The aim of the present study was to evaluate the feasibility and analyze preliminary data of the effectiveness of affect phobia therapy (APT) adapted to a structured group format. APT is a treatment that targets emotional avoidance and deficiency in emotion regulation that often leads to psychological dysfunction. The target group was patients with comorbid substance use disorder (SUD) and ADHD with core features of affect phobia/emotion dysregulation. Patients in three group treatments with the aim of having eight participants in each group (n = 22) were included in an open design, where targeted symptoms psychological distress, craving, affect phobia, self-compassion, emotion dysregulation, and substance use were evaluated, with repeated measurements every week from the start of therapy to follow-up 4 weeks after the end of treatment. The results showed an increase in self-compassion and a decrease in affect phobia, but no change in symptoms of psychological distress or emotional dysregulation. No reliable reduction in alcohol or drug use could be related to treatment. Craving fluctuated throughout the study period and patients' drinking patterns changed toward more social drinking. The main finding of the study was that affect phobia therapy in a structured group format is a feasible treatment for the patient group and that the therapy showed preliminary effectiveness in increasing adaptive affective functioning and self-compassion. Future randomized controlled trials are needed for conclusive evidence on efficacy, also examining whether the therapy can help reduce substance use.

It is still unclear how changes in alcohol control policies may have contributed to changes in overall levels of alcohol-attributed harm between and within the Nordic countries. We modified and applied the Bridging the Gap (BtG)-scale to measure the restrictiveness of a set of alcohol control policies for each Nordic country and each year between 1990 and 2019. Alcohol-attributed harm was measured as total and sex-specific alcohol-attributed disease burden by age-standardized years of life losts (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) per 100 000 population from the Global Burden of Disease Study (GBD). Longitudinal cross-country comparisons with random effects regression analysis were employed to explore associations, within and across countries, differentiated by sex and the time to first effect. Overall, alcohol-attributed YLLs, YLDs, and DALYs decreased over the study period in all countries, except in Iceland. The burden was lower in those countries with restrictive national policies, apart from Finland, and higher in Denmark which had the least restrictive policies. Changes in restrictiveness were negatively associated with DALYs for causes with a longer time to effect, although this effect was stronger for males and varied between countries. The low alcohol attributed disease burden in Sweden, Norway, and Iceland, compared to Denmark, points towards the success of upholding lower levels of harm with strict alcohol policies. However, sex, location and cause-specific associations indicate that the role of formal alcohol policies is highly context dependent and that other factors might influence harm as well.

Experienced childhood trauma (CT) is prevalent in individuals with alcohol use disorders (AUDs). Few studies examine how experienced CT afects alcohol-treatment outcome. This study accordingly investigates whether experienced CT independently afects treatment outcome 2.5- and 5-years post-treatment, controlling for other signifcant variables, such as self-efcacy, self-directedness, and mental health. Participants (n = 349) with AUDs (without severe psychiatric comorbidity or drug dependence) were recruited from three alcohol-treatment settings and followed up 2.5- and 5 years after treatment initiation. The group with experienced CT had more mental health problems, less self-efcacy, and less self-directedness. Multiple and logistic regressions were conducted using the outcome variables total number of DSM-IV criteria and abstinence. The results indicated that CT did not independently afect treatment outcome. Individuals with AUDs and experienced CT beneftted the same from alcohol treatment as those without such experience; however, studies should also examine groups with AUD and psychiatric comorbidity.

Effort-reward imbalance (ERI) is a form of psychosocial work stress known to contribute to health problems among working populations. Given that men and women tend to work in different industries and job activities, the labour market remains gender segregated. This study investigated the relationships between effort, reward, ERI, overcommitment and problem drinking in a sample of the Swedish working population over time and simultaneously explored whether these relationships differ by gender and the gender composition of industries and main job activities. Data were drawn from the Swedish Longitudinal Occupational Survey of Health, collected biennially from 2010 to 2022, comprising 18 017 workers. Work stress and problem drinking were measured with the ERI questionnaire and the Cut-down-Annoyed-Guilty-Eye opener instrument, respectively. A logistic-generalised estimating equation was used to perform the analysis. The results showed that higher scores of all the components of the ERI–model are significantly associated with problem drinking (p<0.01). However, these associations did not significantly differ by gender and the gender composition of industries and main job activities (p>0.10). Also, overcommitment did not significantly moderate the association between ERI and problem drinking (p>0.10). Our findings demonstrated that all the components of the ERI–model contribute to problem drinking in working populations and highlight the need for organisations and stakeholders to consider gender as a social structure when developing strategies and interventions aimed at improving work stress and reducing problem drinking.

