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Background Risk and protective factors for adverse outcomes among drug users in the general population have been identified. This study considers whether some of these factors predict favourable socio-economic situations in middle age. Methods A 37-year follow-up of 49,411 Swedish male conscripts 1969/70, born 1949–1951. Based on self-reports at conscription, 36,191 living subjects in 2006 were divided into users of certain dominant drugs (n = 3946) and non-users (n = 32,245). Individual data from conscription and national registers were linked. Using logistic bivariate and multivariate regression, odds ratios (ORs) for the categories of dominant-drug users, compared with non-users, were computed for outcomes in 1990 and in 2006: education ≥12 years, being in work, and having a disposable income above the median. The ORs were calculated after considering familial, social and individual risk and protective factors, with separate analyses being performed for drug-use categories. Results Small changes were observed in the ORs for the outcomes in 1990 and 2006. After adjustment for protective and risk factors, users of the various dominant drugs had increased ORs with an education ≥12 years but lower or non-significantly different from non-users for the other outcomes. The ORs decreased with severity of drug use. Among drug users, high intellectual ability, having a father from highest SES group, and communication with parents were among the factors that increased the probability of favourable socio-economic outcomes, especially when several protective factors were involved. Conclusions Protective factors increase the probability of favourable outcomes, but least among individuals with severe drug use.

Injuries represent an important cause of mortality among young adults. We studied the associations between adolescents' family, psychological, behavioural and drug-related risk factors in relation to unintentional injury death. A population-based cohort of 49,411 Swedish conscripts aged 18-20 years was followed for 35 years. The end-point of study was injury death up to 2004. The relationship between two family, four psychological and eight behavioural risk factors and injury death were analysed with Cox proportional hazards analyses and χ(2) tests. Among 485 unintentional injury deaths, 40% occurred in subjects aged 25 years or under. The incidence per 1000 person years was 0.29 (95% CI, 0.26-0.31) and the mean age of death was 33 years. Problem drinking at both adolescent and adulthood was more strongly associated with injury death (HR=5.40) than illicit drug use (HR=2.70) even after adjusted for behavioural risk factors: (HR=3.43) and (HR=1.75), respectively. Adolescent risk factors such as contact with police and juvenile authorities, low emotional control, conduct problems at school and low social maturity were significant predictors of injury death in multivariate analyses. Young adults with social, behavioural and psychological problems and especially alcohol and drug use at both adolescent and adulthood have a high mortality rate due to road traffic injuries and all kind of injuries. Early identification of vulnerable groups of adolescents with psychological and behavioural problems including alcohol and drug use at local levels could make a difference.

Aims To analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006. Design We c ...

INTRODUCTION AND AIMS: To examine the overall mortality and causes of deaths of a large cohort of users of illicit drugs in Stockholm over 37 years. DESIGN AND METHODS: People with substance abuse were identified through records collected by different institutions in Stockholm in 1967. Subjects were followed in registers recording mortality and cause of death and in-patient care stays until 2003. RESULTS: More than half (n = 860) of the 1705 identified substance abusers died at an average age of 47 years, 25-30 years younger than the general population. The standardized rate ratio (SRR) for mortality was 3.3 among men and 3.5 among women. Incidence of mortality per 1000 person-years was also increased, but somewhat lower for women. The difference between these two measures is mainly explained by a lower mortality among women in general. In-patient care stays with both alcohol and drug-related diagnoses were associated with higher risk of dying among women than men: SRR = 14.5 and SRR = 4.0, respectively. Accidents and suicide were the most common cause of death among the youngest subjects (15-24 years) and cardiovascular diseases and tumors among the oldest (> or =55 years). DISCUSSION AND CONCLUSIONS: Accidents and suicide, especially at a young age, are two common causes of death that might be prevented by increased awareness in medical personnel, along with better treatment and supportive measures. Language: en

Empirical data on homicide and homicide offenders are needed in the ongoing discussion on violence and crime prevention. One issue, insufficiently investigated, is the post-trial life course of homicide offenders.To examine whether the mortality rate, as well as cause and manner of death, of homicide offenders is different from the general population.An incidence cohort of Swedish homicide offenders from 1970 to 1980 (n = 153) was re-examined by computerized record linkage with the National Cause-of-Death Register for the period between trial and 1 October 2002, i.e. 22-32 years after the offence. Death certificates were analysed, and standard procedures for calculating Standard Mortality Rate (SMR) and survival analysis were employed.Half of the study subjects had died by 2002. The overall mortality rate was about three times higher than that of the general population. In particular, the risk of suicide was salient.It can be argued that offenders' self-neglect and self-contempt merge with public and professional views, predisposing to an increased risk of premature death.

