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1.	Hedman, Linnea, et al. (författare) Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms 2018 Ingår i: Jama Network Open. - : American Medical Association (AMA). - 2574-3805. ; 1:3 Tidskriftsartikel (refereegranskat)abstract IMPORTANCE There is an ongoing debate about whether electronic cigarettes (e-cigarettes) are the solution to the tobacco epidemic or a new public health threat. Large representative studies are needed to study e-cigarette use in the general population, but hardly any have been published. OBJECTIVES To estimate the prevalence of e-cigarette use and to investigate the association of e-cigarette use with smoking habits, demographic factors, and respiratory symptoms. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of random samples of the population, performed within the Obstructive Lung Disease in Northern Sweden (OLIN) study and West Sweden Asthma Study (WSAS). The same validated questionnaire including identical questions was used in OLIN and WSAS. In 2016, OLIN and WSAS conducted postal questionnaire surveys in random samples of adults aged 20 to 75 years. In OLIN, 6519 participated (response rate, 56.4%); in WSAS, 23 753 participated (response rate, 50.1%). MAIN OUTCOMES AND MEASURES Electronic cigarette use, smoking habits, and respiratory symptoms. RESULTS Of 30 272 participants (16 325 women [53.9%]). 3897 (12.9%) were aged 20 to 29 years; 4242 (14.0%). 30 to 39 years; 5082 (16.8%). 40 to 49 years; 6052 (20.0%), 50 to 59 years; 6628 (21.9%), 60 to 69 years; and 4371(14.4%), 70 to 75 years. The number of current smokers was 3694 (12.3%), and 7305 (24.4%) were former smokers. The number of e-cigarette users was 529 (2.0%). and e-cigarette use was more common among men (275 of 12 347 [2.2%; 95% CI, 2.0%-2.5%]) than women (254 of 14 022 [1.8%; 95% CI, 1.6%-2.0%]). Among current smokers. 350 of 3566 (9.8%; 95% CI, 8.8%10.8%) used e-cigarettes compared with 79 of 6875 (1.1%; 95% CI, 0.9%-1.3%) in former smokers and 96 of 15 832 (0.6%; 95% CI, 0.5%-0.7%) in nonsmokers (P < .001). Among e-cigarette users who answered the survey question about cigarette-smoking habits (n = 525). 350 (66.7%; 95% CI, 62.7%-70.7%) were current smokers, 79 (15.0%; 95% CI, 11.9%-18.1%) were former smokers, and 96 (18.3%; 95% CI, 15.0%-21.6%) were nonsmokers (P < .001 for trend). In a regression analysis, e-cigarette use was associated with male sex (odds ratio [OR], 1.35; 95% CI. 1.12-1.62); age groups 20 to 29 years (OR. 2.77; 95% CI, 1.90-4.05), 30 to 39 years (OR, 2.27; 95% CI, 1.53-3.36), 40 to 49 years (OR, 1.65; 95% CI, 1.11-2.44). and 50 to 59 years (OR, 1.47; 95% CI, 1.01-2.12); educational level at primary school (OR, 1.99; 95% CI, 1.51-2.64) and upper secondary school (OR, 1.57; 95% CI, 1.25-1.96); former smoking (OR. 2.37; 95% CI, 1.73-3.24); and current smoking (OR. 18.10; 95% CI, 14.19-23.09). All respiratory symptoms were most common among dual users and former smokers and nonsmokers who used e-cigarettes. CONCLUSIONS AND RELEVANCE Use of e-cigarettes was most common among smokers, and dual users had the highest prevalence of respiratory symptoms. On a population level, this study indicates that the present use of e-cigarettes does not adequately serve as a smoking cessation tool.
2.	Klingstedt, Marie-Louise, et al. (författare) Reliability and construct validity of five life domains in the adolescent drug abuse diagnosis instrument in a sample of Swedish adolescent girls in special residential care 2020 Ingår i: Nordic Studies on Alcohol and Drugs. - : SAGE Publications. - 1455-0725 .- 1458-6126. ; 37:4, s. 411-426 Tidskriftsartikel (refereegranskat)abstract Aim: This cross-sectional study investigates the psychometric properties of the Swedish edition of the Adolescent Drug Abuse Diagnosis (ADAD), and specifically examines the internal consistency and construct validity of five life domains reported by female adolescents in special residential care in Sweden (N= 780;M-age= 16 years old).Methods: Principal component analysis and entropy-based analysis were used to test construct validity.Conclusion: Results indicate that ADAD may be able to reliably distinguish between areas that are important targets for intervention.
3.	Ahlm, Kristin, et al. (författare) Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs : a retrospective study, 1992-2009 2013 Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 13, s. 216- Tidskriftsartikel (refereegranskat)abstract Background: Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs.Methods: During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine.Results: During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (<= 18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688/4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons.Conclusion: Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program.
4.	Backberg, M, et al. (författare) Occurrence and time course of NPS benzodiazepines in Sweden - results from intoxication cases in the STRIDA project 2019 Ingår i: Clinical toxicology (Philadelphia, Pa.). - : Informa UK Limited. - 1556-9519 .- 1556-3650. ; 57:3, s. 203-212 Tidskriftsartikel (refereegranskat)
5.	Beer, Torfinn, et al. (författare) Increased lung weight in fatal intoxications is not unique to opioid drugs 2023 Ingår i: Journal of Forensic Sciences. - : John Wiley & Sons. - 0022-1198 .- 1556-4029. ; 68:2, s. 518-523 Tidskriftsartikel (refereegranskat)abstract Fatal intoxications with opioids are known to be associated with an increased lung weight, as well as with brain and pulmonary edema and urinary retention. However, there is evidence to suggest that fatal intoxications with non-opioid substances are also associated with increased lung weight; however, the latter aspect has not been comprehensively analyzed. To determine to what extent opioid and non-opioid substances are associated with increased lung and brain weight, we studied these organs in cases where the cause of death was attributed to intoxication with a single agent. Using data from cases autopsied at the National Board of Forensic Medicine (NBFM) in Sweden from 2009 through 2019 where the cause of death was attributed to a single substance, we created models of combined lung weight and brain weight. The models used age and sex as predictors as well as nested varying effects for the specific intoxicant and category of intoxicant. Suicidal hanging with negative toxicology cases served as controls. The population majority was male among both intoxications (68%) and controls (83%). The most common single substance group was opioids. All tested substances were associated with heavier lungs than controls, with the largest effect in the opioid group. Our findings show that several substances are associated with increased lung weight and that among intoxication deaths there is no difference in expected brain weight between substances. Hence, heavy lungs, without a reasonable explanation, should prompt a broad toxicological screening.
6.	Hedlund, J, et al. (författare) Pre-offense alcohol intake in homicide offenders and victims: A forensic-toxicological case-control study 2018 Ingår i: Journal of forensic and legal medicine. - : Elsevier BV. - 1878-7487 .- 1752-928X. ; 56, s. 55-58 Tidskriftsartikel (refereegranskat)
7.	Hedlund, J, et al. (författare) Psychotropic Medications in Swedish Homicide Victims and Offenders: A Forensic-Toxicological Case-Control Study of Adherence and Recreational Use 2017 Ingår i: The Journal of clinical psychiatry. - 1555-2101. ; 78:7, s. E797-E802 Tidskriftsartikel (refereegranskat)
8.	Helander, A, et al. (författare) Reprint of Standardisation and use of the alcohol biomarker carbohydrate-deficient transferrin (CDT) 2017 Ingår i: Clinica chimica acta. - : Elsevier BV. - 1873-3492 .- 0009-8981. ; 467, s. 15-20 Tidskriftsartikel (refereegranskat)
9.	Olsson, Martin O., et al. (författare) High Rates of Tramadol Use among Treatment-Seeking Adolescents in Malmö, Sweden: A Study of Hair Analysis of Nonmedical Prescription Opioid Use 2017 Ingår i: Journal of addiction. - : Hindawi Publishing Corporation. - 2090-7850 .- 2090-7834. ; 2017 Tidskriftsartikel (refereegranskat)abstract Nonmedical prescription opioid use (NMPOU) is a growing problem and tramadol has been suggested as an emerging problem in young treatment-seeking individuals. The aim of the present study was to investigate, through hair analysis, NMPOU in this group and, specifically, tramadol use.
