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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

Quality of life has become an increasingly important measurement in the substance use field. The main aim of the present study was to examine the relationships between non-medical use of prescription analgesics and sedatives and poor quality of life in the general population.Data were drawn from a Swedish national household survey conducted in 2008-2009. A stratified sample of 58,000 individuals aged 15-64 was randomly selected, with a response rate of 38.3% (n = 22,095). We examined the relationships between non-medical prescription drug use and quality of life in a logistic regression analysis, controlling for other substance use and sociodemographic variables.In the final logistic regression model, both non-medical use of prescription analgesics and sedatives were independently associated with poor quality of life. Non-medical use of prescription sedatives was the strongest correlate of poor quality of life among the substance use variables.The associations between non-medical prescription drug use and poor quality of life might imply a need to better identify and provide treatment for this group, especially individuals with non-medical prescription sedative use, which seems to be a particularly strong correlate of poor quality of life.Using a large, general population sample, the present paper is one of few to examine the relationships between non-medical prescription drug use and quality of life.

Berglund’s historiographic overview on the Swedish popular struggle from peasant rebellion to urban riots is based on new research findings as well as a large number of previous studies showing that the individual riots over time became increasingly politicized and together contributed to the long process of democratization in Sweden 1740–1880 until the era of industrialization. Rioting was quite infrequent in Sweden in comparison with other countries in western Europe. A special ‘Swedish culture of negotiation’ during the early modern period has been identified as a part of the explanation. Another reason raised in the chapter is that Sweden was a sparsely populated country with only small towns but a strong central government, which prevented large crowds from gathering.

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.

Although cannabis is well studied in the scientific literature, relatively little is known about the relationship between the frequency of cannabis use and the use of alcohol and other drugs. The aim of this study was to identify differences between frequent and occasional cannabis users with respect to the use of other illicit drugs, hazardous alcohol use, and unauthorized use of prescription drugs.

This randomized trial evaluates whether automated telephony could be used to perform daily assessments in paroled offenders ( N = 108) during their first 30 days after leaving prison. All subjects were called daily and answered assessment questions. Based on the content of their daily assessments, subjects in the intervention group received immediate feedback and a recommendation by automated telephony, and their probation officers also received a daily report by email. The outcome variables were analyzed using linear mixed models. The intervention group showed greater improvement than the control group in the summary scores ( M = 9.6, 95% confidence interval [CI] = [0.5, 18.7], p = .038), in mental symptoms ( M = 4.6, CI = [0.2, 9.0], p = .042), in alcohol drinking ( M = 0.8, CI = [0.1, 1.4], p = .031), in drug use ( M = 1.0, CI = [0.5, 1.6], p = .000), and in most stressful daily event ( M = 1.9, CI = [1.1, 2.7], p = .000). In conclusion, automated telephony may be used to follow up and to give interventions, resulting in reduced stress and drug use, in paroled offenders.

PurposeThe aim of this study was to analyse prescription refill, re-hospitalisation, total mortality, mortality because of suicide and attempted suicide among patients who were taking various types of antipsychotics. MethodsA population-based cohort study analysed all patients (n=26046) in Sweden who had been treated for schizophrenia from 2006 to 2009 with regard to re-hospitalisation and prescription refill for various types of antipsychotic treatment. A case-control study nested within the cohort analysed all-cause mortality, mortality because of suicide and attempted suicide in relation to antipsychotic use. The study adjusted for history of hospitalisation for psychiatric and medical care, attempted suicide and use of antidepressants. ResultsAripiprazole users were the only ones who showed significantly lower all-cause risks of death, but so few events occurred among users of this relatively new drug that the results should be interpreted with caution. Clozapine users showed lower odds of death by suicide (odds ratio [OR]=0.45 [95%CI 0.20-0.98]) and of attempted suicide (OR=0.44 [0.28-0.70]) than haloperidol users after adjustment for age, sex and year of discharge. Olanzapine users showed approximately the same favourable pattern. Patients who used clozapine were most likely to refill prescriptions and had lower rates of re-hospitalisation. Only one death and 23 cases of agranulocytosis were reported compared with 223 suicides and 831 suicide attempts. An etiologic fraction calculation suggests that the use of clozapine rather than traditional drugs could have prevented 95 suicide attempts during the period. ConclusionClozapine and olanzapine reduce the risk of suicide, attempted suicide and re-hospitalisation. Copyright (c) 2014 John Wiley & Sons, Ltd. (Less)

