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  • 1. Agardh, Emilie E.
    et al.
    Allebeck, Peter
    Flodin, Pär
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Ramstedt, Mats
    Knudsen, Ann Kristin
    Øverland, Simon
    Kinge, Jonas Minet
    Tollånes, Mette C.
    Eikemo, Terje A.
    Skogen, Jens Christoffer
    Mäkelä, Pia
    Gissler, Mika
    Juel, Knud
    Moesgaard Iburg, Kim
    McGrath, John J.
    Naghavi, Mohsen
    Vollset, Stein Emil
    Gakidou, Emmanuela
    Danielsson, Anna-Karin
    Alcohol-attributed disease burden in four Nordic countries between 2000 and 2017: Are the gender gaps narrowing? A comparison using the Global Burden of Disease, Injury and Risk Factor 2017 study2021In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 40, no 3, p. 431-442Article in journal (Refereed)
    Abstract [en]

    Introduction and Aims. The gender difference in alcohol use seems to have narrowed in the Nordic countries, but it is not clear to what extent this may have affected differences in levels of harm. We compared gender differences in all-cause and cause-specific alcohol-attributed disease burden, as measured by disability-adjusted life-years (DALY), in four Nordic countries in 2000-2017, to find out if gender gaps in DALYs had narrowed. Design and Methods. Alcohol-attributed disease burden by DALYs per 100 000 population with 95% uncertainty intervals were extracted from the Global Burden of Disease database. Results. In 2017, all-cause DALYs in males varied between 2531 in Finland and 976 in Norway, and in females between 620 in Denmark and 270 in Norway. Finland had the largest gender differences and Norway the smallest, closely followed by Sweden. During 2000-2017, absolute gender differences in all-cause DALYs declined by 31% in Denmark, 26% in Finland, 19% in Sweden and 18% in Norway. In Finland, this was driven by a larger relative decline in males than females; in Norway, it was due to increased burden in females. In Denmark, the burden in females declined slightly more than in males, in relative terms, while in Sweden the relative decline was similar in males and females. Discussion and Conclusions. The gender gaps in harm narrowed to a different extent in the Nordic countries, with the differences driven by different conditions. Findings are informative about how inequality, policy and sociocultural differences affect levels of harm by gender.

  • 2. Agardh, Emilie E.
    et al.
    Allebeck, Peter
    Knudsen, Ann Kristin Skrindo
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. The Norwegian Institute of Public Health, Norway.
    Aronsson, Amanda E.
    Flodin, Par
    Eikemo, Terje A.
    Bangah, Paul R.
    Skogen, Jens Christoffer
    Gissler, Mika
    Ronka, Sanna
    Mcgrath, John J.
    Sigurvinsdottir, Rannveig
    Dadras, Omid
    Deuba, Keshab
    Hedna, Khedidja
    Mentis, Alexios-Fotios A.
    Sagoe, Dominic
    Shiri, Rahman
    Weye, Nanna
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. the Norwegian Institute of Public Health, Norway; Aarhus University, Denmark.
    Hay, Simon I.
    Murray, Christopher J. L.
    Naghavi, Mohsen
    Pasovic, Maja
    Vos, Theo
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; Inland Norway University of Applied Sciences, Norway.
    Danielsson, Anna-Karin
    Disease Burden Attributed to Drug use in the Nordic Countries: a Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 20192023In: International Journal of Mental Health and Addiction, ISSN 1557-1874, E-ISSN 1557-1882Article in journal (Refereed)
    Abstract [en]

    The Nordic countries share similarities in many social and welfare domains, but drug policies have varied over time and between countries. We wanted to compare differences in mortality and disease burden attributed to drug use over time. Using results from the Global Burden of Disease (GBD) study, we extracted age-standardized estimates of deaths, DALYs, YLLs and YLDs per 100 000 population for Denmark, Finland, Iceland, Norway, and Sweden during the years 1990 to 2019. Among males, DALY rates in 2019 were highest in Finland and lowest in Iceland. Among females, DALY rates in 2019 were highest in Iceland and lowest in Sweden. Sweden have had the highest increase in burden since 1990, from 252 DALYs to 694 among males, and from 111 to 193 among females. Norway had a peak with highest level of all countries in 2001-2004 and thereafter a strong decline. Denmark have had the most constant burden over time, 566-600 DALYs among males from 1990 to 2010 and 210-240 DALYs among females. Strict drug policies in Nordic countries have not prevented an increase in some countries, so policies need to be reviewed.