10.	Thiblin, Ingemar (författare) Narkotikarelaterad död 2022. - 3 Ingår i: Beroendemedicin. - Lund : Studentlitteratur AB. - 9789144140810 Bokkapitel (refereegranskat)
11.	Tjäderborn, Micaela, 1983- (författare) Psychoactive prescription drug use disorders, misuse and abuse : Pharmacoepidemiological aspects 2016 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognized and emerging public health concerns.Aim: The aim of this thesis is to estimate the prevalence of psychoactive prescription drug (PPD) use disorders, misuse and abuse, and to investigate the association with some potential risk factors.Methods: A study using register data from forensic cause of death investigations investigated and described cases of fatal unintentional intoxication with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were investigated and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming the intake of one out of five pre-specified PPDs, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a cohort of patients initiating prescribed treatment with pregabalin, using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use of the drug above the maximum approved daily dose (MAD), and factors associated with the utilisation patterns (Study IV).Results: In the first study, 17 cases of unintentional intoxications were identified, of which more concerned men, the median age was 44 years and the majority used multiple psychoactive substances (alcohol, illicit drugs and prescription drugs). The second study identified 104 spontaneously reported cases of tramadol dependence, in which more concerned women, the median age was 45 years, and a third reported a history of substance abuse and 40% of past psychoactive medication use. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription. Non prescribed use was most frequent in users of benzodiazepines and tramadol, and was more likely in younger individuals and in multiple-substance users. In the last paper five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of doses above the maximum approved dosing recommendation. This pattern of use was associated with male sex, younger age, non-urban residency and a recent prescribed treatment with an antiepileptic or opioid analgesic drug.Conclusions: This thesis shows that psychoactive prescription drug use disorders, misuse and abuse occur and may have serious and even fatal consequences. The prevalence varies between different drugs and populations. Abuse and misuse seem to be more common in young people. Fatal intoxications and misuse of prescribed drugs may be more common in men, while drug use disorders following prescribed treatment may be more common in women and non-prescribed use equally distributed between women and men. Individuals with a history of mental illness, substance use disorder or abuse, or of past use of psychoactive medications are likely important risk groups. In summary, the findings suggest a potential for improvements in the utilisation of psychoactive prescription drugs. The results may be useful in the planning of clinical and regulatory preventive interventions to promote the rational, individualised and safe use of such drugs.
12.	Agahi, Neda, et al. (författare) Alcohol Consumption Over the Retirement Transition in Sweden : Different Trajectories Based on Education 2022 Ingår i: Work, Aging and Retirement. - : Oxford University Press. - 2054-4642 .- 2054-4650. ; 8:1, s. 74-81 Tidskriftsartikel (refereegranskat)abstract Retirement is a major life transition that involves changes to everyday routines, roles, and habits. Previous studies suggest that retirement may influence drinking habits. Many natural inhibitors of alcohol consumption disappear with the removal of work constraints. The potential impact depends on both individual and contextual factors. Women in the cohorts undergoing retirement now have been more active on the labor market, including the occupation of higher status jobs, which indicates more financial resources as well as a larger role loss after retirement. Also, the current cohorts who retire have had more liberal drinking habits throughout their lives compared to previous cohorts. We therefore examined changes in alcohol consumption surrounding retirement in different education groups among women and men undergoing retirement using annual data from the Health, Aging and Retirement Transitions in Sweden (HEARTS) study, a longitudinal national study of 60- to 66-year-olds (n = 5,913), from 2015 to 2018. Latent growth curve models were used to estimate trajectories of alcohol consumption. Results showed that those who retired during the follow-up increased their usual weekly alcohol consumption while those who worked or were retired throughout the period had stable drinking habits. Those who were retired reported the highest alcohol consumption. The increase surrounding retirement was driven by people with higher education. Women with tertiary education and men with intermediate or tertiary education increased their weekly alcohol intake after retirement, while those with low education had unchanged drinking habits. Mechanisms and motivations that may fuel increased alcohol intake among people with higher education should be further investigated.
13.	Agahi, Neda, et al. (författare) Social integration and alcohol consumption among older people : A four-year follow-up of a Swedish national sample 2019 Ingår i: Drug And Alcohol Dependence. - : Elsevier BV. - 0376-8716 .- 1879-0046. ; 196, s. 40-45 Tidskriftsartikel (refereegranskat)abstract Background: Today’s older people drink more alcohol than earlier cohorts of older people. Social integration has been identified as an important factor for older people’s drinking, but the association is complex. This study investigates both high and low levels of social integration and their associations with longitudinal patterns of alcohol consumption among older women and men.Methods: Longitudinal nationally representative data of older Swedish women and men aged over 65 – the Swedish Level of Living Survey (LNU) and Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) – from 2010/2011 and 2014 (n = 1048). Associations between social contacts and social activities at baseline and longitudinal patterns of drinking frequency were examined with multinomial logistic regression analyses. Results: Men reported drinking alcohol more often than women, but the most common drinking frequency among both women and men was to drink monthly or less. Drinking habits were generally stable over time. People with high levels of social activity at baseline were more likely to have a stable daily or weekly drinking frequency or increased drinking frequency over the four-year follow-up period, particularly women. People with low levels of social contacts and/or social activities were less likely to have a stable daily or weekly drinking frequency, compared to people in the low and stable drinking frequency group.Conclusions: Alcohol consumption is embedded in a social context, older people drink in social situations and social integration predicts continued drinking patterns.
14.	Philipson, Anna, 1978-, et al. (författare) Adolescent depression and subsequent earnings across early to middle adulthood: A 25-year longitudinal cohort study 2020 Ingår i: Epidemiology and Psychiatric Sciences. - : Cambridge University Press. - 2045-7979 .- 2045-7960. ; 29 Tidskriftsartikel (refereegranskat)abstract Aims: The few available studies on early-onset depression and future earnings offer ambiguous findings, and potential sources of heterogeneity are poorly understood. We examined the differences in adult earnings of males and females with and without a history of depressive disorder in adolescence, with specific focuses on (1) future earnings in clinical subtypes of adolescent depression; (2) the growth and distribution of earnings over time within these subgroups and (3) the mediating role of subsequent depressive episodes occurring in early adulthood. Methods: Data were drawn from the Uppsala Longitudinal Adolescent Depression Study, a community-based cohort study initiated in Uppsala, Sweden, in the early 1990s. Comprehensive diagnostic assessments were conducted at age 16-17 and in follow-up interviews 15 years later, while consecutive data on earnings for the years 1996 to 2016 (ages 20-40) were drawn from population-based registries. The current study included participants with a history of persistent depressive disorder (PDD) (n = 175), episodic major depressive disorder (MDD) (n = 82), subthreshold depression (n = 64) or no depression (n = 218) in adolescence. The association of adolescent depression with earnings in adulthood was analysed using generalised estimating equations. Estimates were adjusted for major child and adolescent psychiatric comorbidities and parental socioeconomic status. The indirect (mediated) effect of depression in early adulthood (ages 19-30) on earnings in mid-adulthood (31-40) was estimated in mediation analysis. The study followed the 'STrengthening the Reporting of OBservational studies in Epidemiology' (STROBE) guidelines. Results: Earnings across early to middle adulthood were lower for participants with a history of a PDD in adolescence than for their non-depressed peers, with an adjusted ratio of mean earnings of 0.85 (0.77-0.95) for females and 0.76 (0.60-0.95) for males. The differences were consistent over time, and more pronounced in the lower percentiles of the earnings distributions. The association was partially mediated by recurrent depression in early adulthood (48% in total; 61% for females, 29% for males). No reduction in earnings was observed among participants with episodic MDD in adolescence, while results for subthreshold depression were inconclusive. Conclusions: Our findings suggest that future earnings of adolescents with depressive disorders are contingent on the duration and natural long-term course of early-onset depression, emphasising the need for timely and effective interventions to avoid loss of human capital.
15.	Swahnberg, Katarina, et al. (författare) Minimizing human dignity : staff perception of abuse in health care 2012 Ingår i: Clinical Ethics. - : SAGE Publications. - 1477-7509 .- 1758-101X. ; 7:1, s. 33-38 Tidskriftsartikel (refereegranskat)abstract In earlier studies we have shown that abuse in health care (AHC) is commonly reported among both male and female patients. In this study, we present an evaluation of an intervention against AHC based on Forum Play. The evaluation was conducted by means of pre- and postintervention interviews with the staff at a woman's clinic. The interviews were analysed using the constant comparative method. The results of this postintervention study stand out in loud contrast to the results of the preintervention studies. Staff had moved from a distant and fluctuating awareness of AHC to a standpoint characterized by both moral imagination and a sense of responsibility.
