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Young adult drinkers engage in a range of drinking patterns from abstaining to heavy drinking in both the United States and Sweden. Heavy drinking during young adulthood in both countries is associated with a variety of negative consequences. Personalized feedback interventions have been identified as effective prevention strategies to prevent or reduce heavy drinking in the United States. This study examined transitions in drinking profiles and compared the efficacy of a personalized feedback intervention for 3965 young adults in the United States (1,735) and Sweden (2230) during their transition out of high school. Using goodness-of-fit criteria, results indicated that three drinking profiles exist among young adults transitioning out of high school: very low drinkers/abstainers, moderate to heavy drinkers, and very heavy drinkers. Latent Markov models revealed a moderating effect of country on personalized feedback intervention such that intervention condition participants in the United States were more likely to belong to the light drinker/abstainer or moderate to heavy profile relative to the very heavy drinking profile at 6-month follow-up. There was no significant effect of personalized feedback intervention in Sweden. Future research could investigate the impact of when personalized feedback interventions are administered and could examine if personalized feedback interventions should be more intentionally culturally adapted in order to be more effective.

Aims: Marijuana is a popular drug among U.S. college students. In Sweden, the prevalence of marijuana use has been relatively low but is increasing. Brief, personalized interventions have been efficacious in reducing substance use, including marijuana, among college students in the U.S. However, prior to implementation of U.S. interventions in Sweden, it is important to compare factors associated with marijuana use among college students in the two countries. Design, Setting, and Participants: Data are from baseline assessments of two large college student intervention studies in the U.S. (N = 3,753, 39% male) and Sweden (N = 2,280, 35% male). Measures: Past 30-day prevalence and frequency of marijuana use was analyzed in regard to relevant demographic factors. The moderating role of nationality was also examined. Findings: Results support previous findings indicating marijuana use is more common in the U.S. than in Sweden. Most demographic factors were similar across the countries, except for relationship status and work status, in which associations with number of marijuana use days (but not odds of any marijuana use) were stronger for Swedish college students compared to U.S. college students. Conclusions: Based on overall similarities between the U.S. and Sweden, comparable interventions might be recommended in both countries.

Few studies have assessed acute dynamic risk repeatedly among paroled offenders to investigate the relationship between changes in acute dynamic risk and recidivism in crime. The present study investigates whether one-month changes in ten stress-related acute dynamic risk factors, collected through automated telephony while the participants were still in prison and over 30 consecutive days following parole, predict one-year criminal recidivism, including its predictive accuracy. The study also investigates whether a brief feedback intervention in conjunction with the daily assessments reduces recidivism compared to an assessment-only control group. Changes in five risk factors were found to be associated with increased risk of criminal recidivism after controlling for the results in prison, the initial value after parole, and the intervention. The predictive accuracy is marginally accurate: Summary score (AUC) = .666; Level of stress (AHSS) = .644; Psychiatric symptoms (SCL-8D) = .641; Anxiety symptoms = .673; Severity of most stressful daily event = .690. No differences in one-year recidivism rates were established between the intervention group and the control group. The study shows that daily assessments can usefully be made of dynamic risk factors in paroled offenders.

Alcohol use is common among United States and Swedish high school students and is related to negative consequences. Whereas drinking intentions are associated with future drinking behaviors, the use of protective behavioral strategies (PBS) is associated with decreased alcohol-related harm among young adults. The interactive effect of PBS and drinking intentions in predicting alcohol outcomes has not been examined. Further, because most PBS studies have been conducted among U.S. college students, PBS research among other populations is needed. The aims of this study were to evaluate longitudinally (a) the relationships between drinking intentions, PBS and alcohol outcomes, and (b) the moderating roles of drinking intentions and country in these relationships among United States and Swedish high school drinkers. Data were collected at baseline, 6- and 12-month follow-ups on 901 Swedish and 288 U.S. high school drinkers. Drinking intentions were associated with more alcohol use and consequences, and use of certain PBS was related to fewer alcohol-related consequences over time. Additionally, the negative prospective relationship between use of PBS and alcohol use, but not alcohol-related consequences, was moderated by intentions, such that the relationship was stronger among participants endorsing high drinking intentions. Country did not moderate these relationships. These results provide initial support for the generalizability of PBS college research to United States and Swedish high school students and suggest that interventions targeting the use of PBS may be most effective among high school drinkers endorsing high drinking intentions. (PsycINFO Database Record

