortality burden while neuropsychiatric diseases contributed most to alcohol-attributable disease burden.

    DISCUSSION/CONCLUSIONS:The underlying assumptions are discussed and reasons are given as to why the estimates should still be considered conservative despite the considerable burden attributable to alcohol globally.

  • 27. Rehm, Jürgen
    et al.
    Andersson, Peter
    Barry, Joe
    Dimitrov, Plamen
    Elekes, Zsuzsanna
    Feijão, Fernanda
    Frick, Ulrich
    Gual, Antoni
    Gmel, Gerrit Jr.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Marmet, Simon
    Raninen, Jonas
    Rehm, Maximilien X.
    Scafato, Emanuel
    Shield, Kevin D.
    Trapencieris, Marcis
    Gmel, Gerhard
    Prevalence of and potential influencing factors for alcohol dependence in Europe2015In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 21, no 1, p. 6-18Article in journal (Refereed)
    Abstract [en]

    Alcohol use disorders (AUDs), and alcohol dependence (AD)in particular, are prevalent and associated with a large burdenof disability and mortality. The aim of this study wasto estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and toinvestigate potential influencing factors. The 1-year prevalenceof AD in the EU was estimated at 3.4% among people18–64 years of age in Europe (women 1.7%, men 5.2%), resultingin close to 11 million affected people. Taking into accountall people of all ages, AD, abuse and harmful use resultedin an estimate of 23 million affected people. Prevalenceof AD varied widely between European countries, andwas significantly impacted by drinking cultures and socialnorms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking,such as liver cirrhosis or injury, were moderate. Theseresults suggest a need to rethink the definition of AUDs.

  • 28. Rehm, Jürgen
    et al.
    Monteiro, Maristela
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Gmel, Gerhard
    Jernigan, David
    Frick, Ulrich
    Graham, Kathryn
    Steps towards constructing a global comparative risk analysis for alcohol consumption:: Determining Indicators and Empirical Weights for Patterns of Drinking, Deciding about Theoretical Minimum, and Dealing with Different Consequences2001In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 7, no 3, p. 138-147Article in journal (Refereed)
    Abstract [en]

    In order to conduct a comparative risk analysis for alcohol within the Global Burden of Disease Study (GBD 2000), several questions had to be answered. (1) What are the appropriate dimensions for alcohol consumption and how can they be categorized? The average volume of alcohol and patterns of drinking were selected as dimensions. Both dimensions could be looked upon as continuous but were categorized for practical purposes. The average volume of drinking was categorized into the following categories: abstention; drinking 1 (>0–19.99 g pure alcohol daily for females, >0–39.99 g for males); drinking 2 (20–39.99 g for females, 40–59.99 g for males), and drinking 3 (≥40 g for females, ≥60 g for males). Patterns of drinking were categorized into four levels of detrimental impact based on an optimal scaling analysis of key informant ratings. (2) What is the theoretical minimum for both dimensions? A pattern of regular light drinking (at most 1 drink every day) was selected as theoretical minimum for established market economies for all people above age 45. For all other regions and age groups, the theoretical minimum was set to zero. Potential problems and uncertainties with this selection are discussed. (3) What are the health outcomes for alcohol and how do they relate to the dimensions? Overall, more than 60 disease conditions were identified as being related to alcohol consumption. Most chronic conditions seem to be related to volume only (exceptions are coronary heart disease and ischemic stroke), and most acute conditions seem to be related to volume and patterns. In addition, using methodology based on aggregate data, patterns were relevant for attributing harms for men but not women.