  • 3. Anderberg, Mats
    et al.
    Dahlberg, Mikael
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Adolescents with substance abuse problems in outpatient treatment: A one-year prospective follow-up study2021In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 38, no 5, p. 466-479Article in journal (Refereed)
    Abstract [en]

    Aim: There is a lack of knowledge about how adolescents with substance abuse problems manage after taking part in treatment. It is also difficult to perform traditional follow-up studies with this group. This article presents the outcome of a prospective study of 455 adolescents who underwent outpatient treatment, based on data taken from official registers. It aims to describe and analyse indications of continued use of substance (CUS) and how various risk and protective factors predict outcomes after initiated treatment at a Maria clinic in Sweden.

    Design: The study is based on structured interviews at intake, and the data that indicated CUS were taken from several different national registers. The analyses included descriptive data and bivariate associations, logistic regressions and a CHAID analysis.

    Results: Almost two thirds of the adolescents have no indication of CUS at one-year follow-up. The ten studied risk factors independently were weak predictors of CUS and it was instead the accumulation of risk factors that were linked to a negative outcome.

    Conclusion: The majority of adolescents who start outpatient treatment for substance abuse problems return to a lesser extent in registers that may indicate a continued problem with alcohol and drugs one year later. A concentration of more than five risk factors appears to be associated with a registration. The study also provides an example of an alternative method for following up adolescents with alcohol and drug abuse problems.

  • 4. Anderberg, Mats
    et al.
    Dahlberg, Mikael
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Criminality among Young People With Substance Use Problems in Sweden: A One-Year Follow-Up Study2022In: Journal of Drug Issues, ISSN 0022-0426, E-ISSN 1945-1369, Vol. 52, no 3, p. 406-420Article in journal (Refereed)
    Abstract [en]

    Swedish drug policy has a strong focus on minor drug violations. This longitudinal study analyses the association between criminality and substance use problems among young people who have received outpatient treatment and risk factors that predict continued problems with criminality. Research on this target group is under development in Sweden, but there are few follow-up studies. The study indicates that about one-quarters of the young people who begin outpatient treatment have been convicted of crimes at 1-year follow-up. Most of them who had been convicted with offences also have ongoing problems with substance use and three-quarters of the young people had been charged with a drug-related offence. More than five risk factors give an elevated risk of continued criminality. Interventions meeting the needs of young people, moving away from the current emphasis on penal law principles, may also contribute to reduced criminality in this target group. 

  • 5. Balldin, Jan
    et al.
    Berglund, Kristina J.
    Berggren, Ulf
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Fahlke, Claudia
    TAQ1A1 Allele of the DRD2 Gene Region Contribute to Shorter Survival Time in Alcohol Dependent Individuals When Controlling for the Influence of Age and Gender. A Follow-up Study of 18 Years2018In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 53, no 3, p. 216-220Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the influence of the A1 allele of the TAQ1A polymorphism in the dopamine D2 receptor (DRD2) gene region on mortality in adult individuals with alcohol dependence. Methods: The study sample consisted of 359 alcohol-dependent individuals treated for severe alcohol withdrawal symptoms in 1997. Years of survival was studied in an 18-year follow-up. In the analyses, gender and age were controlled for. Results: At the 18-year follow-up, 53% individuals had deceased. The analyses showed that older age (P < 0.001), male gender (P < 0.05) and carrying the A1 allele (P < 0.01) all significantly and independently contributed to shorten years of survival. Among the deceased individuals, the genotype A1+ was the only significant contributor to shorten years of survival. Conclusions: An important contribution of the present study is that in alcohol dependence the Taq1A1 allele of the DRD2 gene region is a risk factor for premature death of similar importance as the well-known risk factors of age and gender. Short Summary: We investigated the influence of A1 allele of the TAQ1A polymorphism in DRD2 receptor gene region on mortality in alcohol-dependent individuals in an 18-year follow-up. Age, gender and the A1 allele contributed to shorten years of survival. Among the deceased, the A1+ was the only contributor to shorten years of survival.

  • 6. Berglund, Kristina J.
    et al.
    Alborn, Sven-Eric
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden; Inland Norway University of Applied Sciences, Norway.
    Can a History of Childhood Trauma Impact the Effectiveness of Treatment in Individuals with Alcohol Use Disorders? A 2.5- and 5-Year Follow-up2023In: International Journal of Mental Health and Addiction, ISSN 1557-1874, E-ISSN 1557-1882Article in journal (Refereed)
    Abstract [en]

    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.