BACKGROUND: The phenomenon of repetitive injuries has been judged to be of limited importance in the public health context. A study was therefore initiated in order to analyse all types of single and repetitive injuries using a longitudinal approach. METHODS: Hospital care, medical costs and risk factors were examined for single and repetitive severe injuries. A cross-sectional survey with a 12-year follow-up was performed. Questionnaire information from a survey of a random sample of the adult population 20-89 years old in 1984 in Stockholm County were linked to the Swedish national inpatient and cause-of-death register up to 1996, inclusive. RESULTS: During the study period 13% of males and 15% of females were hospitalized or deceased as a result of injuries. Persons with three or more injuries comprise 19% of the injuries, but account for 63% of the total number of days of hospital care and medical costs. Injuries related to falls were most common among patients requiring hospital care. Factors such as high age, living alone, stroke earlier, and use of hypnotics and sedatives were especially associated with repetitive injuries. The risk factors for single and repetitive injuries covariate, but the size of the risk is overrepresented for stroke, drugs, self-reported injuries and living alone for two or more injuries. CONCLUSION: These results indicate that subjects with repetitive injuries, and with the observed risk factors for such injuries, should be given extra attention, both in policy and prevention, but also in integrated treatment programmes.

Isolated death (ID) (i.e., dying alone without anyone noticing for several days) has been suggested to be related to social isolation, mental disorder, and alcohol and/or drug abuse. A major transfer of patients with a mental disorder and/or alcohol and/or drug abuse from institutionalized care to treatment as outpatients has been enacted in Sweden during the past decade. On the basis of the assumption that such deinstitutionalization is likely to result in increased social isolation, our working hypothesis was that the incidence of ID among patients belonging to these categories has increased in Sweden. The present study involved all deaths subjected to a medicolegal examination in Stockholm County (with a population of approximately 1.9 million people) during the period 1992-2000. The pattern of ID (defined as cases involving a postmortem delay between death and discovery of at least 1 week), as well as the incidence of fatalities subjected to medicolegal examination with a record of mental disorder and/or alcohol and/or drug abuse was evaluated. Throughout this period, the proportion of the deceased with a record of a mental disorder was high among all the cases examined and higher still among the cases of ID, especially among those younger than 65 years of age. There was a rather limited increase in the incidence of ID and a much more pronounced increase in the number of former psychiatric patients whose deaths were subjected to medicolegal examination, but did not satisfy the criteria for ID. A record of alcohol and/or drug abuse was more common than a diagnosis of mental disorder among both the males and females who died at an age of less than 65, with a clear difference between the cases of ID and non-ID in the case of men. There was no significant increase in incidence over the course of this study. Thus, this study reveals a slight increase in the number of IDs and a more pronounced increase in the number of medicolegal examination of non-IDs of individuals with a record of a mental disorder.

Aims Very few studies indicating that low–moderate alcohol consumption protects from myocardial infarction (MI) controlled for social support and working conditions, which could confound the findi ...

In this study, we investigated the association between risk factors, including use of sedatives or hypnotics or alcohol consumption, and injurious falls leading to hospitalization or death among 4023 subjects (1828 men and 2195 women) aged 20-89 years in Stockholm County, Sweden. Questionnaire data obtained from the 1984-1985 Stockholm Health of the Population Study (SHPS) were linked to official data registers on hospitalization and mortality. Of the 4023 subjects, 330 (121 men and 209 women) had been treated for or died of injurious falls during the 12-year follow-up period. High age was significantly associated with injurious falls among both men and women. Multivariate analyses showed that women who had used sedatives or hypnotics during the 2 weeks before an injurious fall were at increased risk [relative risk of 1.83 (95% confidence interval, 1.10-3.06)] for two or more injurious falls, but not for a single fall accident. High alcohol consumption and earlier self-reported injurious falls were significantly associated with injurious falls for women younger than 60 years of age and with earlier self-reported falls and living alone for men in the same age category. Among older women (>60 years of age), high alcohol consumption and use of sedatives or hypnotics were significantly associated with injurious falls, whereas living alone and earlier self-reported accidents were significant predictors for men in the same age category. These results support a cautious prescribing policy for sedatives and hypnotics, as well as an awareness of high alcohol consumption and its association with injurious falls.

Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC), or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the nonviolent method self-poisoning and alcohol-/illicit drug-negative suicide decedents. Multivariate analysis was conducted, and the results revealed that acute influence of THC was related to using the violent suicide method–– jumping from a height (RR 1.62; 95% CI 1.01–2.41). Alcohol intoxication was not related to any violent method, while the central stimulant-positive suicide decedent had a higher, albeit not significant, risk of several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.

This study investigates the role of individual competence factors as modifiers of the risk for adult substance and alcohol abuse in relation to living in high- or low-income areas. The study group consisted of 7,577 18-year-old Swedish conscripts followed for substance and alcohol abuse until the age of 45 ears. Records of alcohol and substance abuse were obtained from official registers. In the 25-year follow-up period, 166 (2.2%) persons were identified as substance abusers and 286 (3.8%) as alcohol abusers. Subjects with many (from five to nine) behavioral risk factors and many (from four to five) competence factors had significantly less adult alcohol and substance abuse in low-income areas compared with those who had few competencies. This finding was also true for alcohol abuse in high-income areas. Experimentation with drugs and alcohol use before conscription was the most powerful risk factor for adult alcohol abuse and substance abuse in both income areas. The results of this study indicate that knowledge of competence factors is important in preventing abuse, especially among high-risk persons coming from low-income areas.

This study investigates the impact of methadone treatment on inpatient care admissions and mortality among 331 methadone-maintained patients compared with 1,483 similar untreated opiate misusers. The methadone patients manifested a lower mortality during treatment than the comparison group and those patients who had left their treatment. The annual incidence rate decreased from 1.4 inpatient care admissions per year for those who had stayed 0-1 year, less than 1 for those who stayed more than 2 years, and 0.3 for those who had stayed longer (>4 years) in methadone treatment. A similar decrease occurred in both sexes. The incidence rate decreased more among the HIV-negative than the HIV-positive patients. The low incidence of inpatient care during treatment may be due to treatment but may also be partly due to selection factors.

Background and Purpose Since stroke is a principal cause of death in elderly people, we analyzed the association between alcohol and stroke mortality in a cohort of 15 077 middle-aged and older men and women. Methods Data on alcohol habits were obtained from a questionnaire in 1967. The subsequent 20 years yielded 769 deaths from stroke, of which 574 were ischemic. Relative mortality risks (RR) were estimated from logistic regression analyses with lifelong alcohol abstainers as a reference group. Adjustments were made for age and smoking. Results No association was found between alcohol intake and hemorrhagic stroke. An elevated risk of ischemic stroke was found for men who drank infrequently, that is, a few times a year or less often (RR, 2.0; 95% confidence interval [CI], 1.3 to 3.2), for those who were intoxicated now and then (RR, 1.8; 95% CI, 1.1 to 2.8), and for those who reported “binge” drinking a few times in the year or less often (RR, 1.6; 95% CI, 1.1 to 2.5). Among women only ex-drinkers had an elevated risk of dying of ischemic stroke (RR, 3.3; 95% CI, 1.5 to 7.2). The risk was reduced for women who had an estimated average consumption of 0 to 5 g pure alcohol per day (RR, 0.6; 95% CI, 0.5 to 0.8); for those who did not drink every day (RR, 0.7; 95% CI, 0.5 to 0.9); and for those who never “went on a binge” (RR, 0.6; 95% CI, 0.5 to 0.8) or became intoxicated (RR, 0.7; 95% CI, 0.5 to 0.9). Conclusions Drinking habits were associated only with deaths from ischemic stroke, and the risk patterns were different for men and women. In analyses, ex-drinkers should not be included with lifelong abstainers, since the former tend to run high health risks.

