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Survey of early alcohol treatment preferences shows higher confidence in face to face meetings Adult men and women (n = 307), working and living in the area of south west Sweden, answered a web based questionnaire where they graded treatment and caregiver preferences while imagining themselves developing an alcohol problem. Alcohol consumption was measured using AUDIT-C. Face-to-face delivered treatment was preferred over telephone or internet based advice. About 53 percent of the men and women considered treatment given by primary health as poor. Only 7,6 percent would prefer help from a health care centre if they were having alcohol problems. Shame and stigma were considered the main obstacles for both seeking and getting help. Despite the availability of effective treatments for early alcohol problems, many avoid seeking help for their problem. This also applies to socially established people. It is important that the health care recognizes and identifies people with less serious problems and offer them treatment.

Data on prevalence of female alcoholism are scarce, especially outside North America. It is even more rare that prevalence is estimated using clinical interviews, as well as by utilizing multiple sources of information. Our sample consisted of five cohorts of adult women (n = 3130) in a mainly suburban area. In a first phase we screened for alcohol-related problems. In a second phase a strategic sample was interviewed (n = 399). Prevalence was calculated for clinical and CIDI-SAM diagnoses, both according to DSM-III-R, also taking medical record data into consideration. It was found that life-time prevalence of alcohol dependence and abuse was 3.27% and 12-month prevalence was 1.49%. Agreement over alcohol dependence was very high for the different diagnostic methods, but lower for alcohol abuse. Prevalence of dependency/abuse was not higher in the attrition group. The alcohol abuse concept was found to be relevant, both in epidemiological research and for clinical purposes.

Background “Clubs against drugs” (CAD) is a comprehensive program with a systems approach to prevention with the intention of preventing drug use in nightclub environment. In 2001 CAD was developed and implemented in Stockholm and was disseminated to 20 other municipalities in Sweden up until 2010. This study investigates the factors related to the implementation and compares Stockholm to the rest of the municipalities. Methods A sequential exploratory method was used which consisted of three steps including a questionnaire and two rounds of interviews. Questionnaires included all communities and the interviews included twelve respondents from three example municipalities in the first phase and four respondents from Stockholm in the second phase. The interviews were analyzed using content analysis. Results In Stockholm the program was described as having been implemented and sustained over time. The implementation in the example municipalities was perceived as difficult with many obstacles and achieving sustainability was also described as difficult. Two of three municipalities were not active at the time of this study, illustrating that the program only lasted a few years. Factors identified as being related to implementation outcomes were need assessments, participation, support, collaboration and local enthusiasts. Conclusions The capacity to implement and sustain CAD differed substantially between Stockholm and the other municipalities. If the prerequisites and capacity are not sufficient the implementation is not likely to be successful, even when the activities are promoted on a national level like CAD. The needs of the interventions and the capacity to implement the program should be examined before adopting the program. This was not done, probably because the drive to spread the activity was not sufficiently questioned.

This longitudinal study aimed to examine the pattern of alcohol consumption (using the AUDIT-C) among the oldest old (80+) and how it changed two years later. Five hundred seventy-six persons from the Gothenburg metropolitan area were interviewed between 2008 and 2011. Men represented a higher proportion of at-risk consumers (21.8%) than women (14.5%), but there was no sex difference in binge drinking (13.8% versus 12%). Men decreased their weekly consumption and also the proportion of binge drinking, and women decreased only in binge drinking. Further studies of the causality between alcohol consumption and health are suggested.

To investigate the extent to which Swedish primary health care (PHC) general practitioners (GPs) and nurses discuss alcohol issues with their patients, their reasons for and against addressing alcohol issues, their perceived importance of these issues, and factors that could facilitate increased alcohol intervention activity among the PHC professionals.All Swedish GPs and nurses who have the authority to issue prescriptions were surveyed with a postal questionnaire. The questionnaire was returned by 1821 GPs (47% response rate) and 3125 nurses (55% response rate).Fifty percent of the GPs and 28% of the nurses stated that they "frequently" discussed alcohol with their patients. The two most common reasons for asking patients about their drinking were that the GPs and nurses considered it part of their routines and the belief that the patient had alcohol-related symptoms. GPs said that improved opportunities for referral to specialists and provision of more knowledge about counselling techniques for use when alcohol-related symptoms are evident were the most important facilitators to increased intervention activity. Concerning the nurses, 93% stated that more time devoted to health-oriented work could facilitate increased alcohol intervention activity.The findings highlight a considerable gap between the recognition of the significance of the alcohol problem and Swedish PHC intervention activity.