Positive alcohol expectancies and alcohol use tend to increase from adolescence to young adulthood, yet little is known about the associations between these constructs across cultures. The current study adds to the extant literature by examining the growth trajectories of positive alcohol expectancies and drinking behavior among United States (US) and Swedish participants during a critical period where significant change in these outcomes may be expected to occur. A total of 870 (US, N = 362; Sweden, N = 508) high school seniors completed baseline, 6-month, and 12-month assessments of alcohol expectancies and drinking (i.e., drinks per week). Changes in positive alcohol expectancies and drinking behavior were examined using a parallel process latent growth model. In both samples, higher baseline levels of positive alcohol expectancies were associated with a higher number of drinks consumed per week at baseline. In the US sample, lower baseline levels of positive alcohol expectancies were associated with a greater increase in positive alcohol expectancies at 12-month follow-up, and lower baseline levels of drinks per week were associated with a greater increase in drinks consumed per week at 12-month follow-up. In the Swedish sample, an increase in positive alcohol expectancies over time was associated with an increase in drinks consumed per week over the same period of time. Additional research is needed to examine when and for whom expectancy-based alcohol interventions are most efficacious.

This study examines aspects of prediction of suicide and death of undetermined intent. We investigated all consecutive, autopsied patients between 1993 and 1997 who had been in contact with the Addiction Centre in Malmo from 1968 onwards. The staff was asked, shortly after autopsy but before they knew of the manner of death, if they thought the patient had committed suicide. The case records were blindly evaluated, and toxicological autopsy findings for alcohol in blood samples investigated. The specificity of prediction was 83% and significantly more often correct than the sensitivity, which was only 45% for suicide and for suicide/death of undetermined intent (93% versus 39%). Suicidal communication was more often considered non-serious before death of undetermined intent than before suicide. The former could be predicted by ideation but not by suicide attempt reported in case records, unlike suicide, which was predicted by both. The undetermined group also showed higher levels of alcohol in the blood at autopsy. We concluded that more serious clinical investigation of suicidal feelings, which may be hidden and not taken seriously, and treatment of alcohol use disorders with active follow-up appear urgent in the efforts to prevent suicide.

Objectives: Several studies have shown mortality and suicide risk in substance use disorders, and autopsy findings with respect to the used substances. However, there seems to be a gap in the knowledge about substances misused in life and at death at the within-person level. Methods: All consecutive, autopsied patients during 1993 to 1997, who had been in contact with the Addiction Centre in Malm&ouml, from 1968, were investigated (365 subjects). Drug misuse in the long-term course noted in case records was related to autopsy findings. Self-inflicted death (suicide/undetermined suicide/accidental overdose) was compared with natural death. Results: Benzodiazepine misuse was associated with a high risk of autopsy findings of the substance in suicide and death of undetermined intent. It was also associated among non-misusers, but less so. An alcohol level above 1&permil, was found more often in self-inflicted death. Prescription opioids at autopsy were mainly found in self-inflicted death among non-misusers. Heroin misuse was related to overdose. Central nervous system stimulants (CNS-S) and cannabis were rarely found in self-inflicted death among previous misusers. The overlap between depression in life and antidepressants at death was low. Conclusions: Benzodiazepines and alcohol seem to disinhibit suicidal tendencies. Suicide risk among users of cannabis and CNS-S may be related to other risk factors than acute use. Implications for suicide prevention are discussed.

Objective Adolescent alcohol use predicts a myriad of negative mental and physical health outcomes including fatality (Midanik, 2004). Research in parental influence on alcohol consumption finds parental monitoring (PM), or knowing where/whom your child is with, is associated with lower levels of alcohol use in adolescents (e.g., Arria et al., 2008). As PM interventions have had only limited success (Koutakis, Stattin, & Kerr, 2008), investigating moderating factors of PM is of importance. Country may serve as one such moderator (Calafat, Garcia, Juan, Becona, & Fernandez-Hermida, 2014). Thus, the purpose of the present report is to assess the relationship between PM and alcohol use in the US and Sweden. Method High school seniors from the US (n = 1181, 42.3% Male) and Sweden (n = 2171, 44.1% Male) completed assessments of total drinks consumed in a typical week, problematic alcohol use, and perceived PM. Results Generalized linear mixed modeling (GLM, Cohen, Cohen, West, & Aiken, 2013; Hilbe, 2011) was used to examine whether country moderated the relationship between PM and alcohol use. Results revealed main effects of country and PM and a significant interaction between country and PM in predicting total drinks per week and PM in predicting problematic alcohol use (p Conclusions While PM is related to lower quantity of alcohol consumed and problematic alcohol use, greater PM appears to be more strongly related to fewer drinks per week and less problematic alcohol use in the US, as compared to Sweden.