16.	Hodgins, S., et al. (författare) Individuals developing schizophrenia are hidden among adolescent substance misusers 2016 Ingår i: Psychological Medicine. - 0033-2917 .- 1469-8978. ; 46:14, s. 3041-3050 Tidskriftsartikel (refereegranskat)abstract Background Strategies are needed to identify youth developing schizophrenia. The present study aimed to determine whether adolescents treated for substance misuse were at elevated risk to develop schizophrenia, whether this risk has changed since the late 1960s, and whether substance misuse in adolescence predicted poorer outcomes through adulthood. Method In a Swedish city, since the mid-1960s there has been only one clinic for adolescent substance misuse. Three samples from this clinic were studied: 1992 individuals treated from 1968 to 1971 followed to age 50 years; 1576 treated from 1980 to 1984 followed to age 35 years; and 180 treated in 2004 followed to age 22 years. Each clinical sample was matched on age, sex and place of birth to an equal, or larger, number of randomly selected individuals from the general population. Schizophrenia, substance use disorders, physical disorders related to substance misuse, criminal convictions, poverty and death were identified using national registers. Results Individuals treated for substance misuse in adolescence were at increased risk to subsequently develop schizophrenia: in males the increase was approximately four-fold and in females between five- and seven-fold. There was no difference in risk for those treated in 1968-1971 and from 1980 to 1984 when cannabis use increased from 37.6% to 49.8% of the clinical samples. Among males who developed schizophrenia, treatment for substance misuse was associated with increased risk of substance use disorders and criminal convictions through adulthood. Conclusions Treatment programmes for adolescents misusing substances include a disproportionate number developing schizophrenia. Early detection and treatment have the potential to improve long-term outcomes.
17.	Larm, Peter, et al. (författare) Do non-drinking youth drink less alcohol in young adulthood or do they catch up? : Findings from a Swedish birth cohort 2023 Ingår i: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 33:4, s. 640-644 Tidskriftsartikel (refereegranskat)abstract Background Alcohol consumption among adolescents has declined considerably during the last two decades. However, it is unknown if these adolescents' alcohol consumption will remain low as they grow older. To our knowledge, this is one of the first studies that uses longitudinal data to examine if non-drinking adolescents have a lower alcohol consumption in young adulthood or if they catch up. Methods A self-report survey was distributed to a birth cohort (n = 794) born in 1997 in a Swedish region when cohort members attended ninth grade (age 14-15 years) in 2012. Responders were divided into non-drinkers and alcohol users and assessed again in their late teens (17-18 years) and young adulthood (20-21 years). Results In their late teens (17-18 years), non-drinkers at baseline consumed less alcohol and had a lower probability of harmful use compared with their alcohol-using peers. In young adulthood (20-21 years), these effects disappeared when adjustment was made for covariates. However, a stratified analysis showed that non-drinking adolescents low in conduct problems consumed less alcohol and had a lower probability of harmful use in young adulthood than alcohol-using peers. Conclusions This study suggests that the decline in alcohol use among adolescents in the past decades may be associated with a lower alcohol consumption in the late teens and young adulthood among those low in conduct problems. This may have promising implications for alcohol-related morbidity and mortality.
18.	Larm, Peter, et al. (författare) How are social capital and sense of coherence associated with hazardous alcohol use? : Findings from a large population-based Swedish sample of adults 2016 Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 44:5, s. 525-533 Tidskriftsartikel (refereegranskat)abstract Aims: This study examined whether social capital and a sense of coherence are associated with hazardous alcohol use in a large population-based Swedish sample. In particular, the objectives were (a) to examine which of five subdimensions of social capital is associated with hazardous alcohol use, (b) to investigate the moderating role of sense of coherence and (c) to examine possible sex differences. Methods: A postal survey was distributed to a sample of respondents (aged 18-84 years) from five Swedish counties that was stratified by sex, age and city; 40,674 (59.2%) participants responded, of which 45.5% were men and 54.5% were women with a mean +/- SD age of 53.8 +/- 17.9 years. Results: Structural dimensions of social capital were associated with an increased probability of hazardous alcohol use among both men and women, whereas the increased probability associated with cognitive dimensions occurred mostly among women. Sense of coherence was robustly associated with a decreased probability of hazardous alcohol use among both men and women. There were few moderating effects of sense of coherence and sex differences emerged mainly for the cognitive dimension of social capital. Conclusions: Associations between social capital dimensions and hazardous alcohol use were partly sex-specific, whereas the benefits of a sense of coherence accrued to both sexes. Social capital dimensions and sense of coherence were generally unrelated to each other. Only associations between the cognitive dimensions of social capital and hazardous alcohol use differed by sex.
19.	Mohamed, Mohamed S., et al. (författare) Differential change in alcohol consumption during the COVID-19 pandemic : the role of loneliness, socialization, and mental well-being 2024 Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 15 Tidskriftsartikel (refereegranskat)abstract Introduction: The COVID-19 pandemic led to a surge in mental health issues and psychological distress, disruption to work/studying conditions, and social isolation particularly among young adults. Changes in these factors are differentially associated with alcohol use. Moreover, the relationship between these factors are bidirectional and may have fluctuated throughout the different phases of the pandemic. However, studies focusing on young adults had conflicting results, short follow-up periods, and lacked comprehensive data to describe underlying mechanisms.Methods: 1067 young adults participated in repetitive measures termed wave 4 (2021) of the Survey of Adolescent Life in Västmanland Cohort “SALVe” Cohort. Of these, 889 also completed pre-pandemic measurements termed wave 3 (2018). Participants completed the Alcohol Use Disorders Identification Test (AUDIT) to evaluate alcohol consumption and harmful use. Cross-sectional associations between perceived changes in alcohol use and shift in individual, mental health, and work environment factors were examined using Chi-square tests. Logistic regression was utilized to identify pre-pandemic predictors of harmful consumption during the pandemic.Results: Harmful consumption decreased only in females following the COVID-19 pandemic. Participants who reported increased feelings of depression, anxiety, and loneliness were more likely to increase their alcohol use. Interestingly, the subgroup who felt less lonely and met their friends more often, as well as those who continued working/studying from their regular workplace also had an increased likelihood of higher consumption. Only pre-pandemic ADHD and delinquency symptoms predicted harmful alcohol consumption following the pandemic.Conclusion: Females reduced harmful alcohol consumption during the COVID-19 pandemic. While those who suffered the burden of social isolation and distress were more likely to increase their alcohol use, young adults who felt less lonely and met their friends more often also had a similar outcome. The relationship between loneliness and alcohol consumption among young adults is influenced by the social factors that may be facilitated by drinking.
20.	Agahi, Neda, et al. (författare) Alcohol consumption in very old age and its association with survival : A matter of health and physical function 2016 Ingår i: Drug And Alcohol Dependence. - : Elsevier BV. - 0376-8716 .- 1879-0046. ; 159, s. 240-245 Tidskriftsartikel (refereegranskat)abstract Background: Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old. Methods: Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n=863) collected in 2010/2011 were used. Mortality was analyzed unti12014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5-30 drinks/month) and heavy drinker (>30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed. Results: Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant. Conclusions: The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.
21.	Ahlner, Felicia, 1987, et al. (författare) Patterns of Alcohol Consumption and Associated Factors in a Population-Based Sample of 70-Year-Olds: Data from the Gothenburg H70 Birth Cohort Study 2014-16 2022 Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601 .- 1661-7827. ; 19:14 Tidskriftsartikel (refereegranskat)abstract Older adults of today consume more alcohol, yet knowledge about the factors associated with different consumption levels is limited in this age group. Based on the data from a population-based sample (n = 1156, 539 men and 617 women) in The Gothenburg H70 Birth Cohort Study 2014-16, we examined sociodemographic, social, and health-related factors associated with alcohol consumption levels in 70-year-olds, using logistic regression. Total weekly alcohol intake was calculated based on the self-reported amount of alcohol consumed. Alcohol consumption was categorized as lifetime abstention, former drinking, moderate consumption (<= 98 g/week), and at-risk consumption (>98 g/week). At-risk consumption was further categorized into lower at-risk (98-196 g/week), medium at-risk (196-350 g/week), and higher at-risk (>= 350 g/week). We found that among the 1156 participants, 3% were lifetime abstainers, 3% were former drinkers, 64% were moderate drinkers, and 30% were at-risk drinkers (20% lower, 8% medium, 2% higher). Among several factors, former drinking was associated with worse general self-rated health (OR 1.65, 95% CI 1.08-2.51) and lower health-related quality of life (measured by physical component score) (OR 0.94, 95% CI 0.91-0.97), higher illness burden (OR 1.16, 95% CI 1.07-1.27), and weaker grip strength (OR 0.96, 95% CI 0.94-0.98). Higher at-risk drinkers more often had liver disease (OR 11.41, 95% CI 3.48-37.37) and minor depression (OR 4.57, 95% CI 1.40-14.95), but less contacts with health care (OR 0.32, 95% CI 0.11-0.92). Our findings demonstrate the importance of classifications beyond abstinence and at-risk consumption, with implications for both the prevention and clinical management of unhealthy consumption patterns in older adults.