Drug users in clinical samples have elevated mortality compared with the general population, but little is known about mortality among users of drugs within the general population.To determine whether self-reported use of illicit drugs and non-prescribed sedatives/hypnotics among young men in the general population is related to mortality.A 35-year follow-up of 48024 Swedish men, born 1949-1951 and conscripted in 1969/1970, among whom drug use was reported by 8767 subjects. Cross-record linkage was effected between individual data from the Swedish conscription and other national registers. Deaths and causes of death/1000 person-years were calculated. Cox PH regression was used to estimate hazard ratios (HRs) for death with 95% confidence intervals (95% CIs). An HR was calculated for users of different dominant drugs at conscription compared with non-users by age interval, after adjusting for confounders and hospitalisation with a drug-related diagnosis.Drug users showed elevated mortality (HR 1.61, p0.05) compared with non-users. After adjusting for risk factors, users of stimulants (HR 4.41, p0.05), cannabis (HR 4.27, p0.05), opioids (HR 2.83, p0.05), hallucinogens (HR 3.88, p0.05) and unspecified drugs (HR 4.62, p0.05) at conscription with a drug-related diagnosis during follow-up showed an HR approaching the standard mortality ratios in clinical samples. Among other drug users (95.5%), only stimulant users showed statistically significantly increased mortality (HR 1.96, p0.05).In a life-time perspective, drug use among young men in the general population was a marker of premature death, even a long time after exposure.

To analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006.We collected data from surveys of methadone maintenance treatment units, of buprenorphine and methadone sales, and of mortality and inpatient care in Sweden.Sweden.Patients in maintenance treatment.Survey data of treatment policy to all units in 2003 and 2005. Trend tests and correlation analyses of data on sales, mortality, inpatient care and forensic investigations.The surveys showed a marked change to a less restrictive policy, with increased use of 'take-away doses' and a reduction of discharges due to side misuse. The one-year retention rate stayed high. Sales of buprenorphine and methadone and the number of patients in treatment increased more than threefold from 2000 to 2006, with the greatest increase for buprenoprphine, introduced in year 2000. There was a significant 20-30% reduction in opiate-related mortality and inpatient care between 2000-2002 and 2004-2006 but not of other drug-related mortality and inpatient care. This decline was larger in Stockholm County, which had a less restricted treatment policy. However, a significant increase in buprenorphine- and methadone-related mortality occurred. For the study period 1998-2006, statistically significant declines occurred only in Stockholm County.The liberalization of Sweden's drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.

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.

Injuries represent an important cause of mortality among young adults. We studied the associations between adolescents' family, psychological, behavioural and drug-related risk factors in relation to unintentional injury death. A population-based cohort of 49,411 Swedish conscripts aged 18-20 years was followed for 35 years. The end-point of study was injury death up to 2004. The relationship between two family, four psychological and eight behavioural risk factors and injury death were analysed with Cox proportional hazards analyses and χ(2) tests. Among 485 unintentional injury deaths, 40% occurred in subjects aged 25 years or under. The incidence per 1000 person years was 0.29 (95% CI, 0.26-0.31) and the mean age of death was 33 years. Problem drinking at both adolescent and adulthood was more strongly associated with injury death (HR=5.40) than illicit drug use (HR=2.70) even after adjusted for behavioural risk factors: (HR=3.43) and (HR=1.75), respectively. Adolescent risk factors such as contact with police and juvenile authorities, low emotional control, conduct problems at school and low social maturity were significant predictors of injury death in multivariate analyses. Young adults with social, behavioural and psychological problems and especially alcohol and drug use at both adolescent and adulthood have a high mortality rate due to road traffic injuries and all kind of injuries. Early identification of vulnerable groups of adolescents with psychological and behavioural problems including alcohol and drug use at local levels could make a difference.

To examine the overall mortality and causes of deaths of a large cohort of users of illicit drugs in Stockholm over 37 years.People with substance abuse were identified through records collected by different institutions in Stockholm in 1967. Subjects were followed in registers recording mortality and cause of death and in-patient care stays until 2003.More than half (n = 860) of the 1705 identified substance abusers died at an average age of 47 years, 25-30 years younger than the general population. The standardised rate ratio (SRR) for mortality was 3.3 among men and 3.5 among women. Incidence of mortality per 1000 person-years was also increased, but somewhat lower for women. The difference between these two measures is mainly explained by a lower mortality among women in general. In-patient care stays with both alcohol and drug-related diagnoses were associated with higher risk of dying among women than men: SRR = 14.5 and SRR = 4.0, respectively. Accidents and suicide were the most common cause of death among the youngest subjects (15-24 years) and cardiovascular diseases and tumours among the oldest (or =55 years).Accidents and suicide, especially at a young age, are two common causes of death that might be prevented by increased awareness in medical personnel, along with better treatment and supportive measures.