Aims: To analyse correlates of anabolic androgenic steroids (AAS) use in the general male population. Design: A national household survey. Participants: Individuals aged 15–64 years in Sweden. Measurements: AAS use and potential correlates of AAS use, including demographic data, financial situation, physical training, and substance use. In hierarchical logistic regression analyses, lifetime users of AAS (n = 240) were compared to all nonusers (n = 13,920) and to nonusers who reported that they had been offered AAS (n = 487). Results: AAS use was most strongly associated with a lifetime history of illicit drug use and the misuse of prescription drugs. When controlling for substance use, AAS was associated with physical training and lower education. Illicit drug use and misuse of prescription drugs separated AAS users from nonusers who had been offered AAS. No associations were seen with AUDIT scores for risk alcohol drinking. Conclusions: In this general population survey in men, lifetime use of AAS appears to share common characteristics with illicit substance use. Both substance use variables and physical training remained associated with AAS use when controlling for one another.

M. Lindén-Boström & C. Persson & M. Berglund: Risk consumption of alcohol among older people – results from a Swedish population study Aim The aim of this study was to describe risk consumption of alcohol among older people and relate it to living conditions, health behaviour, social support and health. Method We used data from Life & Health 2008, a postal questionnaire to inhabitants aged 18–84 in 55 municipalities in central Sweden. The study population included 40 267 respondents aged 18–84 and 21 326 respondents aged 55–84. The overall response rate was almost 60 per cent, a figure that differed between age groups with the highest rate, >70 per cent, among respondents aged 65–79. The first three questions in the AUDIT questionnaire were used to estimate risk consumption. They were also analysed separately to describe different patterns of alcohol consumption. Results In the 65–75 age group, 2.7 per cent of men and 1.9 per cent of women could be defined as risk consumers of alcohol. In the 76–84 age group, the corresponding figure is less than 1 per cent for both sexes. Risk consumption is related to high education, smoking, use of snuff, physical inactivity, psychological distress and use of tranquilisers. Conclusion Targeted preventive strategies need to be developed to tackle risk consumption among older people.

Aims: The aim of the study was to compare alcohol use, consequences and common risk factors between American and Swedish college students. Methods: A secondary comparative analysis from one American and two Swedish studies in college settings. Results: Swedish freshmen report higher alcohol use than US freshmen students. Swedish residence hall students report higher alcohol use than US residence hall students, but lower than American fraternity/sorority members. US students were less likely to be drinkers. Controlling for age, country moderated the relationship between family history and harmful drinking scores for women (stronger in the USA), and between expectancies and harmful drinking scores for men (stronger in Sweden), though in both cases this represented a small effect and patterns were similar overall. Conclusions: Swedish students are at higher risk for alcohol use than US students, but similar patterns between aetiological predictors and outcomes in both countries suggest that research from the USA is generalizable to Swedish students and vice versa. More research is needed to better understand unique relationships associated with age and family history.

This survey, “Life and Health—Young People 2005,” included all 15/16-year-old adolescents in mainstream schools in the county of Örebro, Sweden. Just students with a slight/mild or moderate hearing loss were included. There were 56 (1.9%) “hard-of-hearing (HH) students with multiple disabilities,” 93 (3.1%) students who were “just HH,” 282 (9.7%) students with some “other disability than HH,” and 2,488 (85.2%) students with “no disability.” “HH with multiple disabilities” reported considerably higher scores for mental symptoms, substance use, and school problems than the “no disability” group. Those with “just HH” and those with “other disability than HH” had more mental symptoms and school problems than the “no disability” group but no significant differences in substance use. In conclusion, the combination of a hearing loss and some other disability strongly increases the risk for mental symptoms, school problems, and substance use. This group, thus, is an important target for preventive measures.

Aim: Examine the effect of a 10 h intervention programme compared with post-mailed minimal intervention (PMMI) given to high-risk alcohol-drinking university freshmen in a random design. Method: In total 693 freshmen at the Lund Institute of Technology, Lund University, Sweden were included in the study. A cognitive behavioural alcohol program (CBAP) or PMMI was given to high-risk drinking freshmen ( n = 177) in a randomized design. A 10-item screening instrument, Alcohol Use Disorder Identification Test (AUDIT), was used before and 1 year after the intervention programmes were given. Results: There were no significant differences between the CBAP and the PMMI groups. Both groups declined their AUDIT scores with −1.7 [CI 95% −2.6, −0.7] and −2.7 [CI 95% −3.6, −1.7], respectively which could be explained by effects of regression to the mean. Conclusion: No significant differences between the groups were found. ( Received 29 April 2005; first review notified 15 July 2005; in revised form 28 August 2005; accepted 25 October 2005)