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: Respondent-driven sampling is a research technique, new to the Scandinavian setting, used in hard-to-reach populations, such as subjects at risk for HIV, including drug users. This study aimed to evaluate the use of respondent-driven sampling originating from syringe exchange clients, as a method to identify ‘hidden’ drug users without treatment or social service contact. Methods: Nine heroin and amphetamine injectors were recruited as ‘seeds’ and instructed to recruit up to three heavy drug users in a chain-referral process. Recruited clients were interviewed about drug use, social conditions and contacts with treatment, syringe exchange and other authorities. In order to estimate whether the recruitment managed to evolve into groups of ‘hidden’ drug users, clients included beyond the fourth wave of chain-referral were compared with seeds (wave 0) and clients recruited in waves 1–3. Results: Five seeds were generative, and in total, 66 clients were assessed. Except for one of the 35 variables studied, clients in waves 4–9 did not differ from clients in waves 0–3, and were no less likely to have contacts with authorities. All clients except one were injectors and syringe exchangers, and clients recruited later in the chain-referral even tended to attend the syringe exchange more frequently. Conclusions: Respondent-driven sampling originating from syringe exchange clients may have difficulty reaching beyond the population of injectors and syringe exchangers. The technique, new to this geographical setting, has potential for future studies, but particular efforts may be necessary to study out-of-treatment heavy drug users unknown to the syringe exchange program.

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.

BACKGROUND: Polysubstance use is common in substance users, and may complicate their clinical course. This study, in a criminal justice setting in Sweden, examines the association between the number of concurrently used substance types and psychiatric symptoms during 30 days before incarceration, while controlling for background variables such as family history (drug and alcohol problems, psychiatric problems, criminality), demographic data and history of emotional, physical or sexual abuse. METHODS: The data material comprised 5659 criminal justice clients reporting a substance use problem, examined with the Addiction Severity Index. Variables were compared in a multinomial regression analysis, comparing clients reporting one (n=1877), two (n=1408), three (n=956), four (n=443) and five or more (n=167) substance types. RESULTS: The 30-day prevalence of most psychiatric symptoms included in the study (depression, anxiety, cognitive problems, hallucinations, difficulty controlling violent behaviour, suicidal ideation, suicide attempts) was higher in individuals with a higher number of concurrent substance types used. In multinomial regression analysis, while controlling for background variables, these associations remained for concurrent suicidal ideation, cognitive problems, hallucinations and violent behaviour, with the latter two being associated with the higher numbers of substance types. Binge alcohol drinking, tranquilizers, opioids and the number of substance types reported were associated with several of the psychiatric symptoms. CONCLUSIONS: In the present criminal justice setting in Sweden, the use of multiple substance types and concurrent psychiatric symptoms appear to be associated, and a sub-group reporting particularly high numbers of concurrent substance types are particularly likely to report potentially severe psychiatric problems.

The aim of this study was to identify factors associated with repeated suicide attempts among criminal justice clients examined for substance abuse using the Addiction Severity Index. Among suicide attempters (n = 1,404), repeaters (two or more attempts, n = 770) were compared to nonrepeaters. In logistic regression, repetition was associated with younger age, opioid analgesics, somatic medication, overdose, maternal psychiatric problems, delirium tremens, cognitive problems, and violent behavior. As in other settings, factors associated with repetition differed from those associated with suicide attempts in general. In this setting, substance use complications and cognitive problems were connected to repetition and should be addressed in risk assessments. (Less)

Background: Prospective follow-up of heroin users is known to be difficult due to their unstable lifestyle, and high follow-up rates have usually demanded major tracking efforts. In Sweden, mobile telephones are commonly used by heavy drug users for drug trading. Objectives: This methodology study aims to examine the efficacy of mobile telephone contact for prospective follow-up interviews with injecting heroin users recruited at the syringe exchange program of Malmo, Sweden. Methods: Seventy-eight heroin users with mobile telephone numbers were included. Subjects reported using heroin for 28 days of the previous 30 days, and only 8% reported they had recently been engaged in work or studies. Clients were contacted between 15 and 21 times over 2 years, with each contact attempt generally involving two telephone calls on consecutive days. Results: During follow-up, 68% of subjects had been successfully contacted for at least one follow-up interview (on average 6.9 interviews), and 25% of follow-up attempts were successful. In 23% of the sample (n = 18), at least 50% of follow-up attempts were successful, and these subjects tended to be older (p = .05) and more likely to be female (p = .07), whereas follow-up rates were unrelated to baseline heroin use. Conclusions: Despite limited effort, and despite the severe situation of intravenous heroin users, mobile telephone contact can be used with heavy drug users in the present setting. (Less)

