Aims: Craving is commonly described as an ‘intense desire’ to use drugs. Due to its relevance for addiction theories and treatment, much effort has been put into understanding how and when craving occurs. An undisputed definition of craving is however still lacking. The aim of this article is to explore how craving is experienced and resisted after cessation of substance use.

Methods: This article analyses interviews with former addiction treatment clients. By analyzing the described event of craving, the study shows the complexities in such narratives.

Findings: We found that the interaction between temporal, relational and material forces move people toward or away from craving. Craving thus seemed to be both relational and located in-between forces.

Conclusions: We conclude that craving appeared in the studied narratives to emanate from different atmospheres, with a concurrent focus on settings rather than on substances. A relational understanding of craving can add to the typical, but limited, account of craving as an individual issue. It also avoids stigmatizing ideas that people who do not resist cravings simply fail to say no. We end by asking if craving is a relevant concept within the addiction field at all.

Introduction

Conduct problems (CP) predict cannabis use prospectively but the research is mixed as to whether this association is stronger among girls. A stronger association among girls would suggest a ‘gender paradox’ as both CP and cannabis use is less common in this group. This study aimed to assess whether the longitudinal association between CP and cannabis use in Swedish adolescents is stronger among girls.

Methods

Data from two waves of a nationally representative cohort study of Swedish adolescents born in 2001 were used. Baseline measurements were collected in 9th grade (at age 15–16) and follow-up measures at 11th grade (at age 17–18).

Results

CP at baseline were significantly associated with cannabis use at follow-up adjusted for hyperactivity problems, emotional problems, socio-demographics, parental monitoring, school grades and truancy at baseline (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06–1.24) but not when also adjusting for substance use at baseline. Boys were more likely to have used cannabis during the past year, even when controlling for prior substance use (OR 2.29, 95% CI 1.76–2.98). The association between CP and cannabis use was significantly weaker for boys (OR 0.83, 95% CI 0.72–0.95 in the fully adjusted model). The predicted probability of cannabis use was stable at 0.13 for boys across levels of CP, but ranged from 0.05 to 0.16 for girls.

Discussion and Conclusion

The longitudinal association between CP and cannabis use was stronger among girls. The findings are indicative of a ‘gender paradox’ in the association between CP and cannabis use.

Background

Lately, there has been massive media coverage of gang-related criminality in ‘exposed areas’ in Sweden. Politicians have blamed the illegal drugs trade without questioning the country’s prohibitionist drug policy. This study analyzes how cannabis is constructed in Swedish newspaper articles that mention both organized crime and cannabis. We ask how the drug and its buyers and sellers are described, what discourses are drawn upon, and discuss the relationship between media coverage and drug policy.

Methods

We analyzed recent (2021) articles from four newspapers (n = 71) through Critical Discourse Analysis.

Results

Cannabis was constructed as a commodity linked to violence and deviance. Agency was attributed to people with power and status (e.g. gang leaders), and recreational cannabis users were described as guilty of feeding organized crime. A combination of economic and moral discourses was used to make the reported events meaningful, and to motivate both prohibition and decriminalization/legalization.

Conclusion

The study shows that assumedly neutral journalistic voices emphasized the link between cannabis and violence and problematized cannabis buyers and sellers. This homogenous media coverage will probably contribute to keep the question of cannabis law reform discursively lifeless in Sweden.

Aim:  This exploratory study analyses the interplay between the treatment philosophies of Alcoholics Anonymous (AA) and Relapse Prevention (RP) in personal stories of addiction. While the basic ideas of AA and RP are compatible in many ways, they also carry some fundamental differences.

Methods: The data consisted of interviews with 12 individuals recovering from substance use problems, who had experience of both AA and RP. The analysis drew on a dialogical narrative perspective, and the concept polyphony was used to shed light on the interplay between different treatment philosophies in personal stories of relapse.

Findings: Although sometimes resulting in incoherence, the treatment philosophies were combined idiosyncratically, in ways that appeared productive for the participants’ self-images and recovery journeys.

Conclusion: The combination of AA and RP philosophies in narratives of relapse and recovery may reflect a new treatment discourse where individualisation and responsibilisation stand in a complicated relationship with collectivism and surrendering to so-called addicting processes.

The National Board of Health and Welfare (NBHW) in Sweden (Socialstyrelsen, 2023) recently updated its threshold for risky drinking, to be considered by healthcare staff in patient work. This is part of their national guidelines for the treatment and prevention of unhealthy lifestyles. The scientific basis for NBHW's threshold consists of recent guidelines published in other countries and two additional systematic reviews identified through literature searches. According to the new threshold, women and men who drink 10 or more standard units (referred to as “standard glasses”) of alcohol during a week are drinking risky (“riskbruk”). Drinking four or more standard units on one occasion at least once a month is also considered risky. As a reference, a standard unit of alcohol in Sweden is defined as 12 g of pure ethanol, corresponding to, for example, 330 ml of strong beer, or 120–150 ml of wine. Below, we raise some concerns with the threshold.