  • 29.
    Room, Robin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Graham, K.
    Rehm, J.
    Jernigan, D.
    Monteiro, M.
    Drinking and its burden in a global perspective: policy considerations and options2003In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 9, no 4, p. 165-175Article, review/survey (Refereed)
    Abstract [en]

    Aims: To identify the policy implications of the magnitude and characteristics of alcohol consumption and problems, viewed globally, and to summarize conclusions on the effectiveness of the strategies available to policymakers concerned with reducing rates of alcohol problems. Design/Methods/Setting: This summative article draws on the findings of the articles preceding it and of reviews of the literature. Findings and Conclusions: Overall volume of consumption is the major factor in the prevalence of harms from drinking. Since consumption and associated problems tend to increase with economic development, policymakers in developing economies should be especially aware of the need to develop policies to minimize overall increases in alcohol consumption. Unrecorded consumption is also an important consideration for policy in many parts of the world, and poses difficulties for alcohol control policies. Drinking pattern is also an important contributing factor toward alcohol-related harm. Although some drinking patterns have been shown to produce beneficial health effects, because the net effect of alcohol on coronary disease is negative in most parts of the world, policies that promote abstinence or lower drinking overall may be the safest options. Moreover, sporadic intoxication is common in many parts of the world, and policies are unlikely to change this drinking pattern at least in the short to medium term. At the same time, because injuries comprise a large proportion of the burden of alcohol, it is appropriate to enhance these policies with targeted harm reduction strategies such as drinking and driving countermeasures and interventions focused on reducing alcohol-related violence in specific high-risk settings. Alcohol consumption is a major factor for the global burden of disease and should be considered a public health priority globally, regionally, and nationally for the vast majority of countries in the world. The need for alcohol policy is even stronger when it is taken into consideration that the burden of alcohol estimated in the WHO Global Burden of Disease project includes primarily health problems related to drinking. From the limited evidence available, however, social problems related to drinking seem to impose at least as much burden. Moreover, the burden for both social and health harms fall not only on the drinker, but also on others. There is a broad literature on policy interventions to reduce alcohol problems. Effective strategies include controls over distribution and sale, taxation, drinking-driving countermeasures, brief interventions by health workers or counselors, and selected harm reduction measures. There is a need to develop the growing literature on comparative evaluations of cost-effectiveness of such strategies. In addition, international agreements are needed to support the effectiveness of national strategies.

  • 30. Savic, Michael
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Centre for Alcohol Policy Research, Turning Point, Australia; University of Melbourne, Australia.
    Differences in alcohol-related research publication output between countries: a manifestation of societal concern?2014In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 20, no 6, p. 319-323Article in journal (Refereed)
    Abstract [en]

    In a recent bibliometric analysis of alcohol- and other drugrelatedresearch publications in 11 countries, differenceswere found in research output across countries. In this paperwe use additional secondary data to explore possible sociohistoricalfactors that may contribute to differences in alcohol-related peer-reviewed publications across countries.Aside from general scientific productivity, we propose a possiblelink between the degree to which societies are concernedwith alcohol and alcohol-related research outputs.

  • 31.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Sellin, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Fahlke, Claudia
    Department of Psychology, University of Gothenburg, Göteborg, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    The Impact of Childhood Maltreatment on Age of Onset of Alcohol Use Disorder in Women2018In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 24, no 6, p. 278-285Article in journal (Refereed)
    Abstract [en]

    It is unclear whether exposure to childhood maltreatment is associated with the age of onset of alcohol use disorder (AUD). A group of socially stable women with AUD seeking treatment (n = 75) were interviewed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview. They also filled out the Childhood Trauma Questionnaire-short form. Emotional abuse, sexual abuse and multiple childhood traumas were found to be associated with earlier onset of AUD. Multivariable linear regression analysis showed that independent predictors for an earlier onset of AUD were exposure to emotional abuse (beta = -7.44, SE = 2.83, adjusted p = 0.010) and mother's alcohol/substance problems (beta = -7.87, SE = 3.45, adjusted p = 0.026). These variables explained 18.9% of the variance of age of onset of AUD. These findings highlight a need for increased clinical attention to AUD subgroups who have experienced childhood maltreatment, especially emotional abuse, as well as a need for including support in the patient's own parental role in the treatment.