Few medications for treating alcohol dependence exist. Greater partnership is needed between academia and the pharmaceutical industry to develop, licence and market efficacious medications for treating alcohol dependence. Methodologies that span the divide between preclinical and large-scale clinical studies need to be developed in order to provide sufficient information on safety, toleration, drug-interaction profile and efficacy, with which to guide development decisions. Due to the heterogeneous nature of alcohol dependence, the effort of developing an efficacious medication is likely to be enhanced by clearer choices about the characteristics of the population. Careful consideration of potential mechanism of action of the putative therapeutic medication should enable the appropriate choice of drinking endpoint. The pharmaceutical industry in collaboration with academia might need to develop new approaches to determining appropriate treatment endpoints with regulatory bodies. The investment risk to industry should be appraised not only in terms of the rather poor results of previous marketing efforts but with a view to the opportunity to penetrate a potentially enormous and largely untapped market.

Aims: Dependence on legal psychotropic drugs (PTD) has been reported to have increased in alcoholics, but previous studies report conflicting results concerning the rate of increase and clinical characteristics. The aim of the present study was first, to assess the dependence rate of PTD among alcoholics in open and institutionalized care, and to compare these populations with the general population, and second, to assess rates and doses of high- and low-dose PTD-dependence among alcoholics. Methods: In 1997, alcoholics in open and institutionalized care were asked to anonymously fill in a questionnaire on their drug use and dependence. Healthy controls were included. The number of attending subjects was 130 open-care alcoholics at the Department of Alcohol and Drug Diseases in Malmo, Sweden; 23 alcoholics in institutionalized care at Karlsvik Rehabilitation Centre in Hoor, Sweden; and 120 healthy controls at Vardcentralen Kirseberg, a primary health care centre located in a Malmo area. The approximate attendance rate was 75, 70 and 95%, respectively. The questionnaire was based on DSM-IV criteria for dependence. Results: The total rate of PTD-dependent alcoholics was higher in the institutionalized group (35%) than in the open-care setting (14%): difference in proportions (p1–p2 21%; 95% CI: 1%, 41%). Alcoholics were more often PTD-dependent (17%) than were healthy controls (2%), (p1–p2 15%; 95% CI: 9%, 21%). Benzodiazepines (BZD) were the most common PTD. Only four out of a total of 23 BZD-dependent alcoholics developed high-dose BZD-dependence. Those subjects were also misusing other drugs, including cannabis. Conclusions: We conclude that alcoholism is associated with legal PTD-dependence and illegal drug misuse. High-dose BZD-dependence is infrequent among BZD-dependent alcoholics. ( Received 8 April 2002; first review notified 14 May 2002; in revised form 4 July 2003; accepted 5 August 2003 )

Seventy-two alcoholics were treated with acupuncture to the ear in a randomized single-blind controlled design over 10 weeks. Orthodox points and incorrect points 3-5 mm from orthodox points were used. No initial differences were found regarding social characteristics, the responses to the Swedish version of the Alcohol Use Inventory and the Three-dimensional Personality Questionnaire, indicating a successful randomization. There were non-significant tendencies towards gender differential response after acupuncture treatment (P = 0.07). There was no difference in the number of drinking days or level of craving between treatment and control patients. Among females, those in the treatment group reported reduction of anxiety after 1 month, more often than those in the control group (P < 0.05). Response to acupuncture was not related to personality or drinking pattern. Patients' experience of needle placement was similar in the study and control groups. The effects of acupuncture were less pronounced than those previously reported.

This study concerns the relation between mortality and the short-term outcome of inpatient treatment for alcoholism. A total of 121 patients (87 men, 34 women) were included, of whom 89 were voluntary and 32 compulsorily committed. They had a mean age of 41 +/- 7 (SD) years and attended a 5-week programme at Runnagården, Orebro, Sweden. Most patients were socially unstable and severely alcohol-dependent. Ten months (mean) after discharge, 96% of the patients and their referring social workers were contacted with mail questionnaires. Of these patients, 13% had been totally abstinent and a further 42% improved but had had relapses. After a mean of 8.5 +/- 0.27 years, 27 patients (24%) had died. All abstainers survived, but non-abstainers had nine-fold higher mortality than expected. Non-abstinent improved women tended to survive longer than non-improved women, but among non-abstinent improved men no such tendency was found. In conclusion, a reduction in the frequency and quantity of abusive drinking was not enough to reduce the higher risk of death. Only abstinence seemed to be preventive.