Drug testing plays a key role in youth substance use treatment in Sweden. Young people treated for substance use problems are routinely required to leave urine samples, and there is often controversy between patients and staff around its relevance. Still, there is a lack of research on how young people make sense of this practice. This article contributes to this knowledge through an ANT-inspired (Actor Network Theory) analysis of how youth enact urine testing in their treatment experiences. We attempt to tease out what kind of sociomaterial object urine testing is according to youth, and how it affects their lives. The study is based on interviews with 25 previous patients (mean age 17). The analysis shows that the participants enacted urine testing as both a stable object that creates binaries in knowledge networks (use or nonuse), and as a flickering object that appears in and affects diverse drug-body-treatment assemblages (even outside the clinic). The participants had internalized the importance of leaving negative samples to get discharged and avoid adult surveillance. They described a practice that made substance use a demarcated, individual and treatable problem, and also, often contrary to their own self-understandings, devalued their ability to be honest about and regulate their conduct. Through establishing substance use as a simplified either/or phenomenon and through attributing patients with the agency to become nonusers only, urine testing appears counter-productive if treatment is to strengthen informed decision making and responsibility among soon to be adults.

Background: Attention deficit hyperactivity disorder (ADHD) has in several studies been linked to substance use, including cannabis use. However, crucial gaps remain regarding how to understand this association. Analyzing the association between ADHD and substance use is complicated because of a pronounced overlap between ADHD, conduct problems, and traits such as sensation-seeking. Objectives: Using data from a large and nationally representative study among Swedish adolescents, this study explored the role of conduct problems, but also of sensation-seeking, in accounting for the association between ADHD and cannabis use. Results: There was a notable association between ADHD and cannabis use that was attenuated when conduct problems were controlled for. The association between cannabis use and conduct problems, in turn, was attenuated when sensation-seeking was controlled for. Individuals with both ADHD and conduct problems were more likely to have used cannabis than individuals with ADHD only, but not compared with individuals with conduct problems only. Conclusions: Whereas conduct problems largely explain the link between ADHD and cannabis use, sensation-seeking seems to account for the association between conduct problems and cannabis use.

This article explores how professionals within Swedish addiction treatment (n = 18) describe and make sense of relapse prevention (RP). RP is known as a self-control programme for maintaining behavioural change, helping people deal with high-risk situations. However, since self-control techniques have been incorporated widely in the addiction treatment field, the specificities of RP have become vague. To grasp what RP ‘is’, we draw on John Law’s and Annemarie Mol’s thoughts on how logics enact objects and realities. We thus follow critical scholarship in Science and Technology Studies and view treatment as a local knowledge-making practice that may depart from how it was originally designed. A key question is how RP is potentially transformed and made-to-matter when moved from the controlled settings of theorising and experimental studies to practice. The professionals used a logic of fixity to make RP stable, structured and evidence-based, easily distinguishable from other interventions. They also used a logic of fluidity to explain how and why they tinkered with it and adapted it to the preferences of both staff and attendees. The two logics enacted two different realities of addiction treatment: one in which RP is standardised, temporally demarcated and can solve most addiction problems, and another where interventions must be individualised, continuous and adapted to local settings and needs. It did not appear contradictory to ‘make up’ RP as both fixed and fluid; the two realities exist side by side, but with different material effects.

Background: Research is needed on how substance use patterns develop over time in the general adolescent population. This knowledge is crucial in calibrating prevention and other interventions. Method: The study concerns use of cigarettes, alcohol, and cannabis in a nationally representative cohort of Swedish adolescents (n = 3999). Two waves (9th and 11th school grade) from the Futura01 study were analyzed using latent transition analysis (LTA) and multinomial regression analysis. Results: Four substance use patterns, were identified, ranging from Non-user, Alcohol experienced, Alcohol User to Co-user of cigarettes, alcohol, and cannabis. Statuses thus conveyed a continuum from no use to more advanced use. Half of the individuals remained in their original status between time-points, and half transitioned, most often one step on the continuum. Alcohol user was the most stable status over time (0.78), and the Non-user status the least (0.36). The probability of remaining in the Alcohol experienced status was 0.57, and 0.45 for the Co-user status. There was a low probability of transitioning from alcohol to cannabis use. Females were more likely to belong to Alcohol experienced and males to Co-user statuses, but these associations weakened over time. Conclusions: The study identified transitions across substance use statuses between time-points. These usually concerned different levels of alcohol use, and not into more advanced substance use that included the illegal substance cannabis. The study corroborates that young Swedes belong to a “sober” generation and usually do not transition from legal into illegal substance use during late adolescence, though with some gender differences.

For public health interventions to be effective, they need to be supported or at least accepted by those affected, and social policy should therefore be understood as political and strategic. This raises questions about the relationship between the analytical, the political and the personal in policy processes. This article offers an in-depth analysis of such issues, as they were enacted during interviews with Swedish alcohol policy stakeholders. It focuses on the assumptions and a priori 'truths' articulated in interviews about Responsible Beverage Services (RBS) at Swedish football stadiums or 'Football Without Bingeing'. We argue that the participants combined different narrative forms, such as seemingly objective chronological accounts and personal ethical judgments, in talking about the policy initiative. Through such narrative intersections, three key 'truths' were produced that reinforced the link between alcohol and violence, necessitated blanket population-level measures to reduce alcohol use and made gendered behavior an irrelevant policy target.