| 1. |
- Amstadter, Ananda B., et al.
(författare)
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Testing Phenotypic Models of Posttraumatic Stress Disorder and Alcohol Use Disorder Comorbidity Using Longitudinal Registry Data
- 2023
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Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 84:3, s. 378-388
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Two predominant phenotypic models of causality exist to explain the high co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD): the self-medication and susceptibility models. Population-based longitudinal studies that simultaneously examine both models are needed. Thus, the goal of the pres-ent study is to test these models using the Swedish National Registries. Method: Registries were used to conduct longitudinal Cox proportional hazard models (n ≈ 1.5 million) and cross-lagged panel models (N ≈ 3.8 million) with follow-up periods of ~23 years. Results: Covarying for cohort and socioeconomic status, Cox proportional hazards model results found strong support for the self-medication model. Results showed that PTSD predicted increased risk for AUD among both men (HR = 4.58 [4.42, 4.74]) and women (HR = 4.14 [3.99, 4.30]), significantly more so for men (interaction HR = 1.11 [1.05, 1.16]). Support was also found for the susceptibility model, although the effects were lower in magnitude than those for the self-medication model. AUD increased risk for PTSD among men (HR = 2.53 [2.47, 2.60]) and women (HR = 2.06 [2.01, 2.12]), and significantly more so for men (interaction term HR = 1.23 [1.18, 1.28]). Cross-lagged model results of simultaneously testing both models found support for bidirectionality. The PTSD-to-AUD paths and the AUD-to-PTSD paths were of modest effect for men and women. Conclusions: The results from both complementary statistical approaches demonstrate that the models of comorbidity are not mutually exclusive. Although the Cox model results evidenced more support for the self-medication pathway, the cross-lagged model results suggest that the prospective relationships between these disorders are nuanced across development. (J. Stud. Alcohol Drugs, 84, 378–388, 2023).
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| 2. |
- Jiang, Heng, et al.
(författare)
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Beyond the Drinker : Alcohol's Hidden Costs in 2016 in Australia
- 2022
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Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 83:4, s. 512-524
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Drawing on a study of the range and mag-nitude of harms that alcohol caused to specific others in Australia, and on social and health agency statistics for collective costs, this article produces an analysis of the economic cost of alcohol's harm to others (AHTO) in Australia. Method: This study used a general population survey and routinely collected social response agencies' data to quantify different costs of AHTO, using methods consistent with International Guidelines for Estimating the Costs of Substance Abuse. This approach estimates costs for health care and social services, crime costs, costs of productivity loss, quality of life-year loss and other expenses, including both tangible costs (direct and indirect) and intangible costs of loss of quality of life (respondents' self-reported loss of health-related quality of life). Results: The cost of AHTO in Australia was AUD$19.81 bil-lion (95% CI [11.99, 28.34]), with tangible costs accounting for 58% of total costs ($11.45 billion, which is 0.68% of gross domestic product in 2016) and intangible costs of $8.36 billion. The costs to private individu-als or households ($18.1 billion and 89% of total costs of AHTO) are greater than the costs to the government or society because of others' drinking in Australia. Conclusions: This study presents an estimation of the economic cost of harm from others' drinking. The economic costs from others' drinking are large and of much the same magnitude as the costs that drinkers impose on themselves, as found in previous studies. Preventing harm to others from drinking is important as a public health goal for both economic and humane reasons.
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| 3. |
- Katainen, Anu, et al.
(författare)
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Regulating Alcohol Marketing on Social Media : Outcomes and Limitations of Marketing Restrictions of Finland's 2015 Alcohol Act
- 2020
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Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 81:1, s. 39-46
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to assess the effectiveness of the 2015 law restricting alcohol marketing on social media in Finland.Method: The study compared posts that market alcohol on Finnish and Swedish social media in terms of number, content, and user engagement during the month of January in three separate years: 1 year before, 1 year after, and 2 years after the 2015 Alcohol Act came into effect in Finland. The data consisted of all posts (Finland, N = 1,536; Sweden, N = 1,204) published during the selected months by alcohol brands that had active national social media accounts at the time of data collection. The coding protocol included numbers of posts and measures of consumer engagement, as well as content restricted by the law.Results: Social media posting increased between the 2014 and 2016 samples in both countries. In Finland, the number of posts decreased in 2017. The proportion of posts with content restricted by the 2015 law increased in both countries between the 2014 and 2016 samples. However, in Finland, the amount of restricted content decreased in the 2017 sample, whereas in Sweden it increased, Pearson chi(2)(1) = 29.273, p <.001. The level of user engagement increased in both countries between the 2014 and 2017 samples.Conclusions: The social media regulation in the Finnish 2015 amendment has had an impact on alcohol brands' social media content, but it has not affected marketers' ability to increase consumer engagement.