  • 7. Berglund, Kristina
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Typologisering av alkoholberoende individer i relation till kön och genus2014In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 91, no 6, p. 624-631Article in journal (Refereed)
  • 8. Berglund, Kristina
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    UIV- en intervju som redovisar kvalitet utifrån brukares och socialsekreterares bedömningar2014In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 91, no 6, p. 614-623Article in journal (Refereed)
  • 9. Berman, Anne H.
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Sinadinovic, Kristina
    Changes in Mental and Physical Well-Being Among Problematic Alcohol and Drug Users in 12-Month Internet-Based Intervention Trials2015In: Psychology of Addictive Behaviors, ISSN 0893-164X, E-ISSN 1939-1501, Vol. 29, no 1, p. 97-105Article in journal (Refereed)
    Abstract [en]

    Twelve-month well-being outcomes were investigated for 835 participants in 1 of 2 randomized controlled trials offering online assessment and brief intervention for either problematic alcohol (n = 633) or drug use (n = 202). The well-being of participants who had reduced their substance use to a less problematic level (regardless of intervention) over 12 months was compared with that of participants who had maintained or increased their use. At a 12-month follow-up, the 227 alcohol trial participants with reduced use showed better well-being in comparison to the 406 with stable or increased use, in physical health and sleep quality, as well as general well-being, ability to concentrate, lower stress, better social life satisfaction and sense of control, and a lower rate of depressed mood. Among the 70 drug trial participants who had reduced their drug use over 12 months, 80% had ceased all drug use, and at follow-up they had fewer alcohol-related problems than the stable group. No differences in well-being between these groups were identified. Self-reported access to additional treatment modalities beyond the trial interventions (e.g., speaking to someone about problematic use and accessing additional Internet-based interventions) was higher among participants in both cohorts with reduced substance use in comparison to those with stable/increased use. Drug users who reduced their use accessed prescribed medication to a larger extent than those whose use remained stable or increased. Points to consider when conducting future research on well-being and problematic substance use are discussed.

  • 10. Berman, Anne
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Källmen, Håkan
    AUDIT och DUDIT – Att identifiera problem med alkohol och droger2012Book (Other academic)
    Abstract [en]

    Formulären AUDIT och DUDIT är evidensbaserade och lättillgängliga verktyg som identifierar problematiskt alkohol- och drogbruk och ger ett bra underlag för dialog mellan behandlare och klient/patient. AUDIT och DUDIT rekommenderas som förstahandsval för screening (identifiering) i Socialstyrelsens riktlinjer för missbruks- och beroendevård.

    Det här är en handbok som tar upp användning, poängsättning och tolkning av formulären samt olika alternativ för att gå vidare vid positivt utfall. Den presenterar också hur man kan samtala kring resultatet och hur vidare utredning, diagnostisering och uppföljning går till.

    Boken AUDIT och DUDIT - identifiera problem med alkohol och droger vänder sig till behandlare och rådgivare inom bland annat hälso- och sjukvård, elevhälsa, mödravård, socialtjänst, beroendevård, kriminalvård och psykiatri.

  • 11. Boson, Karin
    et al.
    Anderberg, Mats
    Melander Hagborg, Johan
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institute, Sweden.
    Dahlberg, Mikael
    Adolescents with substance use problems in outpatient treatment: a one-year prospective follow-up study focusing on mental health and gender differences2022In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 17, no 1, article id 53Article in journal (Refereed)
    Abstract [en]

    Background: Although several studies have found a high incidence of coexisting mental health problems among adolescents with substance use problems, follow-up studies addressing how these conditions change over time are rare. The study will describe and analyze indications of mental health problems and how various risk factors predict outcomes 1 year after initial treatment contact. In addition, gender-specific risk factors are explored.

    Methods: A clinical sample of 455 adolescents (29% girls, median age 17 years) answered a structural interview at baseline and were followed up using official records 1 year after initiated treatment. Bivariate associations and logistic regressions were conducted to analyse the links between risk factors at the individual, social, and structural levels as well as links between various mental illness symptoms at treatment start and indications of mental health problems 1 year later were analysed.