The aim of the present study was to investigate the distribution of suicide attempts across the depressive episodes in suicides and controls with a severe depression. A blind record evaluation was performed of 100 suicide victims and matched controls admitted to the Department of Psychiatry between 1956 and 1969 and monitored to 2006. There was a similar number of episodes in suicides and controls and in the early episodes a similar number of suicide attempts in both groups. However, in the later episodes future suicides showed more suicide attempts as compared to controls. This was found for unipolar depression only. This difference was found despite previously shown similar rates of adequate treatment and improvement. In conclusion, more depressive episodes including suicide attempts appeared to be related to suicide.

Background: The present study examines a population of criminal justice clients for suspected substance-related problems. Aims: It aims to identify variables associated with a history of suicide attempt (SA). Method: 6,836 clients were interviewed with the Addiction Severity Index (ASI). Attempters were compared to nonattempters regarding substance use, medical/psychiatric status, family history, and social relationships in a stepwise forward logistic regression. Results: Attempters (21%) were more likely to report binge drinking, intake of illicit drugs, injection of drugs, physical and mental illness, problematic family history, and history of being abused. After logistic regression, SA was independently associated with older age, female gender, binge drinking, delirium tremens, injection, overdose, medical problems, psychiatric symptoms, family history of alcohol or psychiatric problems, and sexual, physical, and emotional abuse. The psychiatric and family/social domains (including being abused) most strongly separated attempters from nonattempters. Conclusions: Family background factors, psychiatric symptoms, severity of substance use, and sexual, physical, and emotional abuse appear to be factors associated with SA among criminal justice clients.

Background The first year of university studies is associated with increased levels of alcohol drinking and stress. This study examines the one-year outcome of both primary and secondary interventions of one alcohol programme and one stress intervention programme at an intervention university in comparison with a control university. Methods At the intervention university all freshmen were offered a primary prevention programme for hazardous alcohol use and stress management and, in addition, those who had high ratings for stress and/or hazardous alcohol use were offered a secondary intervention programme for alcohol consumption and/or stress management. Freshmen still attending the two universities one year later responded to follow-up questionnaires. Results The primary alcohol and stress interventions were associated with lower alcohol expectancies and mental symptoms, but no differences in AUDIT scores (- 0.2, CI 95% - 0.5 to 0.1), estimated blood alcohol concentrations or stress in comparison to freshmen at the control university. The secondary alcohol interventions were associated with decreased AUDIT (– 1.1, CI 95% - 2.0 to – 0.2) as well as alcohol expectancies, blood alcohol concentrations, stress and mental symptoms in comparison to high-risk freshmen at the control university. The secondary stress interventions were associated with decreased mental symptoms and alcohol expectancies, but not stress, AUDIT scores (- 0.6, CI 95% - 1.4 to 0.2) and blood alcohol concentrations in comparison to high-risk freshmen at the control university. Conclusion This study suggests that both primary and secondary alcohol and stress interventions have 1-year effects in university freshmen and could be implemented in university settings.

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.

Girls and boys with disabilities, 15–16 years of age, report a significantly higher rate of sexual debut than adolescents with no disabilities. In a society where a young person with a disability often is considered to have an essentially asexual status, there can be several fronts for adolescents to fight. The survey Life and Health—Young People 2005 was completed by 3,084 adolescents attending mainstream schools in Sweden. In this study the sexual debut in girls and boys with and without disabilities is related to mental health, school exposure and substance use. Our findings might be explained by a mechanism of identity construction from the adolescents’ ideas of normality and by a battle for acceptance and confirmation of life. The ideas of normality can be erroneous but still influence the adolescents’ sexual activity. Multivariate analyses also showed that the relationship between sex and substance use is strong among all adolescents.

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.