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| 4. |
- Kendler, Kenneth S., et al.
(författare)
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Cross-Lagged Analyses Across Middle-Adulthood of the Bidirectional Associations Between Substance Use Disorders and Psychosocial Dysfunction
- 2023
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Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 84:2, s. 185-197
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We sought to clarify the causal nature of the bidirectional associations in adulthood between substance use disorder (SUD) and psychosocial dysfunction (PSD). Method: As assessed from National Swedish registers, SUD is measured by alcohol use disorder (AUD) and drug use disorder (DUD) and PSD by unemployment (UN), low income (LI), and high community deprivation (HCD). A cross-lagged structural equation model from ages 31 to 48 is applied to the native Swedish population born 1960–1980 and residing in Sweden at age 29 followed through 2017 (n = 2,283,330), excluding individuals with prior SUD and PSD. Results: All models fitted well. Focusing on the cross-lagged paths, across sexes¸ substances, and forms of PSD, parameter estimates for the SUD to PSD paths consistently exceeded those for the parallel PSD to SUD paths. SUD to PSD paths were nearly all statistically significant. Although the UN to SUD and LI to SUD paths were usually significant, most HCD to SUD paths were not. The differences between the UN to SUD and SUD to UN paths grew larger with increasing age, whereas the opposite pattern was seen for the HCD to SUD and SUD to HCD paths. Conclusions: Across sexes, forms of SUD, and dimensions of PSD, in a fully parametrized and good-fitting cross-lagged model of middle adult life, a diagnosis of SUD consistently predicted future PSD whereas PSD often but not always predicted future SUD. The SUD to PSD paths were consistently larger than the parallel PSD to SUD paths. Our results suggest a bidirectional causal relationship between SUD and PSD across adulthood, driven largely, but not entirely, by the negative effects of SUD on future psychosocial functioning.
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| 5. |
- Kendler, Kenneth S., et al.
(författare)
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Does neighborhood alcohol availability moderate the impact of familial liability and marital status on risk for alcohol use disorders? A Swedish national study
- 2020
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Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 81:6, s. 816-823
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The purpose of this study was to determine whether ease of access to alcohol at the neighborhood level moderates the impact of familial liability and marital status on risk for alcohol use disorder (AUD). Method: Individuals in Sweden were divided into those residing in a neighborhood with (n = 14.1%) versus without (n = 85.9%) an alcohol outlet (bars/nightclubs or government stores). AUD was detected through national medical, legal, and pharmacy registries. Using an additive model predicting AUD registration over 5 years in 1,624,814 individuals, we tested for interactions between the presence of outlets in the individuals’ neighborhoods and familial risk for external-izing syndromes and marital status. Results: In both males and females, we found positive and significant interactions in the prediction of AUD between the presence versus absence of a nearby alcohol outlet with (a) familial risk and (b) single and divorced versus married status. Similar but nonsignificant interactions were seen between nearby outlets and widowed versus married status. These results changed little when all cases with prior AUD were removed from the sample. For males, most of the interaction arose from the proximity of bars/nightclubs, whereas for females the results varied across different kinds of outlets. Conclusions: Environments that provide easy access to alcohol augment the impact of a range of risk factors for AUD, especially familial vulnerability and the reduced social constraints associated with single, divorced, and widowed marital status.
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| 6. |
- Kendler, Kenneth S., et al.