During the last decades, a positive relation between a good alliance and a successful therapy outcome has been demonstrated across a variety of different therapeutic modalities. The relationship between alliance and drinking outcomes in long-term treatment of alcoholics (12 months or more) has not, as far as we know, been presented. In the present study, alcoholics were randomized to two outpatient treatment programmes; multimodal behavioural therapy (MBT) and psychiatric treatment based on a psychodynamic approach (PT). As part of the study, analyses were performed concerning differences in alliance between the two treatment models (MBT, n = 17; PT, n = 18), and concerning the relationship between alliance and treatment outcome. A Swedish version of the Helping Alliance Questionnaire was used to measure alliance. All therapy sessions were tape-recorded. An independent researcher rated the patient's and therapist's contribution to the alliance at the third session (early alliance). Early patient and therapist alliances were not related to sociodemographic data or initial measures of alcohol severity, psychiatric symptoms, or personality structure in either therapy. Early therapist alliance was better in MBT in comparison with PT. For MBT patients, a significant positive correlation was found between early patient alliance and mood dimensions at 6 months. There were no significant positive correlations between early alliance and drinking outcome during the course of treatment and in the third year after start of treatment. Mood and drinking outcome also showed low correlations. In conclusion, an initial positive alliance seems insufficient to reduce alcohol misuse. The relationship between early alliance and improvement in alcohol misuse needs to be further investigated.

(Received 1 April 2003; accepted 1 April 2003) We appreciate the careful reading and evaluation of the Swedish Council on Technology Assessment in Health Care (SBU, 2001) report by Dr Poikolainen (SBU, 2002). Poikolainen discusses several important issues, not only related to the report but also to systematic reviews in general. First, we shall comment on the SBU methodology. It is important to stress that the methodology applied is basically a series of systematic reviews of the available literature. The use of meta-analytical procedures depends on the character of the studies on the different topics. In most previous SBU reports meta-analytical techniques have not been applied. In our opinion, the development of meta-analytical methodology and the availability of effective software for performing meta-analytical calculations have made this technique simple and more applicable for systematic literature reviews. The number of meta-analytical reviews in most scientific fields, including alcohol and drug treatments, have also rapidly increased in recent years. It is also important to stress that the procedure after the completion of the reviews, including a first draft of Council’s executive conclusions, and leading to the final report, is rather extensive. It includes reviews by external experts and by the SBU’s Executive Board and Scientific Advisory Board, where the evidence was carefully evaluated. The process from final review to publication took more than a year. We should now like to acknowledge some shortcomings of the Swedish version of the SBU report and then to …

Aim: The objective of the study was to evaluate the effi cacy of the Outcome Questionnaire 45 (OQ-45) with feedback in a Swedish psychiatric outpatient population using a randomized controlled design. Method: In all 1720 patients made at least one regular visit to the clinics in the period 12 February 2007 to 10 February 2008 and received information about the study. Of these, 374 patients (22%) agreed to participate. After written consent, 188 patients were randomized to the feedback group and 186 patients to the control group. Those constituted the intention-to-treat (ITT) group. Two hundred and sixty-two patients (70%) completed the OQ-45 questionnaire at least twice, and they were included in the per-protocol analysis. Those who improved less than expected and were at risk for treatment failure were called alerted patients. Results: There was a tendency that patients who received feedback improved more than the controls in OQ-45 total score. In the ITT analysis, the P -value was 0.061 and the effect size g 0.21. In the per-protocol analysis the P -value was 0.076 and the effect size g 0.24. In the intervention group, 27% of the patients were alerted because of risk of treatment failure vs. 28% in the control group (reaching level of alertness). The OQ-45 differences between the intervention and control groups did not signifi cantly differ for patients who were alerted/ reaching level of alertness and for non-alerted patients ( g 0.17 and g 0.28, respectively). Conclusions: The feedback group had a tendency to improve more than the control group, possibly indicating that the method is effective, and the result (basically) supports previous fi ndings.  Feedback , Intervention , Outcome Questionnaire 45 (OQ-45) , Psychiatric outpatient population , Psychiatric treatment , Randomized controlled trial.

Background Substance use in general has been shown to predict criminal recidivism. The present study aimed to examine potential predictors of criminal recidivism, including substance-specific substance use patterns, in prisoners with substance use. Methods A cohort of prisoners with substance use problems (N = 4,152) were assessed with the Addiction Severity Index (ASI) in the Swedish criminal justice system. Clients were followed for an average of 2.7 years. Criminal recidivism was defined as any return to the criminal justice system. Results During follow-up, 69 percent (n = 2,862) returned to the criminal justice system. Recidivism was associated with amphetamine and heroin use, with an additive risk for injectors, and with polysubstance use. Also, recidivism was negatively associated with alcohol, other opioids than heroin/methadone and with hallucinogenic drugs, and positively associated with previous psychiatric in-patient treatment, violent behaviour, and with a shorter index sentence. Associations remained when controlling for type of crime. Conclusions Even when controlling for type and severity of crime, and for psychiatric problems, risk of criminal relapse was increased by substance use variables, including amphetamine, heroin and polysubstance use, and an additional risk was shown for injection drug users. These findings have implications for the need for substance abuse treatment after release from prison.