An 18-year addiction career, 1985-2003, for 157 heroin dependent subjects (73% men; 49% human immunodeficiency virus seropositive) admitted for the first time to Stockholm's Methadone Maintenance Treatment program during 1989 to 1991 was analyzed with data from seven official registers and patient records. Regression analyses and incidence rates for various outcomes were calculated for subjects in first methadone maintenance treatment at the end of the observation period, discharged from first methadone maintenance treatment, in second methadone maintenance treatment, and discharged from second methadone maintenance treatment. Being human immunodeficiency virus positive (HR = 3.8), lodging (HR = 1.9) and prison sentence (HR = 1.7) predicted mortality for the 45% deceased. Approximately 70% of living subjects participated in methadone maintenance treatment at some period each year. Subjects in first or second methadone maintenance treatment had less criminality and had spent more time in methadone maintenance treatment (70% to 100%) than those discharged from first or from second methadone maintenance treatment (50%). Efforts and interventions should be intensified to increase time in treatment also for those with high problem severity.

Aims: Changes in AUDIT score trajectories were examined in a student population during their first 4 years at a university, including high-risk consumers and a subsample of low-risk consumers. Method: 359 students were selected for the present study, comprising all high-risk consumers (the 27% with highest scores, i.e. 11 for males and 7 for females) and a randomized sample of low-risk consumers (n = 177 and 182, respectively). The Alcohol Use Disorder Identification Test (AUDIT) was used as screening instrument. Trajectory analyses were made using a semiparametric group-based model. Results: In the low-AUDIT group, five distinct trajectories were identified: three stable non-risky consumption groups (83%) and two increasing groups (17%; from non-risky to risky). In the high-AUDIT group, three groups were identified: two stable high groups (58%) and one decreasing group (from risky to non-risky consumption; 41%). In the integrated model, stable risky consumption comprised 16% of the total sample, decreasing consumption 11%, increasing consumption comprised 13% and stable non-risky consumption 60% of the sample. Gender influenced the trajectories. Conclusion: The pattern of changes in risk consumption is similar to that found in corresponding US studies.

Objective: This study aimed to analyze illicit drug use of participants in a methadone treatment program in relation to methadone dose, counseling, and retention.Methods: This was a longitudinal study of a cohort of 204 heroin-dependent subjects admitted for the first time to a methadone program in Stockholm. The patients were admitted between 1995 and mid-2000 and were followed until December 2000 or discharge. Up to June 11, 1998, individual psychosocial counseling was provided; after this date individual counseling was replaced with group counseling. Clinical data were collected from patient records and from a laboratory database. Rates of drugpositive urine analyses during different time periods were measured.Results: The mean observation time was 2.5 years for all patients. The one-year retention rate was 84 percent, and the two-year rate was 65 percent, with no major differences between the two counseling groups. Almost all patients relapsed to illicit drug use. Discharged patients had a significantly higher rate of positive urine samples (21 percent versus 9 percent) than patients who remained in treatment. Also, low methadone dose and younger age predicted discharge from treatment.Conclusion: The frequent urine monitoring showed that illicit drug use was rather common, even in a program with structured psychosocial interventions, although it was lower than in other studies. This testing policy can be used for early identification of patients at risk for drop-out or discharge who should be offered complementary interventions.