22.	Ahorsu, Daniel Kwasi, et al. (författare) Associations Between Fear of COVID-19, Mental Health, and Preventive Behaviours Across Pregnant Women and Husbands : An Actor-Partner Interdependence Modelling 2022 Ingår i: International Journal of Mental Health and Addiction. - : Springer. - 1557-1874 .- 1557-1882. ; 20, s. 68-82 Tidskriftsartikel (refereegranskat)abstract The present cross-sectional study examined the actor-partner interdependence effect of fear of COVID-19 among Iranian pregnant women and their husbands and its association with their mental health and preventive behaviours during the first wave of the COVID-19 pandemic in 2020. A total of 290 pregnant women and their husbands (N = 580) were randomly selected from a list of pregnant women in the Iranian Integrated Health System and were invited to respond to psychometric scales assessing fear of COVID-19, depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. The findings demonstrated significant dyadic relationships between husbands and their pregnant wives' fear of COVID-19, mental health, and preventive behaviours. Pregnant wives' actor effect of fear of COVID-19 was significantly associated with depression, suicidal intention, mental quality of life, and COVID-19 preventive behaviours but not anxiety. Moreover, a husband actor effect of fear of COVID-19 was significantly associated with depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. Additionally, there were significant partner effects observed for both the pregnant wives and their husbands concerning all outcomes. The present study used a cross-sectional design and so is unable to determine the mechanism or causal ordering of the effects. Also, the data are mainly based on self-reported measures which have some limitations due to its potential for social desirability and recall biases. Based on the findings, couples may benefit from psychoeducation that focuses on the effect of mental health problems on pregnant women and the foetus.
23.	Dauber, Hanna, et al. (författare) Older adults in treatment for alcohol use disorders : service utilisation, patient characteristics and treatment outcomes 2018 Ingår i: Substance Abuse Treatment, Prevention, and Policy. - : Springer Science and Business Media LLC. - 1747-597X. ; 13 Tidskriftsartikel (refereegranskat)abstract Background In western countries demographic changes are leading to an ageing society. Consequently, the number of older adults with alcohol use disorders (AUDs) will rise and the demand of treatment is likely to increase. However, thus far not many older adults with an AUD are seeking treatment and little is known about the efficacy of treatment for older adults. The present study aimed at determining the proportion of older adults with an AUD in addiction treatment, particular characteristics and treatment outcomes of this clientele.Methods Using data of 10,860 patients with an AUD aged 60 and over that are documented within the national German addiction care system we conducted exploratory analyses with regard to prevalence, sociodemographic, disorder- and treatment-related variables.Results Overall, we found a low proportion of older patients in treatment due to AUDs, but highly positive treatment outcomes. With regard to sociodemographic and disorder-related characteristics, older females and late-onset patients in particular constitute a unique clientele.Conclusions The low service utilisation on the one hand but good treatment prognosis on the other emphasise the need to promote treatment seeking among older adults with AUDs. In this context, the special characteristics we found among older patients may contribute to better reach this population and to improve provisions of targeted treatment approaches.
24.	Jemberie, Wossenseged Birhane, 1985-, et al. (författare) "Ageing with an alcohol problem is not what I envision" : reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems 2023 Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 23 Tidskriftsartikel (refereegranskat)abstract Background: Eliciting and understanding older persons’ descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing.Methods: Eight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews.Results: Three themes were identified: “Tipping the balance”, “Staying behind a veil” and “Lifting the vail”. First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery.Conclusions: Older persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons’ desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.
25.	Jemberie, Wossenseged Birhane, 1985- (författare) Alcohol and aging : a multimethod study on heterogeneity and multidimensionality 2023 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background and Objectives: With an ageing population, the number of older persons with substance use problems, particularly problematic alcohol use, is increasing. Despite growing recognition of the negative consequences of problematic alcohol use on older persons, there is a dearth of knowledge about the alcohol use profiles and the dimensionality of alcohol problems in older people. Moreover, little is known about older persons’ experiences and perspectives on alcohol use in relation to their ageing and their personal goals regarding treatment and recovery. This thesis aimed to (i) describe the characteristics of older persons who accessed municipal substance use treatment and care services (addiction services) and to investigate their future hospitalization; (ii) examine the heterogeneity and multidimensionality of problematic alcohol use among older persons; and (iii) to shed light on the experiences and perspectives of older persons regarding ageing, alcohol problems and recovery.Methods: For studies I-III, municipal Addiction Severity Index (ASI) assessment data (between 2003 and 2017) from adults aged 50 years and older were used to select the study samples. Generalized linear regression models investigated hospitalization related outcomes among 3624 older persons in Study-I. In Study-II, a latent class analysis was applied on ASI data from 1747 individuals with alcohol problems. Study-III linked the ASI data from Study-II to hospital discharge and mortality data forming time-to-repeated-event dataset; Andersen-Gill regression model with a robust variance estimator was used for the analysis. Study-IV applied qualitative content analysis on interview data from ten older persons recruited from a specialist outpatient clinic for alcohol treatment. Results: Nearly three-fourth of older persons assessed for substance use severity at municipal addiction services were later hospitalized (Study-I). Individuals diagnosed with substance use disorders, psychiatric or dual diagnoses had more cumulative hospitalized days, higher rates of hospital readmissions, and shorter time to first admission following an initial ASI assessment at municipal addiction services (Study-I). Five distinct groups of older persons with comparable alcohol problem severity but with variation in onset age, psychiatric comorbidities, polysubstance use, social support and gender composition were identified (Study-II). The five groups varied in risks of repeated hospitalizations due to substance use and psychiatric disorders (Study-III). Older persons experienced their ageing and alcohol use having a dynamic interplay (Study-IV). They needed to constantly negotiate with their environment to maintain a positive ageing trajectory. They perceived moderate alcohol use fosters healthy ageing, but over time, experienced their alcohol use as unsustainable and a threat to their pursuit of healthy ageing. Stigma and ambivalence delayed treatment seeking (Study-IV). They accessed treatment programs which respected their preferences and autonomy, engaged them in goal setting and strengthened their agency. After reducing their alcohol use, positive changes in their biopsychosocial functioning encouraged them to continue their recovery journey even in the presence of setbacks (Study-IV).Conclusion: Most older persons who access municipal addiction services are hospitalized repeatedly. Many older persons with alcohol problems live with medical and psychiatric comorbidities suggesting multiple care needs from health and social care services. Incorporating older persons’ desire for healthy ageing into alcohol treatment plan can facilitate treatment engagement and recovery. Many older persons aim to moderate their alcohol consumption. Clinicians can deliver person-centered care for older persons, by considering their heterogeneity in treatment goals, biopsychosocial functioning, and available resources. A multidimensional identification of alcohol use profiles could improve treatment by establishing the variation in alcohol problems among older treatment seekers. Older persons stay engaged in alcohol treatment programs which value their experiences and expertise, incorporate their personal treatment and life goals, respect their autonomy and agency, and involve them as active participants. Sensitizing service providers on old age substance use problems could provide multiple points of contact for screening of older persons and earlier referral to treatment. A streamlined data sharing within and between health and social care services fosters timely and equitable care and facilitates an integrated and person-centered care across the continuum.