  • 32. Sinadinovic, Kristina
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Johansson, Magnus
    Berman, Anne H.
    Targeting Individuals with Problematic Alcohol Use via Web-Based Cognitive-Behavioral Self-Help Modules, Personalized Screening Feedback or Assessment Only: A Randomized Controlled Trial2014In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 20, no 6, p. 305-318Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Most problematic alcohol users never seek professional help to reduce their use, and Web-based interventions might fulfill users' unmet needs for professional support. Methods: This randomized controlled trial compared two open Web-based interventions, one extended self-help program and one brief screening and feedback intervention, with an assessment-only control group. Participants were 633 Internet help seekers with at least hazardous alcohol use (Alcohol Use Disorders Identification Test, AUDIT >= 6 for women and >= 8 for men). Results: All groups reduced their alcohol use at 3-month follow-up (p < 0.001), remaining stable at the 6-and 12-month follow-ups (n.s.) according to AUDIT-C and AUDIT scores (intention-to-treat, ITT, analysis). Per protocol (PP) analysis, including only participants who accessed the interventions and also reported accessing additional outside interventions during the trial, showed that about 75% of extended self-help participants moved from probable dependence, harmful or hazardous use to lower alcohol use levels at 3- and 6- and 12-month follow-ups, compared to about 40-60% of brief intervention users and controls who accessed extra help (p < 0.05). Conclusion: ITT analysis suggested parity over time for all interventions, including assessment only, in reducing problematic alcohol use. In contrast, PP analysis suggested that cognitive- behavioral extended self-help in combination with other interventions was more effective in changing alcohol use than brief intervention or assessment only.

  • 33. Skarberg, Kurt
    et al.
    Nyberg, Fred
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Engström, Ingemar
    Is There an Association between the Use of Anabolic-Androgenic Steroids and Criminality?2010In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 16, no 4, p. 213-219Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of this study was to improve our understanding of the proposed association between anabolic-androgenic steroids (AAS) and criminality. Methods: The study was based on interviews and criminality data involving 32 users of AAS who had sought treatment for AAS-related problems at a psychiatric addiction clinic in Sweden. A score derived from the number of crimes, their level of severity and the relevant time periods was computed to allow comparisons between subgroups sorted according to type and timing of drug use. Results: The criminal activity level increased for 69% of the individuals after having started to use drugs. This was particularly obvious in the group who had started its involvement with drugs by using AAS. Crimes of violence and weapon offences showed a great increase in incidence after drug use had been initiated. The study also showed a significant decrease in criminality after treatment, particularly among individuals who had started their drug use with AAS. Conclusion: The results suggest that there is an association between the use of AAS and criminality, especially with regard to crimes of violence and weapon offences, and that this criminality may be enhanced when AAS are combined with other drugs of abuse.

  • 34. Skarberg, Kurt
    et al.
    Nyberg, Fred
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Engström, Ingemar
    Multisubstance use as a feature of addiction to anabolic-androgenic steroids2009In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 15, no 2, p. 99-106Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore and describe total drug use among anabolic-androgenic steroid (AAS) users and the reasons given for the use of these drugs. The study was based on semi-structured interviews and questionnaires involving 32 patients who were attending an addiction centre in Orebro, Sweden, for AAS use. The results indicated that a history of polysubstance use among the patients was frequent. Over half were using drugs of abuse and also taking various other pharmaceuticals. Almost half of the patients took human growth hormones, and almost half of the interviewed persons were drinking alcohol to a hazardous or harmful extent. The most common reason given for taking AAS and other hormones was to increase muscle mass and strength, but some participants also used insulin as a means of losing fat. Cannabis was used to improve sleep, heroin to decrease pain and amphetamine to increase endurance and burn fat. Our data suggest that most of the current AAS users who have been admitted to a treatment programme are multiple drug users with polysubstance dependence. The study stresses the importance of carefully examining total drug use as part of the assessment regimen for this group.

  • 35.
    Skårberg, Kurt
    et al.
    Örebro University, School of Health and Medical Sciences. Addiction Centre, Örebro County Council, Örebro, Sweden.
    Nyberg, Fred
    Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden .
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Is there an association between the use of anabolic-androgenic steroids and criminality?2010In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 16, no 4, p. 213-219Article in journal (Refereed)
    Abstract [en]

    Aims The aim of this study was to improve our understanding of the proposed association between anabolic-androgenic steroids (AAS) and criminality.

    Methods: The study was based on interviews and criminality data involving 32 users of AAS who had sought treatment for AAS-related problems at a psychiatric addiction clinic in Sweden. A score derived from the number of crimes, their level of severity and the relevant time periods was computed to allow comparisons between subgroups sorted according to type and timing of drug use.