This study analyzed indicators of alcohol-related problems in opiate addicts before, during, and after leaving methadone maintenance treatment (MMT), in relation to illicit drug use and retention in treatment. The study was based on 204 patients, admitted to MMT for the first time between 1 January 1995 and 31 July 2000, and followed until 31 December 2000. Three measures were used to indicate alcohol use and alcohol-related problems; records of hospital care with an alcohol-related diagnosis, any treatment with alcohol-sensitizing drugs (disulfiram or calcium carbimide) during MMT, and results of the 5-hydroxytryptophol to 5-hydroxyindoleacetic acid ratio (5HTOL/5HIAA) in urine, a sensitive biomarker for recent drinking. Use of illicit drugs was determined by routine urine drug testing. About one third of the patients (n = 69) had a lifetime prevalence of hospital treatment for an alcohol-related diagnosis, 45 of whom had been hospitalized (mean 4.2 stays) prior to the start of MMT. There was a significant association (p

To determine the total mortality related to the Stockholm methadone programme during the period 1988-2000, both the mortality related to the treatment and fatal methadone intoxications in the Stockholm area during the same period.The study comprised all individuals (n = 848) who had been in contact with the methadone programme in Stockholm during the study period, including those patients who had been discharged from treatment and those opiate users who had applied for but not received methadone treatment. All deaths that had been the subject of medico-legal examination at the Department of Forensic Medicine in Stockholm where methadone was found in blood or urine were also analysed during the same period.The mortality was lower among those opiate users who remained in maintenance treatment and 91% of the deceased individuals had died due to natural causes, in most cases related to HIV or hepatitis C, acquired before admission to the programme. Those who had been discharged from methadone treatment had a 20 times higher risk of dying from unnatural causes compared to the patients who remained in treatment. The majority died due to heroin injections ('overdoses'). Eighty-nine cases of fatal methadone intoxication were found, but in only two of these cases was there evidence of leakage from maintenance treatment.The 'high threshold programme' is safe as long as the patients remain in treatment and there are very few deaths due to leakage from the programme. However, there is a high mortality among those discharged from the programme and only a minority of the heroin users in Stockholm had applied for treatment.

Several studies, mainly from the U.S. and usually with selected male samples, show that aftercare is positively related to lower risk of re-addiction or re-treatment. The present study extends this line of research in a report from public health health care addiction treatment services in Stockholm County. The study sample comprises all 196 men and 100 women alcohol-dependent patients from 10 districts hospitalized for at least 2 days during 1997-99 and who received outpatient care within 5 days. These patients were followed up until 2000, without attrition for renewed rehospitalization. Greater length of outpatient treatment was significantly related to reduced rehospitalization, but only in men. The intensity (average number of visits) of outpatient treatment was not significantly related to rehospitalization. The different effect of length of outpatient treatment between the genders may be due to differences in severity of alcohol dependence, social situation, psychiatric co-morbidity, and/or the extent to which treatment met patients' needs.

Very few studies indicating that low-moderate alcohol consumption protects from myocardial infarction (MI) controlled for social support and working conditions, which could confound the findings. Therefore, a first aim was to study the risk of non-fatal and total MI in relation to volume of alcohol consumption and measures of social support and working conditions. A second aim was to analyse the impact of the volume of earlier alcohol use in abstainers.Data came from a case-control study, the Stockholm Heart Epidemiology Program (SHEEP), including first MI among Swedish citizens 45-70 years old.Stockholm County 1992-94.There were 1095 cases of MI in men and 471 in women (928 and 372 were non-fatal), and 2339 living controls from the general population.Information about alcohol use at different periods in life and job strain, social anchorage and life control besides pre-existing health problems, smoking, physical activity, socio-economic status and marital status was obtained by a questionnaire from the cases and the controls.In multivariate logistic regression analyses, the relative risk for MI (especially non-fatal) was reduced among alcohol consumers. RR for non-fatal MI was 0.52 (95% confidence intervals 0.32, 0.85) in men with a consumption of 50-69.9 g 100% ethanol/day and 0.21 (95% confidence interval 0.06, 0.77) in women with a consumption of 30 g or more per day (reference category 0.1-5 g 100% ethanol/day). Men who were abstainers during the previous 1-10 years and with an earlier average consumption of 5-30 g 100% ethanol/day had a significantly lower relative risk compared to such abstainers with an earlier higher consumption. Earlier consumption among abstainers may also have an impact on gender differences in MI. Analyses showed positive interaction between abstention and low life-control in women, but only 4% of the female cases were due to this interaction. There were no other interactions between measures of alcohol use and social anchorage, life control and working situations.Alcohol use had a protective impact on MI, with little impact of job strain, social anchorage and life control, giving increased support for a protective impact of low-moderate alcohol use. The level of previous alcohol consumption among male 1-10-year-long abstainers influenced the risk of MI.