    Results: The results show that mental health problems among adolescents largely persisted 1 year after start of outpatient care for substance use problems. Forty-two per cent of the sample displayed indications of mental health problems at follow-up, and registrations for both outpatient treatment and psychiatric medication were more common among the girls. Girls also reported more mental illness symptoms at treatment start than boys did, especially anxiety. Depression and suicidal thoughts had predictive values regarding indications of mental health problems and small cumulative effects were found for 6-10 co-occurring risk factors.

    Conclusions: Adolescents with depression and suicidal thoughts at treatment start should yield attention among clinicians as these general risk factors could predict indication of mental health problems at 1 year follow-up effectively. Also, patients with more than six co-occurring risk factors seem more vulnerable for continued mental health problems. Generally, girls displayed a greater mental health and psychosocial burden at treatment initiation and were more likely to show indication of mental health problems at follow-up. These results suggests that girls are more likely to get psychiatric out-treatment parallel to, or after, substance abuse treatment. We recommend further investigation of gender differences and gender-specific needs in substance use treatment.

  • 12. Boson, Karin
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Fahlke, Claudia
    Berglund, Kristina
    Personality traits as predictors of early alcohol inebriation among young adolescents: Mediating effects by mental health and gender-specific patterns2019In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 95, p. 152-159, article id S0306-4603(18)31301-7Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to predict alcohol inebriation and mental health (internalizing and externalizing problems plus well-being), and potential gender-specific patterns among young adolescents, by a biopsychosocial model of personality traits. Self-reported data from 853 adolescents (479 girls) in Sweden, aged 13-15 years, from the Longitudinal Research on Development In Adolescence (LoRDIA) program were used. Predictions from personality to inebriation and mediating effects of mental health were estimated by means of logistic regression and generalized structural equation modelling. Separated gender analyses were performed throughout the study to reveal potential gender-specific patterns. Externalizing problems, Novelty Seeking and Cooperativeness had independent effects on alcohol inebriation for both genders as well as Harm Avoidance among girls and Internalizing problems among boys. Novelty Seeking and Self-Directedness had indirect effects through externalizing problems and Harm Avoidance and Self-Directedness had indirect effects through internalizing problems for boys. Self-directedness showed an indirect effect through externalizing problems for girls. The combination of an immature character (low Self-directedness and Cooperativeness) with an extreme temperament profile (high Novelty Seeking and low Harm Avoidance) was a predictor of inebriation across gender, both directly and indirectly through mental health. This study contributes with valuable information about gender-specific considerations when developing and conducting preventative interventions targeting psychological risk and resilience factors for early alcohol inebriation among young adolescents.

  • 13.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Alm, Susanne
    Stockholm University, Faculty of Social Sciences, The Swedish Institute for Social Research (SOFI).
    Olsson, Gabriella
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden .
    Future orientation, gambling and risk gambling among youth: a study of adolescents in Stockholm2020In: International Journal of Adolescence and Youth, ISSN 0267-3843, E-ISSN 2164-4527, Vol. 25, no 1, p. 52-62Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to analyze the association between adolescents’ future orientation and their engagement in gambling and in risk gambling, respectively. The data used come from the Stockholm School Survey, collected in 2016 among students in the ninth grade in elementary school (15–16 years) and in the second grade of upper secondary school (17–18 years) in Stockholm municipality (n = 11,661). The results showed that adolescents who expected their future to be ‘much worse’ than that of others were more inclined to engage in gambling and in risk gambling compared with adolescents who expected their future to be similar to that of others. Furthermore, adolescents who expected their future to be ‘much better’ than that of others had an increased likelihood of engaging in gambling but not in risk gambling. The results are discussed in the light of elements from rational choice theory.

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  • 14.
    Brolin Låftman, Sara
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Modin, Bitte
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Olsson, Gabriella
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Svensson, Johan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    School ethos and adolescent gambling: a multilevel study of upper secondary schools in Stockholm, Sweden2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 130Article in journal (Refereed)
    Abstract [en]

    Background: Gambling is not uncommon among adolescents, and a non-trivial minority has serious problems with gambling. Therefore, enhanced knowledge about factors that may prevent against problematic gambling among youth is needed. Prior research has shown that a strong school ethos, which can be defined as a set of attitudes and values pervading at a school, is associated with a lower inclination among students to engage in various risk behaviours. Knowledge about the link between school ethos and adolescent gambling is however scarce. The aim of the study was to investigate the association between teacher-rated school ethos and student-reported gambling and risk gambling, when controlling also for sociodemographic characteristics at the student- and the school-level.