26.	Jemberie, Wossenseged Birhane, 1985-, et al. (författare) Studying the trajectories and mediators of old-age problematic alcohol use and the agency of older persons 2023 Annan publikationabstract Unit of analysis: IndividualPopulation: Older people aged between 61 and 73 years who have sought treatment for alcohol at a specialist outpatient clinic in a metropolitan city in Sweden.Time Method: Cross-sectionSampling procedure: Non-probability: PurposiveThe study participants were purposefully recruited from a specialist outpatient alcohol treatment clinic located in a Swedish metropolitan city. To be eligible for the study, participants had to be 55 years or older, had to self-report a history of problematic alcohol use and treatment for alcohol use after the age of 50. Individuals who were unable or unwilling to provide informed consent or participate in the interview via Zoom, Skype, or telephone were excluded from the study.Time period(s) investigated: 2021-12 – 2022-04Number of individuals/objects: 10Data format / data structure: Text
27.	Li, Hansen, et al. (författare) Chan-Chuang and resistance exercise for drug rehabilitation : a randomized controlled trial among Chinese male methamphetamine users 2023 Ingår i: Frontiers In Public Health. - : World Academic Publishing Co., Limited. - 2296-2565. ; 11 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To examine the health benefits of Chan-Chuang and resistance exercise.METHODS: We deployed an 8-week randomized controlled trial, in which 76 male methamphetamine users were allocated to control (n = 25), Chan-Chuang (n = 26), and residence exercise groups (n = 25). Our primary outcomes were drug craving, mental wellbeing, sleep quality, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP). Our secondary outcomes were body mass index (BMI), vital capacity, grip strength, balance, and vertical jump.RESULTS: Chan-Chuang exercise resulted in reduced HR, DBP, and MAP, along with improvements in vital capacity, grip strength, and balance compared to the control group. Resistance exercise reduced SBP and MAP, and also improved vital capacity, grip strength, balance, and vertical jump.CONCLUSION: These findings may support the role of Chan-Chuang and resistance exercise in maintaining the physical fitness of methamphetamine users at mandatory detention centers.
28.	Collier, Elizabeth S, et al. (författare) Satisfaction with a digital support tool targeting alcohol consumption : perspectives from participants in a randomized control trial 2024 Ingår i: Alcohol and Alcoholism. - : Oxford University Press. - 0735-0414 .- 1464-3502. ; 59:1 Tidskriftsartikel (refereegranskat)abstract Aim: Intervention design may be improved through evaluating the feedback from those who have been exposed to such interventions. As such, here the perspectives of the intervention group from a recent randomized control trial investigating the effectiveness of a digital alcohol intervention, in terms of perceived suitability and usefulness of the support tool they engaged with, were investigated. Methods: Respondents (N=475; 45% of the intervention group) answered five quantitative questions addressing user experience, completed the 10-item System Useability Scale, and were offered the opportunity to write free-text feedback. Quantitative measures were analysed using ordinal and linear regression with baseline characteristics as predictors, and free-text responses were evaluated using content analysis. Results: Overall, respondents were positive towards the intervention in terms of it fitting their needs, the usefulness of the tools included, and the usefulness of text message content. The intervention was perceived as more helpful by respondents with lower total weekly alcohol consumption, higher self-reported confidence in their ability to reduce their drinking, and the perceived importance there of, at baseline. The free-text comments revealed the value of reminders as prompts to reflect on one’s own drinking behaviour. Nonetheless, criticisms of the intervention were voiced, primarily highlighting the repetitive nature of the reminders and the lack of individuation in advice. Some also feltlike the intervention was impersonal and targeted only a specific drinking pattern. Conclusions: Experiences of the intervention group in this trial were generally positive, though there may be demand for more individualised, targeted intervention design.
29.	Hanpatchaiyakul, Kulnaree, et al. (författare) Thai Men’s experiences of Alcohol Addiction and Treatment 2014 Ingår i: Global Health Action. - : Informa UK Limited. - 1654-9716 .- 1654-9880. ; 7:1, s. Article number 23712- Tidskriftsartikel (refereegranskat)abstract Background: Men are overrepresented with regard to alcohol addiction and in terms of alcohol treatment worldwide. In Thailand, alcohol consumption continues to rise, but few of those afflicted with alcohol addiction attend alcohol treatment programs, even though there is universal care for all. No comprehensive studies have been done on men's experiences with addiction and alcohol treatment programs in Thailand.Objective: The aim of this study was to explore men's experiences in terms of the 'pros and cons of alcohol consumption' in order to identify the barriers that exist for Thai men with regard to alcohol addiction and the decision to stop drinking. Design: Purposive sampling was applied in the process of recruiting participants at an alcohol clinic in a hospital in Thailand. Thirteen men with alcohol addiction (aged 32-49 years) were willing to participate and were interviewed in thematic interviews. The analysis of the data was done with descriptive phenomenology. Results: Through men's descriptions, three clusters of experiences were found that were 'mending the body', 'drinking as payoff and doping related to work', and 'alcohol becoming a best friend' as ways of describing the development of addiction. Conclusions: The results highlight the importance of addressing concepts of masculinity and related hegemonic ideas in order to decrease the influence of the barriers that exist for Thai men with alcohol addiction with regard to entering treatment and to stop drinking. © 2014 Kulnaree Hanpatchaiyakul et al.
30.	Högberg, Hjördis, et al. (författare) Alcohol consumption among partners of pregnant women in Sweden: a cross sectional study 2016 Ingår i: Bmc Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 16 Tidskriftsartikel (refereegranskat)abstract Background: Antenatal care in Sweden involves a visit in pregnancy week 6-7 for counseling about lifestyle issues, including alcohol. The aim of this study was to investigate alcohol consumption among partners of pregnant women, their motives for changing drinking patterns when becoming a parent and their perceptions of the midwife's counseling about alcohol. Method: The study was conducted at 30 antenatal care centers across Sweden in 2009-2010. All partners who accompanied a pregnant women in pregnancy week >17 were asked to participate. The questionnaire included questions on alcohol consumption. Results: Questionnaires from 444 partners were analyzed. Most, 95 %, of the partners reported alcohol consumption before pregnancy; 18 % were binge drinking (6 standard drinks or more per occasion, each drink containing 12 grams of pure alcohol) at least once every month during the last year. More than half, 58 %, of all partners had decreased their alcohol consumption following pregnancy recognition and a higher proportion of binge drinkers decreased their consumption compared to non-frequent binge drinkers (p = 0.025). Their motives varied; the pregnancy itself, fewer social gatherings (potentially involving alcohol consumption) and a sense of responsibility for the pregnant partner were reported. Of the partners, 37 % reported support for decreased drinking from others (pregnant partner, parents, friend or workmates). Further, most partners appreciated the midwife's counseling on alcohol. Conclusion: A majority of partners decreased their alcohol consumption in transition to parenthood, which also appears to be a crucial time for changing alcohol-drinking patterns. The partners with higher AUDIT-C scores reported more support for decreased drinking. Most partners appreciated the midwife's talk about alcohol and pregnancy and those who filled out AUDIT in early pregnancy reported that the counseling was more engaging. During pregnancy it is possible to detect partners with high alcohol consumption, and promote interventions for decreased drinking, also for the partners. Written information addressing alcohol use and directed to partners is needed.
31.	Blindow, Katrina J., et al. (författare) Gender-based harassment in Swedish workplaces and alcohol-related morbidity and mortality : A prospective cohort study 2023 Ingår i: Scandinavian Journal of Work, Environment and Health. - : Nordic Association of Occupational Safety and Health (NOROSH). - 0355-3140 .- 1795-990X. ; 49:6, s. 395-404 Tidskriftsartikel (refereegranskat)abstract Objective: The study investigated experiences of different types of work-related gender-based harassment (GBH), specifically sexual and gender harassment, as risk factors for alcohol-related morbidity and mortality (ARMM).Methods: Information about experiences of (i) sexual harassment (SH-I) and (ii) gender harassment (GH-I) from inside the organization and (iii) sexual harassment from a person external to the organization (SH-E) were obtained from the Swedish Work Environment Survey 1995–2013, a biannual cross-sectional survey, administered to a representative sample of the Swedish working population. The survey responses from 86 033 individuals were connected to multiple registers containing information about alcohol-related diagnoses, treatment, or cause of death. Cox proportional hazard models were fitted to assess hazard ratios (HR) of incident ARMM during a mean follow-up of eight (SH-I and GH-I) and ten (SH-E) years.Results: A higher prospective risk estimate of ARMM was found among participants who reported experiences of SH-E [HR 2.01, 95% confidence interval (CI) 1.61–2.52], GH-I (HR 1.33, CI 1.03–1.70), or SH-I (HR 2.37, CI 1.42–3.00). Additional analyses, distinguishing one-time from reoccurring harassment experiences, indicated a dose–response relationship for all three harassment types. Gender did not modify the associations. Under the assumption of causality, 9.3% (95% CI 5.4–13.1) of the risk of ARMM among Swedish women and 2.1% (95% CI 0.6–3.6) among Swedish men would be attributable to any of the three types of GBH included in this study.Conclusions: Experiences of GBH in the work context may be a highly relevant factor in the etiology of ARMM.