(författare)
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Mediational pathways from genetic risk to alcohol use disorder in swedish men and women
- 2021
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Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 82:3, s. 431-438
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The purpose of this study was to clarify the mediational pathways from genetic risk for alcohol use disorder (AUD) to AUD itself. Method: Using information on AUD status from first-through fourth-degree relatives obtained from national registries, we created a genetic risk score for AUD for the Swedish population. We first tested a simple mediational path model in males and females separately, with early onset externalizing psychopathology (EPP), internalizing psychopathology (IPP), and poor educational attainment (EA). We then tested a more complex model in a smaller, older sample of males that contained additional self-report measures from late ado-lescence. Results: In our basic model, the largest mediational pathway from AUD genetic risk to AUD in both sexes was via high EPP followed by low EA and high IPP. The EPP pathway was considerably stronger in males, the low EA pathway was modestly stronger in females, and the IPP pathway was identical in both sexes. Our more complex model replicated the strong externalizing pathway to AUD, showing that it connected to key downstream risk factors such as early drug and alcohol use and low resilience. Conclusions: Our models concurred in showing that the strongest mediational pathway for genetic risk to AUD includes externalizing symptoms and disorders, which in turn predict further key downstream risk factors. Pathways through lower EA and IPP had smaller effects. IPP had mixed effects (partly predisposing and partly protective) on downstream risk factors. The largest sex difference was a stronger externalizing pathway to genetic risk to AUD in males than in females. (J. Stud. Alcohol Drugs, 82, 431–438, 2021).
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| 7. |
- Kendler, Kenneth S., et al.
(författare)
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Nature of the causal relationship between academic achievement and the risk for alcohol use disorder
- 2020
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Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 81:4, s. 446-453
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Tidskriftsartikel (refereegranskat)abstract
- Objective: We evaluated the claim that interventions to improve academic achievement can reduce the risk for alcohol use disorder (AUD). Method: Using nationwide data for individuals born in Sweden from 1972 to 1981 (n = 930,182), we conducted instrumental variable and co-relative analyses of the association between academic achievement and AUD with a mean 21.4-year follow-up. Our instru-ment, used in the instrumental variable analyses, was month of birth. Co-relative analyses were conducted in cousins, full siblings, and monozygotic twins discordant for AUD, with observed results fitted to a genetic model. The academic achievement–AUD association was modeled in Cox regression. AUD was assessed using national medical, criminal, or pharmacy registries. Results: Later month of birth was significantly associated with poorer academic achievement. Lower standardized academic achievement had a strong relationship with the risk for subsequent AUD registration: hazard ratio (HR) [per SD] = 2.14 [2.11, 2.17]. Instrumental variable analysis produced a substantial but moderately attenuated association: HR = 1.52 [1.28, 1.80]. Controlling for modest associations between month of birth and parental education and AUD risk reduced the association to HR = 1.43 [1.20, 1.69]. Our genetic co-relative model fitted the observed data relatively well and estimated the academic achievement–AUD association in monozygotic twins discordant for academic achievement to equal an HR of 1.44 [1.35, 1.52]. Results were broadly similar when analyzed separately in males and females. Conclusions: Two distinct methods with different assump-tions produced results suggesting that the association observed between academic achievement at age 16 and the risk for AUD into middle adulthood is partly causal, thereby providing support for interventions to improve academic achievement as a means to prevent later AUD risk.
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| 8. |
- Kendler, Kenneth S., et al.
(författare)
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Predicting the Onset of Opioid Use Disorder in the Swedish General Population
- 2022
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Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 83:3, s. 332-341
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Given the public health importance of opioid use disorder (OUD), we sought to understand better its risk predictors in the Swedish general population. Method: We examined the Swedish population, born 1950–1970 (n = 2,092,359), and followed through 2018. Using Cox, logistic, and co-sibling models, we explored associations between a wide range of putative risk factors and a first onset of OUD—assessed through medical, criminal, and pharmacy registers—in the entire cohort and in the cohort wherein prior cases of drug use disorder (DUD) were censored. Results: OUD was predicted by the following four risk factor domains: (a) externalizing syndromes, especially prior non-opioid DUD; (b) psychopathology; (c) psychosocial factors, including social class and immigrant and marital status; and (d) serious injuries and pain diagnoses. When predicting OUD as the first form of DUD, the importance of pain diagnoses as a predictor increased. Co-sibling analyses suggested that the association of some of these risk factors with OUD onset was likely largely causal, whereas others were a mixture of causal effects and familial confounding. An aggregate risk score from these individual risk factors had reasonable receiver operating characteristic (ROC) curve performance. Conclusions: OUD is a multifactorial syndrome for which risk can be meaningfully predicted by prior externalizing syndromes, internalizing and psychotic psychopathology, indicators of psychosocial status, and predictors of pain diagnoses. Some important differences were seen in the prediction of any OUD onset versus OUD onset as the first form of DUD. Much of the effect of these predictors appear, in co-sibling analyses, to likely reflect causal influences.