    Methods: Data from two separate cross-sectional surveys were combined. The Stockholm School Survey (SSS) was performed among 5123 students (aged 17–18years) in 46 upper secondary schools, and the Stockholm Teacher Survey (STS) was carried out among 1061 teachers in the same schools. School ethos was measured by an index based on teachers’ ratings of 12 items in the STS. Adolescent gambling and risk gambling were based on a set of single items in the SSS. Sociodemographic characteristics at the student-level were measured by student-reported information from the SSS. Information on sociodemographic characteristics at the school-level was retrieved from administrative registers. The statistical method was multilevel regression analysis. Two-level binary logistic regression models were performed.

    Results: The analyses showed that higher teacher ratings of the school’s ethos were associated with a lower likelihood of gambling and risk gambling among students, when adjusting also for student- and school-level sociodemographic characteristics.

    Conclusions: This study showed that school ethos was inversely associated with students’ inclination to engage in gambling and in risk gambling. In more general terms, the study provides evidence that schools’ values and norms as reflected by the teachers’ ratings of their school’s ethos have the potential to counteract unwanted behaviours among the students.

  • 15. Bronner, Kerstin Birgitta Thelin
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kallmen, Hakan
    Schult, Marie-Louise Birgitta
    Alcohol habits in patients with long term musculoskeletal pain: comparison with a matched control group from the general population2012In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 35, no 2, p. 130-137Article in journal (Refereed)
    Abstract [en]

    This prospective study aimed to describe alcohol habits in patients with chronic pain compared with those in a matched control group from the general Swedish population. In total, 100 consecutive patients enrolled were matched against 100 individuals in a control group on the basis of age and sex. Alcohol habits were measured using the Alcohol Use Disorders Identification Test in both groups. The patients were recruited if they underwent a biopsychosocial pain analysis for possible participation in pain rehabilitation. The patients with chronic pain drank alcohol significantly less, less often, in smaller quantities, and became intoxicated less than the control group did. The study was rather small and at a single site, but its strengths were the comprehensive and simple design and the possibility to describe the sample's representativeness compared with other clinics on the basis of data from a national quality register.

  • 16. Dahlberg, Mikael
    et al.
    Anderberg, Mats
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Psychometric properties of the UngDOK: A structured interview for adolescents with substance-use problems2017In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, Vol. 34, no 2, p. 160-172Article in journal (Refereed)
    Abstract [en]

    Aim: This article describes and discusses the Swedish UngDOK interview and its psychometric properties. Method: The study is based on empirical data from 1633 intake interviews collected by 15 units in ten cities and focused primarily on the two central sections of intake form: alcohol and drug use and mental health. The statistical analyses concern internal consistency, test-retest reliability, discriminant validity and internal non-response. Results: The reliability of AUDIT-C and the mental health domain was good with regard to both internal consistency and test-retest. The test-retest values were generally satisfactory, except for frequency of drug use and association with peers who use drugs. The discriminant validity shows that the interview clearly distinguishes adolescents with more profound problems from a group with milder problems and that a minor degree of inconsistency and non-response bias may occur in empirical material based upon self-reported information. Conclusion: The study showed that the psychometric properties of the UngDOK interview are generally satisfactory and may be regarded as a valuable option for practices engaged in treating adolescents with substance-use problems.

  • 17. Dahlberg, Mikael
    et al.
    Boson, Karin
    Anderberg, Mats
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Long-Term Outcomes for Young People With Substance Use Problems in Outpatient Treatment: Gender-Specific Patterns2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 888197Article in journal (Refereed)
    Abstract [en]

    This study presents the results of a longitudinal research project focusing on long-term outcomes among young people after initiation of outpatient treatment for substance use problems (SUP) in Sweden. Young people are defined with the age group 13–25 years. A clinical sample of 451 young people (29% girls, median age 17 years) completed a structured interview at baseline and was followed using official records one, two, and 3 years after initiation of treatment. Gender-specific patterns at intake were described and bivariate associations and logistic regressions were calculated to analyse the links between risk factors at treatment start and indications of substance use problems 3 years later. Significantly more boys than girls displayed indications of continued SUP at 3-year follow-up. More specifically, 49% of the boys vs. 35% of the girls were identified through records as still having problems with substance use. Predictive risk factors also displayed gender-specific patterns. Primary drug use frequency and age at intake predicted indications of SUP among boys but not among girls. Placement in foster care/residential homes, depression, and early drug debut had significant predictive value regarding indications of SUP among females but not among males. Girls also displayed a greater psychosocial burden at treatment start, but a more favorable treatment outcome at follow-up. Youths with a heavy risk load at treatment start (i.e., over six risk factors) did not display a greater risk of SUP at 3-year follow-up, although our results suggest that this subgroup has indications of continued problems with mental health. Consequently, future studies should further explore gender-specific treatment pathways for young people with substance use problems. Since women and girls seem to have different risk factors, co-occurring psychiatric problems and more experiences of trauma compared to men, they might need multidimensional and more comprehensive treatment interventions that run over a longer period of time.