The current study assessed the responses from a survey titled 'Life and Health - Young People 2005', completed by 2878 15-16-year-old adolescents in mainstream schools in the county of Orebro, Sweden. Thirty-nine percent of students with hearing loss (slight, mild, or moderate) and 6% of students with normal hearing reported tinnitus often or always during the past three months. Almost no gender difference was observed among students with normal-hearing reporting tinnitus (boys 6.3%, girls 5.6%); however, a gender difference was noticed among hard-of-hearing (HH) students (boys 50%, girls 28%). Adolescents with both hearing loss and tinnitus reported considerably higher scores for mental health symptoms, substance use, and school problems than other students. Anxiety in the past three months, male gender, and alcohol consumption in the past year were associated with tinnitus in HH students; irritation and anxiety in the past three months, disability, use of illicit drugs, and truancy predicted tinnitus in the normal-hearing group. Consequently, students with a hearing loss and tinnitus are at high risk and should be monitored for subsequent problems.

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.

Background: Only a few intervention studies aiming to change high-risk drinking behavior have involved university students with heredity for alcohol problems. This study evaluated the effects after 2 years on drinking patterns and coping behavior of intervention programs for students with parents with alcohol problems. Method: In total, 82 university students (57 women and 25 men, average age 25 years) with at least 1 parent with alcohol problems were included in the study. The students were randomly assigned to 1 of the 3 programs: (i) alcohol intervention program, (ii) coping intervention program, or (iii) combination program. All the 3 intervention programs were manual based and individually implemented during 2 2-hour sessions, 4 weeks apart. Before the participants were randomly assigned, all were subjected to an individual baseline assessment. This assessment contained both a face-to-face interview and 6 self-completion questionnaires: the Alcohol Use Disorders Identification Test, estimated Blood Alcohol Concentration, Short Index of Problems, the Symptom Checklist-90, Coping with Parents' Abuse Questionnaire, and The Interview Schedule for Social Interaction (ISSI). Follow-up interviews were conducted after 1 and 2 years, respectively. The results after 1 year have previously been reported. Results: All participants finished the baseline assessment, accepted and completed the intervention. Ninety-five percent of the students completed the 24-month follow-up assessment. Only the group receiving the combination program continued to improve their drinking pattern significantly (p < 0.05) from the 12-month follow-up to the 24-month follow-up. The improvements in this group were significantly better than in the other 2 groups. The group receiving only alcohol intervention remained at the level of improvement achieved at the 12-month follow-up. The improvements in coping behavior achieved at the 12-month follow-up remained at the 24-month follow-up for all the 3 groups, i.e., regardless of intervention program. Conclusion: Positive effects of alcohol intervention between 1 and 2 years were found only in the combined intervention group, contrary to the 1-year results with effects of alcohol intervention with or without a combination with coping intervention.

Background: The goal of this study was to investigate whether Interactive Voice Response is a technology with which to perform real-time assessments of alcohol consumption and stress. Methods: Fifteen subjects (men and women) were recruited from a previous 4-year intervention study (n = 2,032). The Interactive Voice Response technique was based on mobile telephones. During 1 week, stress and alcohol were measured automatically 3 times daily. In addition, the subjects called the system at the start of the drinking session, and an automated hourly contact was established for the drinking period. Results: Of the data collection calls, 305 (97%) were answered. Real-time drinking was assessed 9 times of 9 (100%). The average length of the IVR assessment was only 28 seconds because of modified technology. Individuals with an estimated blood alcohol concentration above 0.1% under-reported drinking in their day-after reports by between 1 and 10 drinks. The same subjects had more pronounced stress reduction than those with lower BAC levels. Conclusion: Interactive Voice Response methodology offers a promising new technology for daily as well as real-time assessments.

Object: The aim of the present study was to investigate the pattern of non‐fatal heroin overdoses for men and women in Sweden, a country with late onset of heroin use.Material: Subjects were recruited through the Syringe Programme and the Addiction Centre in Malmoe. A total of 149 subjects were interviewed, 108 men and 41 women. They were asked about their social situation, experienced and observed overdoses and circumstances around them.Results: Overdoses were very common; 74% of the subjects had experienced at least one overdose. Almost all, 96%, had observed at least one overdose in others and 32% had witnessed a fatal overdose. Actions taken were often insufficient. A combination with other drugs, mainly benzodiazepine and alcohol and/or a lowered tolerance for heroin after visits in institutions contributed to the overdose in a majority of the cases. Men and women differed in that men used concomitant drugs more often and women more often took heroin alone.Conclusion: Self‐reported and observed non‐f...