Objective: Alcohol and Other Drug (AOD) disorders cause substantial harm. Effective Substance Use Treatment (SUT) exists, but long-term outcomes remain inconclusive. This study used a 20-year prospective follow-up of 1248 service users entering SUT in Stockholm, Sweden, in 2000–2002 to elaborate on how different dimensions of long-term outcomes may be measured by register-based indicators. Baseline characteristics and attrition bias were explicated, and register-based outcomes were examined.Results: Register-based indicators are valuable, but they also have inherent limitations such as the lack of substance use data and inability to differentiate between un/met treatment needs and access. Significant variations in long-term outcomes were evident depending on which register-based indicator was used, and whether used in isolation or combinations. Six out of 10 service users were still alive after 20 years, but as many as 8 out of 10 of the survivors remained in treatment, and only two out of 10 had a stable economic situation. Hence, the register indicators identified only a few survivors, with stable economic and social situations, and without recent treatment contacts 20 years after treatment entry. The long-term outcomes were concerning and even more so when combining outcome dimensions.

Several countries, including Canada and Australia, have developed public health-based lower-risk gambling limits to differentiate lower-risk from higher-risk gambling. This study aimed to identify a preliminary set of lower-risk gambling limits (gambling frequency, duration, expenditure, expenditure as a proportion of personal net income, and diversity), and investigate if gambling types are linked to additional harms, in a Swedish context. The study involved secondary analyses of two online survey studies using the Gambling Disorder Identification Test (GDIT). Receiver operating curve analyses were conducted in relation to both + 1 and + 2 gambling-related harms in a sample of 705 past-year gamblers. Potential lower-risk limits ranges identified were: gambling frequency of “2–3 times a week” to “4 or more times a week” (8–16 times monthly); gambling duration of 6 to 15 h per month; gambling expenditure of 2,000 SEK (approximately $USD190) per month; gambling expenditure as a proportion of personal net income of 5%; and gambling diversity of only one problematic gambling type. Gambling on slots and sports betting were associated with gambling-related harms. The lower-risk limits in the current study were higher than in previous studies, which may be explained by the large proportion of support- or treatment-seeking gamblers with high rates of problem gambling and problematic online gambling in the study sample. An international consensus-based framework on gambling consumption is warranted, with lower-risk limits validated in future empirical studies using larger datasets collected from the Swedish general population.

Gambling type involvement, both in terms of participation (engagement in specific gambling types) and diversity (how many gambling types an individual engages in), is a key feature to address in gambling self-report measures, but such systematic measurement procedures are scarce. The aim of this study was to test the psychometric performance of the gambling type assessment in the recently developed Gambling Disorder Identification Test (GDIT), in terms of test-retest reliability, convergent validity, and patterns of gambling diversity, among help-seeking and general population gambling samples (total n = 603). Overall, online gambling was more commonly reported as problematic than land-based gambling. Retest reliability varied for specific gambling types (ICC range 0.32–0.64, r_tet range 0.66–0.85). In terms of gambling participation, online gambling showed stronger correlations with GDIT total score (i.e., symptom severity) than land-based gambling, where Slots showed the strongest correlation (r = 0.52), followed by Casino table games (r = 0.25), Sports and Horse betting (r = 0.16 and r = 0.14, respectively), and Poker (r = 0.14). Lotteries showed no correlation with GDIT total score (r=-0,01). For Slots gambling, all gambling diversity levels (including Slots as a single gambling type) were on average associated with the highest diagnostic severity level (GDIT total score > 30; severe gambling disorder). Finally, explorative configural frequency analysis identified typical and antitypical gambling diversity patterns. The result from the current study corroborates findings that engagement in specific gambling types matter, and that such features should be included in gambling measurement. We conclude that the GDIT is a reliable and valid measure for systematic assessment of gambling type involvement. The GDIT can be used to assess gambling participation and diversity, as part of a broad measurement setup for problem gambling and gambling disorder.