Regional differences in Sweden in the prevalence of disability pension with a psychiatric diagnosis are unexplained, in spite of the significant impact on the population's health, rehabilitation systems, and the health care system. The purpose of this study was to describe the pattern of disability pensions with a psychiatric diagnosis and to analyze the impact of age and gender. We examined the incidence rates in one urban and one semi-rural region and compared these to national rates. The study sample was drawn from employed persons between 16-64 years of age who, because of their sickness insurance coverage, would be eligible to access disability pensions should it be necessary. Analysis of annual incidences and standardized morbidity ratios were made for 1980, 1985, 1990, 1995, and 1998. Data on disability pension cases were collected from the National Social Insurance registers. In the urban region we found that the proportion of men and women clearly outnumbered the national average: approximately twice the number of persons between 16-64 years of age with a psychiatric diagnosis were receiving a disability pension. In the semi-rural region there were fewer men overall on disability pensions with psychiatric disorders, but in 1980, 1985, and 1995 women clearly outnumbered men. Access to psychiatric care, unemployment, alcohol dependence, and previous sickness absence are suggested as possible factors that might affect the rates of disability pension in different geographical settings.

The purpose of the study was to explore the predictive value of women's alcohol habits in relation to incidence of diabetes and all-cause mortality. Special attention was paid to potential confounding factors such as age, heredity, education, socioeconomic group, physical inactivity, smoking, blood pressure, serum lipids, and, in particular, obesity.A longitudinal population study consisting of a representative sample of 1,462 women aged 38-60 started in Göteborg, Sweden, in 1968-1969 monitoring for diabetes and mortality over 32 years.Alcohol intake, expressed as intake of wine, hard liquor, or total grams of alcohol, was significantly negatively associated to 32-year diabetes incidence independent of age. However, the apparently protective effect of the alcohol variables was attenuated when BMI was included as a covariate. The inverse relationship between wine intake and diabetes did not remain after adjustment for physical activity or socioeconomic group. Beer and wine intake were significantly negatively associated to mortality. Increase of alcohol intake between the examination in 1968-1969 and 1980-1981 was significantly inversely related to the mortality between 1980-1981 and 2000-2001 and independent of all covariates. No relationship was observed between an increase in alcohol intake and diabetes incidence. However, after adjustment for age, family history, and basal alcohol consumption altogether, a significant inverse relationship was observed between increase of alcohol and diabetes incidence.The initially significant inverse associations observed between alcohol and diabetes as well as mortality were dependent on a number of confounding factors, of which BMI seems to be the most important.

In this study, we have evaluated the use of a screening instrument in the first phase of a population study of female alcoholism and alcohol problems. The instrument, called SWAG (Screening, Women, and Alcohol in Goteborg), is a 13-item questionnaire. It includes a modified version of CAGE. The study sample consisted of 3,130 women. Of these, a stratified sample of 479 were invited for interview. Validation was done against interview-based clinical diagnosis according to DSM-III-R (alcohol dependence and abuse), with additional use of medical record information. SWAG had similar sensitivity and specificity used on a population sample, as previously has been found for alcohol problem screening instruments tested in clinical settings. Positive predictive value, rarely reported in studies of other alcohol screening instruments, was 40 to 50%. With logistic regression, we developed a promising set of criteria, called SWAG-L, that had similar sensitivity, specificity, and positive predictive value as the longer version SWAG-1, at the same time it consisted of only four items. CAGE had considerably lower sensitivity than SWAG. SWAG can, so far, be recommended for use in epidemiological studies. It may also prove valuable in clinical settings, although that requires a different scoring method. The question, "I have/have had alcohol problems" was the single item that best predicted alcohol dependence and abuse.