This study investigates criminality among 331 opiate abusers admitted to Stockholm's methadone maintenance programme (SMMP) between 1988 and 1992, and a comparison group of 1483 untreated opiate abusers. Information on arrests, criminal convictions, and intravenous drug abuse was obtained from official records. For both genders the annual rate of convictions decreased from 2.2 convictions per year during the 4 years prior to the first treatment, to 0.5 convictions during treatment, compared to 2.0 convictions for the comparison group. There was an even greater decrease in the rate of arrests for patients on methadone treatment. The decline was observed for both genders and in both HIV-positive and HIV-negative patients. Rates of convictions among patients who had more than one treatment period were clearly reduced during each treatment period, and while the rate increased after they were expelled from treatment it remained at a lower level than during the 4 years prior to treatment. Thus, the methadone treatment is shown to have a profound positive effect on arrests and convictions, not only for patients remaining in treatment but also for those patients who were expelled from treatment involuntarily.

Aims: The association between drunk driving (DD) and/or risky driving (RD) offences and subsequent hospitalization and mortality was studied during a 25-year period. Methods: Information about drinking habits and psychosocial factors for the 8122 conscripts from Stockholm County in 1969-1970 was linked to register data on hospitalization, mortality, DD and RD. Results: Analyses comparing background characteristics of DD and RD groups showed that the prevalence of problem behaviour and drug use was highest in the RD group. The relative risk (RR) for hospitalization after DD and/or RD was significantly elevated in multivariate logistic regression analysis for all the studied diagnostic categories (alcohol diagnoses, narcotic diagnoses, suicide attempts, psychoses, E-codes, all diagnoses), and was especially high for alcohol (RR = 7.2) and diagnosis of drug misuse (RR = 9.2). The RR of all hospital- ization was 1.5 for the DD group, 1.8 for the RD group, and 1.9 for those who had been sentenced both for drunk driving and risky driving (DRD), all of which were significantly increased. The RR of death was significantly elevated in all three groups. Conclusions: The results show a significantly increased risk of hospitalization and mortality both in the DD and the RD group. From a public health and traffic safety perspective, this implies a need for developing and implementing better prevention strategies.

In this study, we investigated the association between risk factors, including use of sedatives or hypnotics or alcohol consumption, and injurious falls leading to hospitalization or death among 4023 subjects (1828 men and 2195 women) aged 20-89 years in Stockholm County, Sweden. Questionnaire data obtained from the 1984-1985 Stockholm Health of the Population Study (SHPS) were linked to official data registers on hospitalization and mortality. Of the 4023 subjects, 330 (121 men and 209 women) had been treated for or died of injurious falls during the 12-year follow-up period. High age was significantly associated with injurious falls among both men and women. Multivariate analyses showed that women who had used sedatives or hypnotics during the 2 weeks before an injurious fall were at increased risk [relative risk of 1.83 (95% confidence interval, 1.10-3.06)] for two or more injurious falls, but not for a single fall accident. High alcohol consumption and earlier self-reported injurious falls were significantly associated with injurious falls for women younger than 60 years of age and with earlier self-reported falls and living alone for men in the same age category. Among older women (60 years of age), high alcohol consumption and use of sedatives or hypnotics were significantly associated with injurious falls, whereas living alone and earlier self-reported accidents were significant predictors for men in the same age category. These results support a cautious prescribing policy for sedatives and hypnotics, as well as an awareness of high alcohol consumption and its association with injurious falls.

Several epidemiological studies have shown that moderate alcohol consumption is associated with reduced mortality from cardiovascular diseases in middle aged and elderly subjects,1 but its effect in younger people is unknown. High alcohol consumption is associated with increased total mortality, but the findings for stroke have varied.1 2 We analysed the association between alcohol consumption and the incidence of myocardial infarction, stroke, and mortality in a 25 year follow up of military conscripts. This study is based on 49 618 Swedish men conscripted between 1 July 1969 and 30 June 1970 and born between 1949 and 1952.2 At conscription, all men were given two questionnaires with questions covering social background, behaviour, and use of alcohol and tobacco, and all met with a psychologist for assessment. The percentage of non-responders was between 1% and 2%. From questions about quantity and frequency …