Buprenorphine misuse by injecting drug users was assessed in a survey of 350 needle exchangers, either amphetamine (57%) or heroin users (42%). 89% of heroin users and 24% of amphetamine users reported using buprenorphine at some time during the previous year. Most users reported illicit acquisition. Among illicit users, 87% of heroin users reported intake for withdrawal treatment or self-detoxification, and 11% for euphoria. Euphoria seeking was more common among amphetamine users (62%, p < 0.001). Intravenous misuse was reported by 43% of illicit users, and snorting by 29%. Sole sublingual intake was more common among heroin users than among amphetamine users (46 vs. 20%, p < 0.05), and less common among patients reporting euphoria seeking (20 vs. 46%, p < 0.05).

The two aims of this study were to analyse the impact of methadone on outcome, and to confirm the results from previous meta-analyses by using a different methodology. The literature on randomized controlled trials (RCT) of methadone as maintenance treatment for opioid dependence was systematically reviewed. Eight studies involving 1511 patients were included. Both dichotomous and continuous variables were transformed into the standardized effect size (d). Homogeneity was analysed. A random effect model was used in all calculations. The combined analyses for retention, abuse and criminality were all significant: d=0.90, d=0.61, and d=0.35, respectively. A test of heterogeneity was significant for all three outcomes: P0.01 for all comparisons. The type of study design was a significant moderator in five of nine comparisons: for retention in all three comparisons, concerning abuse in gradual detoxification vs. untreated controls and concerning criminality in placebo vs. untreated controls. In these sub-groups, three of six studies were homogeneous. In one study, methadone maintenance treatment reduced abuse of illegal opioids in prisoners. We conclude that methadone maintenance treatment in opioid dependence shows positive effects on retention, opioid abuse and criminality compared with non-active controlled conditions. Type of study design could explain some of the heterogeneity found. A different meta-analytical approach made it possible to confirm effects of methadone on retention and opioid abuse from previous studies and document effect on criminality.

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)

Objective To discuss how to develop more effective treatment programmes than those currently available for addictive disorders. Data sources The Swedish SBU report, published in English in 2003. was used as a database. It includes 641 randomized controlled trials and seven longitudinal prospective studies. Methods Meta-analytical calculations were performed in several areas using standardized mean differences (d) effect-size estimate and homogeneity testing. Three critical issues have been the focus of the present analysis: the early intervention phase. treatment procedures and their additive properties and the transitional period between early and late effects of treatment. Results The main findings while integrating the results in a new way were that intervention studies with one single session showed a small but robust homogeneous effect size. whereas studies of interventions with several sessions were heterogeneous with large and small effect sizes among the included studies. Similar effect sizes were found in alcohol, opioid and cocaine treatment studies. Agonist treatment yielded the highest effect sizes. Some evidence was found for a possible additive effect for cognitive behaviour therapy and naltrexone as well as for aversive treatment (disulfiram) and psychosocial treatment in alcohol dependence. So far studies on the transition period between short- and long-term outcome are few and inconclusive. Conclusions There is a prospect of improving addiction treatment, and the following areas are suggested by meta-analysis for future research: (a) to examine in more detail the process between the first and second session of intervention; (b) to randomize simultaneously for independent categories of psychosocial and psychopharmacological treatment: and (c) to intensify studies on the transitional period between short- and long-term outcome. (Less)

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.

From a large consecutive sample (n = 1,312) of hospital-treated alcoholics with multiaxial ratings, 105 were chosen for personal examination two decades after the subjects’ first admission (1949–1969) for alcohol problems. To study patterns of successful adjustment, 70 were chosen on the basis of a good social adjustment (health insurance data) at follow-up, whereas the control subjects had been granted a disability pension. The first follow-up was carried through in 1982–1983. In 1998–1999, the same 105 subjects were studied concerning mortality rate and adjustment patterns. In the good social adjustment group, 33% had deceased as compared with 63% in the control group (p < 0.01). Twenty-three out of 44 surviving subjects accepted a personal interview. Favourable adjustment was generally reported as being stable over the follow-up period. Several subjects reported stable non-problem drinking and others a change between abstinent and non-abstinent adjustment patterns.

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 )

This article represents the proceedings of a symposium at the 2002 annual meeting of the Research Society on Alcoholism in San Francisco, CA, organized and cochaired by Mats Berglund and Sten Thelander. The presentations were (1) Preventive interventions against hazardous consumption of alcohol, by Mikko Salaspuro; (2) Treatment of alcohol withdrawal, by Johan Franck; (3) Psychosocial treatment for alcohol problems, by Sven Andreasson and Agneta Ojehagen; and (4) Pharmacological treatment of alcohol dependence, by Mats Berglund.