The objective of the present study was to investigate whether ego-dystonic and ego-syntonic suicidal ideation occurred at different frequencies during antidepressant therapy. A blind evaluation has been performed on records of 100 suicides with a primary severe depression and 100 matched controls, admitted to the Department of Psychiatry, Lund, Sweden. Ego-dystonic suicidal ideation was more commonly reported during adequate treatment as compared to ego-syntonic ideation (P=.004). Men who committed suicide during adequate antidepressant therapy more often reported ego-dystonic suicidal ideation earlier in their lives compared with those who were not treated (P=.0377). This may indicate that treatment failure for ego-dystonic ideation was a precursor of their suicides. Consequently, ego-dystonic ideation seems to show a poorer response to antidepressant therapy as compared to ego-syntonic ideation, which may be more directly related to depression. Ego-dystonic ideation is proposed to be related to depressive psychosis.

Although it is known that college students have a high alcohol consumption, less is known about the long-term drinking trajectories amongst college students and, in particular, students living in residence halls, known to be high-risk drinkers. Over four consecutive years, the drinking habits of 556 Swedish residence hall students were analyzed. The main instruments for measuring outcome were AUDIT (Alcohol Use Identification Disorders Test), SIP (Short Index of Problems) and eBAC (estimated Blood Alcohol Concentration). The drinking trajectories among Swedish residence hall students showed stable and decreasing drinking patterns, with age and gender being predictors of group membership.

Background Substance use disorders have repeatedly been found to lead to premature death, i.e. drug-related death by disease, fatal intoxications, or trauma (accidents, suicide, undetermined suicide, and homicide). The present study examined the relationship between multi-drug substance use and natural and unnatural death. Methods All consecutive, autopsied patients who had been in contact with the Addiction Centre in Malmö University Hospital from 1993 to 1997 inclusive were investigated. Drug abuse was investigated blindly in the case records and related to the cause of death in 387 subjects. Results Every substance apart from alcohol used previously in life added to the risk of unnatural death in a linear way. There were independent increased risks of fatal heroin overdoses or undetermined suicide. Death by suicide and violent death were unrelated to additional abuse. Conclusion The number of drugs used was related to an increased risk of unnatural death by undetermined suicide (mainly fatal intoxications) and heroin overdose.

Background Suicide attempts have been shown to be less common in older age groups, with repeated attempts generally being more common in younger age groups and severe attempts in older age groups. Consistently, most studies have shown an increased suicide risk after attempts in older age. However, little is known about the predictive value of age on repeated and severe suicide attempts for accomplished suicide. The aim of the present study was to investigate the reduced incidence for initial, repeated, or severe suicide attempts with age in suicide victims and controls by gender. Methods The records of 100 suicide victims and matched controls with severe depression admitted to the Department of Psychiatry, Lund University Hospital, Sweden between 1956 and 1969, were evaluated and the subjects were monitored up to 2006. The occurrence of suicide attempts (first, repeated, or severe, by age group) was analysed for suicide victims and controls, with gender taken into consideration. Results There was a reduced risk for an initial suicide attempt by older age in females (suicide victims and controls) and male controls (but not suicide victims). The risk for repeated suicide attempts appeared to be reduced in the older age groups in female controls as compared to female suicide victims. The risk for severe suicide attempts seemed reduced in the older age groups in female suicide victims. This risk was also reduced in male controls and in male controls compared to male suicide victims. Conclusion In the older age groups repeated attempts appeared to be predictive for suicide in women and severe attempts predictive in men.

Background: High-risk alcohol consumption among university students is well documented. Several types of intervention have proved to be effective in reducing alcohol consumption. This study examines the 2-year outcome of 2 different alcohol intervention programs at university halls of residence. Methods: Ninety-eight university halls of residence (with 556 students) were cluster randomized to 2 different intervention groups: a brief skills training program (BSTP) with interactive lectures and discussions, a twelve-step–influenced (TSI) program with didactic lectures by therapists trained in the 12-step approach, and a control group. All students completing the baseline assessment received personalized feedback by mail. Students responded to mailed follow-up questionnaires after 1, 2, and 3 years, including alcohol use disorders identification test (AUDIT; years 2 and 3), short index of problems (SIP), and estimated blood alcohol concentration (eBAC). Results: All groups significantly reduced their AUDIT scores from baseline to the second year follow-up, with no significant differences between the groups. Seventy-seven percent of the students belonged to a population with high-risk consumption, using the AUDIT cut-off scores of 8 and 4 for men and women, respectively. Students with high-risk alcohol consumption showed significant differences in AUDIT score reduction in favor of the BSTP compared with controls, and had a tendency to show better results than the TSI intervention (p=0.06). Similar trends could be seen using SIP and eBAC. The TSI did not differ significantly from the control group within the group of students with high-risk alcohol consumption. Conclusions: This study suggests that a BSTP is effective as an intervention in students with high-risk alcohol consumption.