32.	Wood, Angela M., et al. (författare) Risk thresholds for alcohol consumption : combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies 2018 Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 391:10129, s. 1513-1523 Tidskriftsartikel (refereegranskat)abstract Background: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.Methods: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12.5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5.6 years [5th-95th percentile 1.04-13.5]) from 71 011 participants from 37 studies.Findings: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5.4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1.14, 95% CI, 1.10-1.17), coronary disease excluding myocardial infarction (1.06, 1.00-1.11), heart failure (1.09, 1.03-1.15), fatal hypertensive disease (1.24, 1.15-1.33); and fatal aortic aneurysm (1.15, 1.03-1.28). By contrast, increased alcohol consumption was loglinearly associated with a lower risk of myocardial infarction (HR 0.94, 0.91-0.97). In comparison to those who reported drinking >0-<= 100 g per week, those who reported drinking >100-<= 200 g per week, >200-<= 350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively.Interpretation: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.
33.	Gunillasdotter, Victoria, et al. (författare) Getting fit for change : exercise as treatment for alcohol use disorder 2023 Ingår i: Addiction Science & Clinical Practice, 2023, vol 18, Suppl. 1, P21. - : BioMed Central (BMC). ; 18:SUPPL 1 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
34.	Hammarberg, Stina Ingesson, et al. (författare) A qualitative interview study of patient experiences of receiving motivational enhancement therapy in a Swedish addiction specialist treatment setting 2023 Ingår i: Addiction science & clinical practice. - : Springer Nature. - 1940-0632 .- 1940-0640. ; 18 Tidskriftsartikel (refereegranskat)abstract Background: Motivational enhancement therapy (MET) has shown to be efficacious as treatment of alcohol use disorder (AUD), in reducing alcohol consumption and related consequences. However, qualitative research on how patients perceive this treatment is lacking. The aim of this study was to explore how patients experience MET as a treatment for AUD.Methods: Fifteen patients (8/7 female/male) participated in semi-structured interviews after receiving MET at a specialized addiction outpatient clinic in Sweden. Data were analyzed by thematic analysis.Results: Five themes were identified: the therapist conveyed the MI-spirit, the therapist did not guide on how to reach the goal, participants were committed to change before starting treatment, participants were uncertain if treatment was enough to maintain change, and significant others were not wanted in sessions. Participants appreciated the supportive relationship with their therapist, but some experienced therapy as overly positive, with no room to talk about failure. Further, they experienced a low level of guidance in goal-setting. For some, this was empowering, while others requested more direction and advice. Participants perceived their motivational process to have started before treatment. MET was considered to be too brief. None of the participants brought a significant other to a session.Conclusions: Therapist behaviors in line with MI spirit were emphasized as key to the development of a positive therapeutic relationship. More specific advice on goal-setting may be effective for supporting change in some patients. Longer treatment is requested among patients to support the patient's self-efficacy for change. Significant others can support change without necessarily being present in sessions.
35.	Jakobsen, Mari Asalie Skrenes, et al. (författare) Home care for patients with opioid use disorders : A qualitative study of registered nurses' experiences of pain management 2024 Ingår i: Nursing Open. - : Wiley-Blackwell. - 2054-1058. ; 11:6 Tidskriftsartikel (refereegranskat)abstract Aim: To explore registered nurses' experiences with pain management in patients with opioid use disorder (OUD) in home care.Design: Qualitative explorative-descriptive design.Methods: Data were collected via nine individual semi-structured interviews with registered nurses working in home care meeting patients with OUD. Data were analysed using systematic text condensation.Results: Three categories were identified: Reciprocity in relationships and a professional approach enhance pain management; Discrepancies between guidelines, patient-reported pain and RNs' observations challenge pain management; and Interprofessional collaboration makes or breaks pain management.
36.	Nordgren, Johan, et al. (författare) Healthcare staff’s perspectives on long-acting injectable buprenorphine treatment : a qualitative interview study 2024 Ingår i: Addiction science & clinical practice. - : BioMed Central (BMC). - 1940-0632 .- 1940-0640. ; 19:1 Tidskriftsartikel (refereegranskat)abstract BackgroundLong-acting injectable buprenorphine (LAIB) formulations are a novel treatment approach in opioid agonist treatment (OAT), which provide patients with a steady dose administered weekly or monthly and thus reduce the need for frequent clinic visits. Several studies have analyzed patient experiences of LAIB but the perspective of OAT staff is unknown. This study aimed to explore how healthcare staff working in OAT clinics in Sweden perceive and manage treatment with LAIB.MethodsIndividual qualitative interviews were conducted with OAT physicians (n = 10) in tandem with nine focus group sessions with OAT nurses and other staff categories (n = 41). The data was analyzed with thematic text analysis.ResultsFive central themes were identified in the data: (1) advantages and disadvantages of LAIB, (2) patient categories that may or may not need LAIB, (3) patients’ degrees of medication choice, (4) keeping tabs, control and treatment alliance, and (5) LAIB’s impact on risk and enabling environments in OAT. Overall staff found more advantages than disadvantages with LAIB and considered that patients with ongoing substance use and low adherence were most likely to benefit from LAIB. However, less frequent visits were viewed as problematic in terms of developing a treatment alliance and being able to keep tabs on patients’ clinical status. Clinics differed regarding patients' degrees of choice in medication, which varied from limited to extensive. LAIB affected both risk and enabling environments in OAT.ConclusionsLAIB may strengthen the enabling environment in OAT for some patients by reducing clinic visits, exposure to risk environments, and the pressure to divert medication. A continued discussion about the prerequisites and rationale for LAIB implementation is needed in policy and practice.
37.	Ohlsson, Bodil (författare) The role of smoking and alcohol behaviour in management of functional gastrointestinal disorders 2017 Ingår i: Best Practice and Research in Clinical Gastroenterology. - : Elsevier BV. - 1521-6918. ; 31:5, s. 545-552 Forskningsöversikt (refereegranskat)abstract Functional gastrointestinal disorders (FGIDs) are common disorders in the population. Lifestyle habits have been suspected to influence the presence and degree of symptoms, and many studies have examined the role of food components and physical activity on the disease development. The role of smoking and alcohol intake on FGID has been less thoroughly examined. This systematic literature review, of a large amount of studies from different countries around the world with different design and application of FGID criteria, shows that smoking seems to be associated with a significant 50% increased risk of FD for current compared with never smokers. The associations between smoking and other FGIDs are weak, if present at all. A moderate alcohol intake is not associated with FGIDs. On the other hand, a high alcohol intake may lead to development and aggravation of FGID symptoms, especially functional dyspepsia.
38.	Petersén, Elisabeth, et al. (författare) Problematic substance use among patients in a Swedish outpatient psychiatry setting : staff and manager perceptions of digital options for increased intervention access 2023 Ingår i: Addiction science & clinical practice. - : BioMed Central (BMC). - 1940-0632 .- 1940-0640. ; 18:1 Tidskriftsartikel (refereegranskat)abstract BackgroundApproximately 50% of the patients who globally seek help in psychiatry have been assessed with problematic substance use or been diagnosed with substance use disorder (SUD). Given the high treatment gap for mental health care, in particular SUD, these individuals risk poorer treatment outcomes in psychiatry. Integrated treatment for psychiatric and SUD disorders has been proposed to reduce the treatment gap for SUD, but access to integrated treatment is low. Digital interventions addressing SUD in psychiatry could potentially make treatment available to patients who otherwise would not have access. In this study “digital interventions” comprise an umbrella term covering all kinds of interventions from minimal motivational app-based interventions to internet-based interventions with and without human guidance, up to remote sessions in telepsychiatry. This study aims to explore healthcare staff perceptions of referring patients to digital interventions for reducing problematic substance use, whether or not diagnosed as SUD, in the psychiatric outpatient setting.MethodThe study was exploratory with a qualitative design. Data were collected in the Swedish outpatient psychiatry setting, via individual semi-structured interviews with managers, and focus groups with healthcare staff. An adapted form of phenomenological hermeneutical analysis was used to analyze the data.ResultsThree themes emerged from the analysis. The first theme was Encountering obstacles on the path to future implementation of digital interventions, with sub-themes: Lacking resources and Feeling concerned about technical solutions. The second theme was Searching for ways forward to achieve increased access to care, with sub-themes: Blended care could facilitate integrated care and Addressing variations in patients’ technical skills. The third theme was Taking steps towards the future, with sub-themes: Wanting to know more about digital interventions and Formulating a vision for the future.ConclusionsThe study reveals a concern that implementing digital interventions in psychiatry will create additional work or be technically challenging. The staff see significant advantages from the patient perspective, but they feel that they themselves need training in implementing digital interventions. In order to establish constructive implementation of digital interventions for SUD in psychiatry, staff attitudes and concerns need to be considered and addressed. This study was conducted within the Swedish healthcare system and the findings may not generalize to other countries with differing healthcare systems.