Background and Aims: Studies using smartphone apps in treatment for alcohol dependence are lacking. This study aimed to test the consumption-reducing effects of using two app-based alcohol interventions as complement to treatment as usual (TAU). Design: Three-armed, parallel, randomised controlled trial. Setting: Specialised outpatient clinic within the Stockholm Centre for Dependency Disorders, Stockholm, Sweden. Participants: 162 alcohol-dependent adults (46% female), with no social problems or mental disorders, who had no other drug use, were included. Mean age was 50 years, and the majority were highly educated, employed and had not previously received any alcohol treatment. Interventions: Participants were randomised to (1) TAU+drink-counting app (Glasklart, n = 52), (2) TAU+app-coupled breathalyser (iBAC Pro, n = 58) or (3) TAU only (n = 52). TAU included four sessions of clinician-led psychological treatment based on motivational interviewing/cognitive behavioural therapy, combined with pharmacotherapy when requested, for 12 weeks. Measurements: The primary outcome was past 4-week heavy drinking days (HDD) at 26 weeks post-randomisation, adjusted for baseline HDD, and assessed by structured interviews using Timeline Followback. Secondary outcomes included weekly consumption, consumption patterns, phosphatidylethanol and dependence at 12 and 26 weeks. Analyses compared TAU+drink-counting app and TAU+breathalyser each with TAU alone. Findings: At 26 weeks, participants with TAU+breathalyser had statistically significantly lower HDD [incidence rate ratio (IRR) = 0.67, 95% confidence interval (CI) = 0.49, 0.91] compared with those with TAU alone. There was no evidence of any effects on HDD for those with TAU+drink-counting app, compared with TAU alone (IRR = 0.94, 95% CI = 0.70, 1.25) or of any other effects. Conclusions: In Sweden, treatment as usual (TAU) for alcohol dependence combined with a smartphone application coupled with a breathalyser was more effective than TAU alone in reducing self-reported heavy drinking. There was no evidence that TAU combined with a smartphone application for drink-counting was more effective than TAU alone.

Objectives: The Gambling Disorder Identification Test (GDIT) is a recently developed self-report measure. The GDIT includes items with multiple response options that are either based on frequency or time, and item response theory evaluations of these could yield vital knowledge on its measurement performance.

Methods: The GDIT was evaluated using Rasch analysis in a study involving 597 Swedish gamblers.

Results: In a three-dimensional Rasch model, the item response difficulty range extended from −1.88 to 4.06 and increased with higher time- and frequency-based responses. Differential item functioning showed that some GDIT items displayed age and gender-related differences. Additionally, person-separation reliability indicated the GDIT could reliably be divided into three to four diagnostic levels.

Conclusions: The frequency- and time-based item response options of the GDIT offer excellent measurement, allowing for elaborate assessment across both lower and higher gambling severity. The GDIT can be used to detect DSM-5 Gambling Disorder, thereby holding significance from both epidemiological and clinical standpoints. Notably, the 3-item GDIT Gambling Behavior subscale also shows potential as a brief screening tool for identifying at-risk gambling behavior.

Background Alcohol dependence is common, yet highly undertreated. Smartphone applications (apps) have potential to enhance treatment accessibility and effectiveness, however evidence is limited, especially studies focussing on user experiences. The aim was to describe patient perceptions on the usability and acceptability of self-monitoring apps provided as treatment complement for alcohol dependence. Methods Individual semi-structured interviews were conducted through video or phone calls with 21 participants, recruited from a randomized controlled trial at a dependency clinic in Stockholm. The participants had used two specific apps for self-monitoring consumption (Glasklart and iBAC) during 12 wk prior to the interviews. Data was analyzed using Qualitative Content Analysis.ResultsTwo domains were identified: 1) Smartphone applications as facilitators to treatment, and 2) Barriers to smartphone application use. Using apps within the treatment context was believed to increase the accuracy of the reported consumption. Participants became more aware of their alcohol problem and described the apps as reinforcers that could increase both the motivation to change and the focus on the problem and commitment to treatment. The apps were further described as helpful to control alcohol consumption. However, app usage was constrained by technical problems, unfit app-specific features and procedures, and alcohol-related shame and stigma. Discussion and Conclusions Self-monitoring alcohol apps have several beneficial features that can help assess, track, and control alcohol consumption, and improve communication with clinicians. The results indicate they can be useful complements to treatment for patients with alcohol dependence, but their use can be limited by different, foremost technical, issues. Smartphone applications for self-monitoring of alcohol consumption may help provide accurate data, increase consumption awareness, focus, motivation, and perceived control; Smartphone applications for self-monitoring of alcohol consumption are considered helpful complements to alcohol treatment; The use of smartphone applications for self-monitoring of alcohol consumption can be constrained by technical problems, and unfit app-specific features and procedures.