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| 9. |
- Kendler, Kenneth S., et al.
(författare)
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The Interrelationship of the Genetic Risks for Different Forms of Substance Use Disorder in a Swedish National Sample : A Top-Down Genetic Analysis
- 2023
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Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 84:3, s. 361-367
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The purpose of this study was to determine, using a top-down genetic analysis, the degree of specificity of the genetic risk factors for individual forms of substance use disorders (SUD). Method: We examined and followed to December 31, 2018, all individuals born in Sweden between 1960 and 1990 (N = 2,772,752) diagnosed with any of the following six SUDs: alcohol use disorder (AUD), drug use disorder (DUD), or one of four specific forms of DUD involving cannabis (CUD), cocaine and other stimulants (CSUD), opioids (OUD), or sedatives (SeUD). We examined population subsamples at high versus median genetic liability to each of these SUDs. In those samples, we then examined the prevalence of our SUDs in the high versus median liability groups, expressed as a tetrachoric correlation. Genetic liability was assessed by a family genetic risk score. Results: All SUDs were concentrated in those at high versus median risk for all six groups. DUD, CUD, and CSUD showed modest genetic specificity in that they were more concentrated in samples with high genetic liability to each of them than were other SUDs. The differences, however, were modest. No evidence for genetic specificity was seen for AUD, OUD, and SeUD, as other disorders were equally or more concentrated in those at high versus median genetic risk for that form of SUD. Conclusions: Individuals at high genetic risk for particular forms of SUD typically had elevated rates for all forms of SUDs, consistent with the nonspecificity of much of SUD genetic liability. Evidence of specificity of genetic risk for particular forms of SUD was noted but was quantitatively modest. (J. Stud. Alcohol Drugs, 84, 361–367, 2023).
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| 10. |
- Kendler, Kenneth S., et al.
(författare)
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The Typology of Alcohol Use Disorder : Latent Class Analyses of a Population-Based Swedish Sample
- 2022
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Ingår i: Journal of Studies on Alcohol and Drugs. - : Alcohol Research Documentation, Inc.. - 1937-1888 .- 1938-4114. ; 83:5, s. 672-679
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The purpose of this study was to clarify the clinical heterogeneity of alcohol use disorder (AUD) in a national Swedish sample of affected individuals using latent class analysis. Method: Using a Swedish population-based sample of AUD cases ascertained from medical, criminal, and pharmacy registries (n = 217,071), we applied latent class analysis to sex, externalizing and internalizing syndromes before first registration, and age at first registration. The re-sulting types were evaluated against 15 diverse validators and degree of resemblance in relative pairs concordant for AUD. Results: A three-class solution was preferred by fit indices. The three classes were as follows: type 1 (male preponderant, externalizing; 32%), type 2 (minimal prior psychopathology; 46%), and type 3 (mixed-sex internalizing; 23%). Repeated split-half analyses revealed the statistical stability of these solutions. Meaningful differences emerged between the classes on many validators. Type 1 had the greatest family disruption, lowest educational levels, most AUD registrations, highest rates of criminal registration, and highest genetic risk for externalizing disorders and AUD. Type 2 had the least social dysfunction. Type 3 had the highest educational attainment, genetic liability to internalizing disorders, and proportion of women. All types significantly aggregated in affected pairs of relatives. Conclu-sions: Meaningful and reproducible subtypes of AUD, consistent with prior typological results, can be obtained from national registry–based samples. Using a range of external validators and patterns of familial aggregation, our results suggest that our three-class solution captured a meaningful proportion of the clinical heterogeneity of AUD.
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