39.	Rane, A, et al. (författare) [Steroids are a growing problem at gyms] 2013 Ingår i: Lakartidningen. - 0023-7205. ; 110:39-40, s. 1741-6 Tidskriftsartikel (refereegranskat)
40.	Richard, Levi, 1958-, et al. (författare) Episodic cluster headache. II : High tobacco and alcohol consumption in males. 1992 Ingår i: Headache. - : Wiley-Blackwell. - 0017-8748 .- 1526-4610. ; 32:4, s. 184-7 Tidskriftsartikel (refereegranskat)abstract Forty-nine out of 51 consecutive male patients with episodic cluster headache were studied with regard to their smoking and drinking habits in general and in relation to cluster headache periods. Questionnaires were constructed for data regarding tobacco intake. Situation-related smoking behavior was registered according to Frith (1971). Screening for alcohol over-consumption was made using the Malmö modification of the brief Michigan Alcoholism Screening Test (Mm-MAST). Eighty-three percent of the patients used tobacco on a regular basis at the time of the study, with an average consumption of 20 cigarettes per day. Only 3% had never used tobacco regularly. The smoking-related desire to smoke in different situations was consistent with what is found in a general population of smokers. Sixty-seven percent of the patients had scores on the Mm-MAST indicative of alcohol over-consumption (i.e. heavy social drinking or alcoholism). During active headache periods 79% decreased their alcohol intake, whereas no consistent change in tobacco consumption was reported for the group as a whole. These findings were further corroborated by the fact that alcohol, but not tobacco intake, was reported by the majority of patients to elicit headache attacks during periods. Thus, our study showed high alcohol and tobacco consumption to be prominent features in male patients with episodic cluster headache. Since neither alcohol nor tobacco appear to have properties of ameliorating headache periods or attacks, the addictive behavior in our patients more likely reflects certain personality characteristics.
41.	Thurang, Anna, et al. (författare) Living an unstable everyday life while attempting to perform normality - the meaning of living as an alcohol-dependent woman 2013 Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 22:3-4, s. 423-433 Tidskriftsartikel (refereegranskat)abstract Aims and objectives To illuminate the meaning of living with alcohol dependency as a woman. Background The number of women suffering from alcohol dependency is increasing. Today there are shortcomings in knowledge about the lived experiences of being a woman with alcohol dependency; knowledge which might be of importance for meeting these women's specific needs of care. Design The study has a qualitative design. Fourteen women with alcohol dependency participated in open in-depth interviews. Method Data were analysed according to a phenomenological-hermeneutic method, and interpreted by help from gender and caring perspectives as well as results from previous research of alcohol dependency. Results In relation to the women's senses of well-being, four main gender formations were found; An unstable self involving continual and rapid swings between emotional and bodily reactions. Ambivalence meaning ambiguous feelings towards themselves as human beings and how they lead their lives. Introspectiveness involving reflections, pondering and being introverted. Attempts to perform normality covering dealing with life through various strategies and facades to live up to the expectations of how to behave as a woman. Conclusion Living with alcohol dependency as a woman constitutes of a rapid shifting everyday life resulting in senses of alienation as well as private introspection leading to self-degradation, and to a lesser extent meaningfulness and hope. It also constitutes of managing to perform normality. Relevance to clinical practice When supporting women with alcohol dependency towards wellbeing, professionals need to work towards approaching the woman's inner thoughts, share them and reflect over them together. To support these women to find balance in life, caregivers need to cooperate with the women to find out how best to live a life adjusted to the woman's abilities and wishes.
42.	Tung, Serene En Hui, et al. (författare) Internet-Related Instruments (Bergen Social Media Addiction Scale, Smartphone Application-Based Addiction Scale, Internet Gaming Disorder Scale-Short Form, and Nomophobia Questionnaire) and Their Associations with Distress among Malaysian University Students 2022 Ingår i: Healthcare. - : MDPI. - 2227-9032. ; 10:8 Tidskriftsartikel (refereegranskat)abstract The present study evaluated the psychometric properties of four instruments related to internet use, namely the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), (nine-item) Internet Gaming Disorder Scale Short Form (IGDS9-SF), and Nomophobia Questionnaire (NMPQ) as well as their associations with psychological distress among Malaysian university students. A total of 380 Malaysian university students (71.6% females, mean age 24.0 years) were recruited through convenience sampling and completed an online survey including questions concerning socio-demographic background, social media addiction, smartphone addiction, internet gaming disorder, and nomophobia. Confirmatory factor analysis and Rasch analysis were applied to evaluate the psychometric properties of the instruments and Cronbach's alpha value and McDonald's omega value were used to confirm the internal consistency reliability of the instruments. The unidimensional structure was confirmed for the BSMAS, SABAS, and IGDS9-SF while the four-factor structure was confirmed for NMPQ. All instruments showed good internal consistency reliability. Promising validity and reliability were confirmed for BSMAS, SABAS, IGDS9-SF, and NMPQ. Therefore, they are useful to assess different types of problematic internet use among university students in Malaysia. Furthermore, a significant association was observed between internet use and psychological distress. The present study is the first to investigate the validity and reliability of BSMAS, SABAS, IGDS9-SF, and NMPQ among Malaysian university students using rigorous psychometric testing methods (i.e., Rasch analysis).
43.	Wallhed Finn, Sara, et al. (författare) Treating alcohol use disorders in primary care - a qualitative evaluation of a new innovation : the 15-method 2021 Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 39:1, s. 51-59 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: This study aims to explore how the characteristics of an innovation, the 15-method, a stepped care model for treatment of alcohol use disorders in primary care was perceived.METHODS/DESIGN/SETTING/SUBJECT: General practitioners and heads of primary care units (n = 10) that delivered the 15-method in a randomized controlled trial participated in individual interviews at two occasions in Stockholm, Sweden. Data were analyzed with theoretical thematic analysis, using Diffusion of Innovation Theory.RESULTS: The participants described that offering the 15-method met a need among their patients. Participants were positive towards the training and the manual for the method. They mentioned a previous lack of routines to work with alcohol use disorders. The 15-method was described as easy to use. It would however be more feasible to implement in a team of different professions, rather than among general practitioners only. Priorities made by regional health care managers were described as important for the implementation, as well as financial incentives. A barrier to implementation was that alcohol screening was perceived as difficult. While the 15-method was perceived as effective in reducing the patients' alcohol use and cost effective, participants expressed uncertainty about the long-term effects.CONCLUSIONS: The 15-method provides structure for treatment of alcohol use disorders and is described by general practitioners and heads as a promising approach. Being able to offer treatment for alcohol dependence may increase the uptake of alcohol interventions in primary care.KEY POINTS Little attention has been given to develop treatment models for alcohol use disorders that are adapted to primary care settings. This study describes how an innovation, the 15-method, a stepped care model for treatment of alcohol use disorders in primary care was perceived. The 15-method provides structure for treatment of alcohol use disorders in primary care and is described by general practitioners and heads as a promising approach. Being able to offer treatment for alcohol dependence may increase the uptake of alcohol interventions in primary care.
44.	Binde, Per, 1956 (författare) A mutual support group for young problem gamblers 2012 Ingår i: International Journal of Mental Health and Addiction. - : Springer Science and Business Media LLC. - 1557-1874 .- 1557-1882. ; 10:4, s. 524-536 Tidskriftsartikel (refereegranskat)abstract A Swedish mutual support group for young problem gamblers is described and discussed. During the study period, 116 weekly meetings occurred, usually involving six to ten participants; in total, 69 problem gamblers (66 male and three female), aged 17–25, and 23 partners and friends attended the meetings. Half the gamblers had problems with Internet poker, one fifth with electronic gambling machines, and the rest with other forms of gambling and computer gaming. Nearly half the problem gamblers participated in under five mutual support meetings, while just over a third attended ten or more meetings. Gambling problems ceased or lessened among most participants in ten or more meetings. In some cases, attending just one or a few meetings had a positive impact on the problems. This mutual support group provides relatively effective help to adolescents and young adults with gambling problems, offering a valuable alternative and complement to professional treatment.