  • 18. Danielsson, Anna-Karin
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska institutet, Sweden; Stockholm County Council, Sweden.
    Hibell, Björn
    Romelsjö, Anders
    Alcohol use, heavy episodic drinking and subsequent problems among adolescents in 23 European countries: does the prevention paradox apply?2012In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 107, no 1, p. 71-80Article in journal (Refereed)
    Abstract [en]

    Aims  According to the prevention paradox, a majority of alcohol-related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems among adolescents in 23 European countries.

    Design and setting  Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16-year-old students were analysed.

    Participants  A total of 38 370 alcohol-consuming adolescents (19 936 boys and 18 434 girls) from 23 European countries were included.

    Measurements  The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol-related problems.

    Findings  Although the mean levels of consumption and alcohol-related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol-related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems.

    Conclusions  The prevention paradox, based on measures of annual consumption and heavy episodic drinking, seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large proportion of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives combined with targeted interventions.

  • 19. Danielsson, Anna-Karin
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Tengström, Anders
    Romelsjö, Anders
    Adolescent alcohol use trajectories: Predictors and subsequent problems.2010In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 35, no 9, p. 848-852Article in journal (Refereed)
    Abstract [en]

    This study aimed at identifying different alcohol drinking trajectories in early to late adolescence. We also examined whether certain factors predicted membership of a specific trajectory and to what extent trajectory membership was linked to later negative consequences. Data were drawn from a longitudinal cohort study starting with 1923 adolescents including all seventh grade students in six school districts in Stockholm, Sweden 2001 (age 14), with follow-up in 2002, 2003, and 2006 (age 19). Cluster- and multinomial logistic regression analyses revealed four developmental pathways: low, gradually increasing, high, and suddenly increasing consumption. “High consumers” and “sudden increasers” reported higher levels of alcohol consumption, heavy episodic drinking, and alcohol-related problems both at age 14–16 and at age 19. The “gradual increasers” were more likely to smoke cigarettes, have easy access to alcohol, visit youth recreation centres, have friends who drink, and report a poorer health, compared to the “low consumer/abstainer group”. “High consumers” were more likely to have drinking peers than both “low consumers/abstainers” and “gradual increasers”.

     

  • 20.
    Elling, Devy L.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brännström Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Effects of a multi-component alcohol prevention program in the workplace on hazardous alcohol use among employees2023In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, article id 1420Article in journal (Refereed)
    Abstract [en]

    Background: The workplace can be affected negatively by hazardous alcohol use, and intervening at an early stage remains a challenge. Recently, a multi-component alcohol prevention program, Alcohol Policy and Managers’ skills Training (hereafter, ‘APMaT’), was delivered at the organizational level. In a previous outcome evaluation, APMaT appeared to be effective at the managerial level. The current study takes a step further by aiming to evaluate the effectiveness of APMaT in decreasing the alcohol risk level among employees.

    Methods: Data from 853 employees (control: n = 586; intervention: n = 267) were gathered through a cluster-randomized study. To analyze changes in the odds of hazardous alcohol use among employees, multilevel logistic regression was applied using group (control vs. intervention), time (baseline vs. 12-month follow-up), and the multiplicative interaction term (group × time) as the main predictors. The intervention effect was further adjusted for sociodemographic characteristics and policy awareness.

    Results: No statistically significant difference was observed in the odds of hazardous alcohol use, although employees in the intervention group showed a larger decrease compared to the control group. This remained even after adjusting for several factors, including the sociodemographic factors and policy awareness.

    Conclusions: The findings are insufficient to determine the effectiveness of APMaT at the employee level at the current stage of the evaluation. Future studies should strive to identify issues with implementation processes in workplace-based alcohol interventions.