    Results: The criminal activity level increased for 69% of the individuals after having started to use drugs. This was particularly obvious in the group who had started its involvement with drugs by using AAS. Crimes of violence and weapon offences showed a great increase in incidence after drug use had been initiated. The study also showed a significant decrease in criminality after treatment, particularly among individuals who had started their drug use with AAS.

    Conclusions: The results suggest that there is an association between the use of AAS and criminality, especially with regard to crimes of violence and weapon offences, and that this criminality may be enhanced when AAS are combined with other drugs of abuse.

  • 36.
    Skårberg, Kurt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nyberg, Fred
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Multisubstance use as a feature of addiction to anabolic-androgenic steroids2009In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 15, no 2, p. 99-106Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore and describe total drug use among anabolic-androgenic steroid (AAS) users and the reasons given for the use of these drugs. The study was based on semi-structured interviews and questionnaires involving 32 patients who were attending an addiction centre in Orebro, Sweden, for AAS use. The results indicated that a history of polysubstance use among the patients was frequent. Over half were using drugs of abuse and also taking various other pharmaceuticals. Almost half of the patients took human growth hormones, and almost half of the interviewed persons were drinking alcohol to a hazardous or harmful extent. The most common reason given for taking AAS and other hormones was to increase muscle mass and strength, but some participants also used insulin as a means of losing fat. Cannabis was used to improve sleep, heroin to decrease pain and amphetamine to increase endurance and burn fat. Our data suggest that most of the current AAS users who have been admitted to a treatment programme are multiple drug users with polysubstance dependence. The study stresses the importance of carefully examining total drug use as part of the assessment regimen for this group.

  • 37.
    Vallejo, Fernando
    et al.
    Centro Nacional de Epidemiología, Instituto de Salud Carlos III.
    Toro, Carlos
    Hospital Carlos III, Madrid.
    de la Fuente, Luis
    Centro Nacional de Epidemiología, Instituto de Salud Carlos III,.
    Brugal, M. Teresa
    Agència de Salut Pública de Barcelona, Barcelona .
    Soriano, Vicente
    Hospital Carlos III, Madrid.
    Silva, Teresa
    Secretaría del Plan Nacional sobre el Sida, Ministerio de Sanidad y Consumo, y .
    Bravo, Maria Jose
    Departamento de Medicina Preventiva, Salud Pública e Historia de la Ciencia, Universidad Complutense.
    Ballesta, Rosario
    Fundación Andaluza para la Atención a las Drogodependencias, Sevilla , España.
    Barrio, Gregorio
    Departamento de Medicina Preventiva, Salud Pública e Historia de la Ciencia, Universidad Complutense; .
    Prevalence of and risk factors for hepatitis B virus infection among street-recruited young injection and non-injection heroin users in Barcelona, Madrid and Seville2008In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 14, no 3, p. 116-124Article in journal (Refereed)
    Abstract [en]

    Background: To evaluate the prevalence of hepatitis B virus (HBV) and associated factors in 949 heroin users (HU): injectors (IHUs) and non-injectors (NIHUs). Methods: Cross-sectional study; structured questionnaire administered by computer-assisted personal interviewing and audio computer-assisted self-interviewing; dry blood samples analysed for the hepatitis B core antigen and hepatitis B surface antigen; bivariate analysis and logistic regression. Results: The prevalence of infection was significantly higher in IHUs (22.5%) than in NIHUs (7.4%) in the three cities. In the logistic analysis of male IHUs, infection was found to be associated with living in Seville, age over 25, foreign nationality, having had a sexual partner who traded sex, hepatitis C virus infection, and having injected for more than 5 years. In female IHUs, HBV infection was associated with age over 25, having injected as the first main route of administration, and having begun to inject before 18 years of age. In NIHUs, the associated factors were female gender, foreign nationality and having been tattooed. In young IHUs, the prevalence of HBV infection remains four times higher than in the general population of the same age group. Conclusion: The vaccination strategy urgently needs to be reinforced and redesigned to achieve acceptable control of the HBV infection in the most vulnerable groups, with special attention to immigrants.

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