45.	Binde, Per, 1956 (författare) A Swedish mutual support society of problem gamblers 2012 Ingår i: International Journal of Mental Health and Addiction. - : Springer Science and Business Media LLC. - 1557-1874 .- 1557-1882. ; 10:4, s. 512-523 Tidskriftsartikel (refereegranskat)abstract Mutual support societies for problem gamblers have existed in Sweden for 20 years. They have helped more people with gambling problems than any other institution inside or outside the Swedish health care system. This paper outlines the background of these societies and describes the meetings of one of them. Data come from interviews with members of a local society and participation in mutual support meetings. It is argued that these mutual support societies provide help in a variety of ways and in all phases of recovery from gambling problems. In particular, they help people form personal narratives about the origin, progression, and resolution of their problems, narratives that give insight and guide recovery. These mutual support societies are valuable complements and alternatives to professional treatment.
46.	Jemberie, Wossenseged Birhane, 1985-, et al. (författare) Substance Use Disorders and COVID-19 : Multi-Faceted Problems Which Require Multi-Pronged Solutions 2020 Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 11 Tidskriftsartikel (refereegranskat)abstract COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.
47.	Mujcic, Ajla, et al. (författare) Effectiveness, Cost-effectiveness, and Cost-Utility of a Digital Alcohol Moderation Intervention for Cancer Survivors : Health Economic Evaluation and Outcomes of a Pragmatic Randomized Controlled Trial 2022 Ingår i: Journal of Medical Internet Research. - : JMIR Publications. - 1438-8871. ; 24:2 Tidskriftsartikel (refereegranskat)abstract Background: Alcohol moderation (AM) interventions may contribute to better treatment outcomes and the general well-being of cancer survivors.Objective: This study evaluates the effectiveness, cost-effectiveness, and cost-utility of MyCourse, a digital AM intervention, compared with a noninteractive digital information brochure for cancer survivors.Methods: A health economic evaluation alongside a pragmatic 2-arm parallel-group randomized controlled trial was conducted with follow-ups at 3, 6, and 12 months after randomization. The study was conducted on the web in the Netherlands from 2016 to 2019. Participants were adult 10-year cancer survivors drinking over the Dutch-recommended drinking guidelines (<= 7 standard units [10 g of alcohol] per week) with the intention to moderate or quit drinking. Overall, 103 participants were randomized and analyzed: 53 (51.5%) in the MyCourse group and 50 (48.5%) in the control group. In the MyCourse group, participants had access to a newly developed, digital, minimally guided AM intervention, MyCourse Moderate Drinking. The primary outcome was the self-reported number of standard drinks (10 g of ethanol) consumed in the past 7 days at the 6-month follow-up. The secondary outcome measures were alcohol-related problems as measured by the Alcohol Use Disorders Identification Test (AUDIT) and treatment satisfaction. For the health economic evaluation, health care costs, costs because of productivity losses, and intervention costs were assessed over a 12-month horizon.Results: Alcohol use at the 6-month follow-up decreased by 38% in the MyCourse group and by 33% in the control group. No difference in 7-day alcohol use was found between the groups (B=2.1, 95% CI -7.6 to 3.1; P=.22) at any of the follow-ups. AUDIT scores for alcohol-related problems decreased over time in both groups, showing no significant difference between the groups (Cohen d=0.3, 95% CI -0.1 to 0.6; P=.21). Intervention costs per participant were estimated at US $279 for the MyCourse group and US $74 for the control group. The mean societal costs were US $18,092 (SD 25,662) and US $23,496 (SD 34,327), respectively. The MyCourse group led to fewer gained quality-adjusted life years at lower societal costs in the cost-utility analysis. In the cost-effectiveness analysis, the MyCourse group led to a larger reduction in drinking units over time at lower societal costs (incremental cost-effectiveness ratio per reduced drink: US $ -1158, 95% CI -1609 to -781).Conclusions: At 6 months, alcohol use was reduced by approximately one-third in both groups, with no significant differences between the digital intervention MyCourse and a noninteractive web-based brochure. At 12 months, cost-effectiveness analyses showed that MyCourse led to a larger reduction in drinking units over time, at lower societal costs. The MyCourse group led to marginally fewer gained quality-adjusted life years, also at lower societal costs.
48.	Spelberoendes riksförbund 10 år: En jubileumsskrift 2010 Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract Den svenska spelmarknaden har förändrats och växt kraftigt den senaste tioårsperioden. Vi har fått statliga kasinon och på Internet går det att spela på det mesta från bingo till poker. Så gott som dagligen rapporterar massmedia om spelpolitik och spelberoende. Medvetenheten om spelberoende har ökat och starkt bidragande till det är Spelberoendes riksförbund. Förbundet har i tio år informerat om spelberoende och gett stöd till människor med spelproblem och deras anhöriga. Den här jubileumsskriften ger en bild av spelproblem i Sverige och kamratstödet i spelberoendes föreningar. Ungas spelande och de anhörigas situation tas upp av flera författare. Läsaren får också veta hur medvetenheten om spelberoende växte fram i Sverige och ta del av diskussioner om hur framtidens spelande kan gestalta sig. I boken medverkar aktiva inom förbundet, eldsjälar från lokalföreningar och spelberoende som har fått hjälp. Även spelforskare och personer som på olika sätt arbetat med spelfrågor har bidragit med kapitel. Skriften är utgiven med stöd av Statens folkhälsoinstitut.
49.	Sundström, Christopher, et al. (författare) What do we know about alcohol internet interventions aimed at employees? : A scoping review 2023 Ingår i: Frontiers In Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 11 Forskningsöversikt (refereegranskat)abstract Background: Internet interventions are a promising avenue for delivering alcohol prevention to employees. The objective of this scoping review was to map all research on alcohol internet interventions aimed at employees regardless of design, to gain an overview of current evidence and identify potential knowledge gaps.Methods: We conducted a literature search in three data bases (PsycInfo, PubMed, and Web of Science). Eligibility criteria were that (1) the study targeted employees age ≥18 years; (2) the intervention was delivered predominantly online; (3) the study focused specifically or in part on alcohol use; and (4) the study was published in English in a peer-reviewed academic journal. Two reviewers independently screened, reviewed, and extracted data.Results: Twenty studies were included, of which 10 were randomized controlled trials, five were secondary analyses, three were feasibility trials, one was a cohort study and one described the rationale and development of an intervention. No qualitative studies were found. Randomized trials tended to show effects when interventions were compared to waitlists but not when more intensive interventions were compared to less intensive ones. We identified two design-related aspects where studies differed; (1) whether all applicants were included regardless of alcohol use level and (2) whether the intervention was explicitly framed as alcohol-focused or not. Significant recruitment problems were noted in several studies.Conclusions: Alcohol internet interventions hold promise in delivering alcohol prevention to employees, but heterogeneity in study design and difficulties in recruitment complicate interpretation of findings.
50.	Gunnarsson, Malin, et al. (författare) Performing normality in working life among heavy substance users 2022 Ingår i: Nordic Studies on Alcohol and Drugs. - : SAGE Publications. - 1455-0725 .- 1458-6126. ; 39:5, s. 473-486 Tidskriftsartikel (refereegranskat)abstract Aim: Work is an important part of most people's everyday lives and well-being. Substance use by employees is associated with several negative consequences, such as absence from work and poor work performance. The study examines the strategies through which people who have problems with substance use produce a “normal” self and avoid becoming stigmatised in the workplace. Methods: The study uses data from in-depth unstructured life story interviews, which were conducted over phone with 13 people. The participants had developed various problematic heavy substance use habits. The interviews were analysed by applying interactional analysis and by using Goffman's concepts of “normality”, “embarrassment”, “face-work”, “stigma” and “performance”. Results: The analysis identified multiple strategies the participants used to produce normality and to avoid embarrassment and stigmatisation at work. These include skilful use of drugs in order not to show withdrawal symptoms, various ways of hiding their heavy substance use, frequent change of jobs, the maintenance of a clean and professional look, and attributing the absence from work to mental or physical illness. Moreover, the participants strategically avoided social contacts in which embarrassing situations could arise. When this was not possible, they manipulated their corporeal looks by hiding such kinds of bodily marks that would connote abnormality. Conclusion: The analysis points out that maintaining normality at work does not only refer to the efforts of trying to hide the effects of the drugs on behaviours and the body. It also reveals that the participants used substances to be able to perform energetically their work tasks, and in this way present themselves as normal workers. This ambivalence in performing normality makes the work life of people who use substances challenging.

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