In several studies, patients with alcohol dependence treated with the opioid antagonist naltrexone have shown fewer relapses to heavy drinking than those receiving placebo. An interaction between the naltrexone effect and the type of psychological therapy has been observed.A 6-month, double-blind, placebo-controlled, parallel-group study was performed at 10 different investigation sites. After a placebo run-in period of 1 week, 118 patients were randomized into 4 treatment groups-50 mg of naltrexone daily or placebo in combination with either cognitive behavioral therapy (CBT) or supportive therapy. The CBT was performed over nine sessions according to the manual of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). The supportive therapy was defined as "the treatment as usual." Alcohol consumption, craving, carbohydrate-deficient transferrin, medication compliance by tablet count, and adverse clinical events were assessed at all visits. Other liver enzymes and psychiatric symptoms were also determined.Ninety-one (77%) patients completed the study, and 92 (78%) were 80% compliant with the medication regimen. A lower percentage of heavy-drinking days was shown in the naltrexone group (p = 0.045) compared with the placebo group, as was a lower craving score (p = 0.029). These results are supported by the lower levels of liver enzyme activities (p0.010 for aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase), but not by the carbohydrate-deficient transferrin levels, in the naltrexone group. The mean time period before the first day of heavy drinking was longer for the group treated with CBT (p = 0.010), especially in combination with naltrexone (p = 0.007). Naltrexone was well tolerated, and no patients discontinued the study due to side effects.This study supports the effect of naltrexone in outpatient treatment of alcohol dependence and suggests that a beneficial interaction effect with CBT can be expected.

Aims To decrease alcohol consumption among patrons in student pubs by server-training programmes. Design Randomized controlled trial. Setting University campus. Participants A total of 1322 students visiting local student pubs during ordinary pub evenings. Intervention Educational programmes were given to bartenders (n = 40) in a randomized design in six of 12 pubs on a university campus. Bartenders in control pubs were not given the programme. Measurements Breath alcohol concentration (BAC), expressed in percentage, among the patrons and the reported social atmosphere in the pub (‘high’, ‘cosy’ and ‘rowdy’) measured on a visual analogue scale in the pub before and after the intervention programme was given. Findings BACs of patrons in the intervention pubs were reduced by more than those of the patrons in the control pubs at a 1-month follow-up. The mean difference in BAC between intervention and control groups was −0.011% (95% confidence interval, 0.022–0.000). The intervention group also decreased more in reported level of ‘rowdy’ social atmosphere than did the control group. The mean difference was −6 points (95% confidence interval −11 to −1). No differences were found in reported ‘cosy’ and ‘high’ atmosphere. Conclusion Alcohol levels among the patrons were decreased and the ‘rowdy’ social atmosphere reduced in the intervention group. Server-training programmes for personnel in student pubs could be a component in the prevention of alcohol problems in university student populations.

Large pulsed-power systems normally use a solid capacitive primary storage and a water capacitor for secondary storage. It is shown that the electrical breakdown strength is increased and the maximum storage time is enhanced from the microsecond level to the millisecond level when the water is replaced by a water/methanol mixture. The increased time scale in the second storage enables the use of an inductive primary storage. The mixing of methanol in the water decreases the relative permittivity. However, due to the increased electrical breakdown strength, a higher energy density is nevertheless possible. Previous work with water/ethylene glycol has manifested the problem of charge injection that occurs when energy is stored for millisecond time scales at high electrical stress. Water/methanol mixtures show less tendency for charge injection and a better ability to store energy at millisecond time scales.

Suicide attempts in the long term course of illness were investigated in 89 suicides with a primary severe depression/melancholia and in matched controls. Multiaxial ratings at index admission between 1956 and 1969 enabled the selection of patients. These patients were tracked to January 1, 1984. A blind record evaluation was performed. Suicide attempts were more common among suicides than controls. General characteristics of attempts, such as severity, the use of a violent method, and repetition did not differentiate suicides from controls. Rather, there were differences in the pattern of suicide attempts. In suicides, only, re-attempts were related to number of episodes of mood disorder. Controls more often made re-attempts after a stressful life event. Serious attempts occurred early in the course of suicide attempts in female suicides, in contrast to controls. There was a correlation between the occurrence of a suicide attempt and completed suicide among male unipolar patients and female bipolar patients.