Aim: To study the effects of alcohol and coping intervention among University students who have parents with alcohol problems. Methods: A total of 82 university students (56 women and 22 men, average age 25) with at least one parent with alcohol problems were included. The students were randomly assigned to one of three programs: (i) alcohol intervention program, (ii) coping intervention program, and (iii) combination program. All programs were manual based and individually implemented during two 2-h sessions, 4 weeks apart. This assessment contained both a face-to-face interview and six self-completion questionnaires; AUDIT, SIP, EBAC, coping with parents' abuse questionnaire, SCL-90 and ISSI. Follow-up interviews were conducted after 1 year. Results: All participants finished the baseline assessment, accepted and completed the intervention, while 95% of the students completed the 12-month follow-up assessment. The two groups that received alcohol intervention improved their drinking pattern significantly more than the group that did not receive alcohol intervention [change of standardized scores -0.27 (CI -0.53 to -0.03)]. The groups receiving coping intervention did not differ from the group not receiving coping intervention concerning their ability to cope with their parents' alcohol problems. Nor did they differ regarding changes in their own mental health or in their social interaction capacity. Conclusion: The intervention improved drinking patterns in adult children of alcoholics.

Aim: To evaluate three different intervention programmes for spouses of alcoholics. Methods: 39 spouses of alcoholics (36 women and 3 men) with an average age of 47 years (ranging from 23 to 60 years) were randomly assigned to one of the three interventions: Coping Skills Training, Group Support, and Information. Follow-up interviews were conducted 12 and 24 months after completing the programme. Coping Behaviour Scale, Symptom Checklist 90 (SCL-90), Hardship Scale and AUDIT at admission and at follow-up were compared. 38 of the 39 spouses completed the 24-month follow-up examination. Results: Improvements of coping behaviour, psychiatric symptoms and hardship noted at the 12-month follow-up examination were still evident in all groups at the 24-month follow-up examination. The three groups scored similarly at 24 months on the four scales. Conclusions: A post hoc examination of subjects with SCL-90 scores above general population means, showed less improvement in the Information group than the two therapy groups combined (P < 0.05).

Alcohol abuse is associated with an increased risk of osteopenia and fractures. Previous histomorphometric studies on iliac crest bone have found decreased bone formation and increased bone resorption in alcohol abusers but it has not been established whether alcohol abuse has any effect on the anatomical location or the healing time of tibial shaft fractures. We studied, retrospectively, 199 adult male patients hospitalized for isolated tibial shaft fracture in the city of Malmo, Sweden, between 1980 and 1990. Forty-nine of the patients had earlier been registered at the Department of Alcohol Diseases and were judged to be problem drinkers. Abusers sustained their tibial shaft fractures more often by falling at ground level (P < 0.0001) or from a higher level (P = 0.009) and the fractures were more often oblique than transverse (P = 0.002) as compared with non-abusers. Healing time was impaired in abusers who had sustained a transverse fracture (P = 0.035), but no difference was observed in healing time in those with a oblique fracture. We found no difference between the abusers and the non-abusers regarding duration of hospital stay, fracture location, amount of displacement, occurrence of open fractures or the rate of complications.

Two different information techniques to reach spouses and relatives of inpatient alcoholics for information of available support, one standardized and one individualized, were compared. Each procedure was tested during 6 months in the same ward. In the standardized model 18% (20/112) and in the individualized model 20% (21/104) of spouses/relatives/friends attended the information session. In those living with a spouse, the rates were 46% and 41% respectively, and among those who were not cohabiting, but had relatives or sober friends, the figures were 11% and 17% respectively. There were no sex differences. Among preferred support, individual support, marital and family support and professional group support received the highest ratings. At the 1 year follow-up, more subjects in the individualized information group had received support compared with those in the standardized group. The low rates of informed subjects are in agreement with the literature and considerably lower than the rates in information programmes for relatives of schizophrenic patients.

Background Those who die by suicide and suffer from depression are known to have made more suicide attempts during their life-span as compared to other people with depression. A behavioural sensitisation or kindling model has been proposed for suicidal behaviour, in accordance with a sensitisation model of depressive episodes. The aim of the present study was to test such a model by investigating the distribution of initial and repeated suicide attempts across the depressive episodes in suicides and controls with a unipolar severe depression. Method A blind record evaluation was performed of 80 suicide victims and controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2010. The occurrence of initial and repeated suicide attempts by order of the depressive episodes was compared for suicides and controls. Results The risk of a first suicide attempt decreased throughout the later episodes of depression in both the suicide group (p < .000) and control group (p < .000). The frequencies of repetition early in the course were actually higher in the control group (p < .007). After that, the risk decreased in the control group, while the frequencies remained proportional in the suicide group. At the same time, there was a significantly greater decreased risk of repeated attempts during later episodes in the control group as compared to the suicide group (p < .000). The differences were found despite a similar number of episodes in suicides and controls. Conclusion Repeated suicide attempts in the later episodes of depression appear to be a risk factor for suicide in severe depression. This finding is compatible with a behavioural sensitisation of attempts across the depressive episodes, which seemed to be independent of a corresponding kindling of depression.

We agree that our interpretation of our results regarding a cognitive behaviour alcohol programme compared with post-mailed minimal intervention (Johnsson and Berglund, 2006) is conservative in that we did not include the interpretations suggested by Cunningham (2006). This particularly applies to the possibility that both interventions were effective in reducing drinking. The design we used was intended to compare a …

A study has been made of the cross-metathesis of alkenylsilanes CH 2 CH(CH 2 ) n SiX 3 ( n  1,2; X = CH 3 , Cl, OMe) with ( Z )-2-pentene with WCl 6 as the catalyst precursor. For allyltrimethylsilane (ATMS; n = 1, X = CH 3 ) the reaction proceeds without added co-catalyst but with an induction period. The catalytically-active intermediate in this case is formed by allyl-group transfer from Si to W, as revealed by the formation of CiSiMe 3 . Allyltrichlorosilane and allyltrimethoxysilane requires the addition of an alkylating co-catalyst, e.g. SnMe 4 . Addition of a Lewis acid, e.g. AlCl 3 or AlBr 3 , show that for ATMS removes the induction period and substantially raises the activity. The initial activity of the E/Z -stereoselectivity are affected in a very similar way by the addition of the Lewis acid. The results indicate that the Lewis acid participates in the initiating, propagating and terminating steps of the reaction.

Two methods for the preparation of the silica-bound chelating phosphine ligand bis(diphenylphosphino)maleimide have been studied. In the first a silica surface with bound amine groups is treated with bis(diphenylphosphino)maleic acid anhydride. By use of different Group VI carbonyl complexes M(CO)6, M(CO)4L (M  Cr, Mo, W; L  norbnornadiene) and M(CO)5Cl− as IR probes it is shown that this method yields two different types of metal-binding sites on the gel, involving amine groups and bidentate phosphine groups, respectively. In the second method bis(diphenylphosphino)maleic acid anhydride is treated with 3-aminopropyltriethoxysilane and the imide formed by this reaction is, without isolation, further condensed on the silica surface. Use of the same type of IR probes as in the first route shows that the silica gel in this case contains the bidentate phosphine group as the sole metal-binding site. The preparations of new metal tetracarbonyl complexes for Cr, Mo and W bound to silica via bidentate phosphino groups are described.

A cationic rhodium(I) complex, viz. Rh NBD diphos+ 4-CH3-C6H5SO3− [NBD = norbornadiene, diphos = (C6H5)2 P-CH2-CH2-P(C6H5)2], has been used as a homogeneous catalyst for the hydrogenation of soybean oil in acetone solution. This complex acts almost in the same way as the corresponding ones with ClO4− or PF6− as conuterions, i.e., it gives high polyene selectivity and low formation oftrans isomers. Because of the somewhat stronger basic character of the p-toluene-sulfonate ion compared with the perchlorate and hexafluorphosphate ions, the relative proportion of reaction via the so-called monohydride path is larger in the present case. When the ionic complex, Rh NBD diphos+, is bound to a solid support, e.g., to the anionic sites of sulfonated polystyrene resins, a nearly total lack of catalytic activity is observed. Possible reasons for these effects are discussed-in terms of π-arene-metal binding and covalent coordination of the sulfonate group.

WCl 6 has been used as a catalyst for the metathesis of various alkenylsilanes and the degree of conversion found to be dependent on the distance between the olefinic bond and the silyl group. The first observation of metathetical conversion of allyltrimethylsilane in the absence of a co-catalyst is reported