  • 21.
    Elling, Devy L.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brännström Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet.
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Effects of a multi-component alcohol prevention programme in the workplace on hazardous alcohol use among employeesManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The workplace can be affected negatively by hazardous alcohol use, and intervening at an early stage remains a challenge. Recently, a multi-component alcohol prevention program, Alcohol Policy and Managers’ skills Training (hereafter, ‘APMaT’), was delivered at the organizational level. In a previous outcome evaluation, APMaT appeared to be effective at the managerial level. The current study takes a step further by aiming to evaluate the effectiveness of APMaT in decreasing the alcohol risk level among employees.

    Methods: Data from 853 employees (control: n = 586; intervention: n = 267) were gathered through a cluster-randomized study. To analyze changes in the odds of hazardous alcohol use among employees, multilevel logistic regression was applied using group (control vs intervention), time (baseline vs 12-month follow-up), and the multiplicative interaction term (group × time) as the main predictors. The intervention effect was further adjusted for sociodemographic characteristics and policy awareness.

    Results: Employees in the intervention group showed a larger decrease in the odds of hazardous alcohol use compared to the control group. However, this difference was not statistically significant, even after adjusting for several factors, including the sociodemographic factors and policy awareness.

    Conclusions: The findings are insufficient to determine the effectiveness of APMaT at the employee level at the current stage of the evaluation. Future studies should strive to identify issues with implementation processes in workplace-based alcohol interventions. 

    Trial registration: ISCRTN: ISRCTN17250048.

  • 22.
    Elling, Devy L.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brännström Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sverige.
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Evaluation of a workplace alcohol prevention program targeted on managers’ inclination to initiate early alcohol interventions2022In: Work: A journal of Prevention, Assessment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 73, no 2, p. 517-526Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol interventions targeting the adult population are often conducted in healthcare settings, while preventive interventions often target adolescents or young adults. The general working population is often overlooked. A workplace-based intervention, consisting of development and implementation of an organizational alcohol policy, and skills development training for managers (APMaT) was carried out in order to prevent and reduce alcohol-related harms by identifying hazardous consumers at an early stage. 

    Objective: This study aims to evaluate APMaT by focusing on managers’ inclination to initiate early alcohol intervention.

    Methods: In a cluster randomized design, data were obtained from 187 managers (control: n = 70; intervention: n = 117). Inclination to initiate early alcohol intervention was measured using three items on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Changes in managers’ inclination to intervene were analyzed by applying multilevel ordered logistic regression. Predictors included in the model were group (control vs. intervention), time (baseline vs. 12-month follow-up), and the multiplicative interaction term (group × time).

    Results: Significant increase in inclination to intervene against hazardous alcohol consumption among managers in the intervention group compared to managers in the control group was observed. Specifically, a 50% increase of confidence to initiate an intervention was observed among managers in the intervention group.

    Conclusions: APMaT seems effective to increase managers’ inclination to intervene early against hazardous consumption in the workplace. The effectiveness of APMaT at the employee level should be explored in prospective studies.

  • 23.
    Elling, Devy L.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    B. Almquist, Ylva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Workplace alcohol prevention: are managers' individual characteristics associated with organisational alcohol policy knowledge and inclination to initiate early alcohol interventions?2020In: International Journal of Workplace Health Management, ISSN 1753-8351, E-ISSN 1753-836X, Vol. 13, no 5, p. 543-560Article in journal (Refereed)
    Abstract [en]

    Purpose - Individual factors associated with managers' organisational alcohol policy knowledge and inclination to initiate early alcohol interventions have been understudied. This study aims to examine differences in managers' policy knowledge and inclination across a range of socio-demographic, work-related and health characteristics, and it aims to examine the association between policy knowledge and inclination to intervene, net of these characteristics.

    Design/methodology/approach - Questionnaire data were collected from 430 managers. Organisational alcohol policy knowledge and inclination to intervene were measured using a 5-point Likert scale ranging from 1 (very low) to 5 (very high). Socio-demographic, work-related and health characteristics included gender, age, education, managerial responsibility, years in current position, self-rated health and alcohol consumption. Associations were examined using multilevel ordinal regression analysis.

    Findings - Managers with a greater number of employees demonstrated the highest level of organisational alcohol policy knowledge and were more inclined to initiate early alcohol interventions. Alcohol policy knowledge was associated with inclination to intervene, net of individual characteristics.

    Practical implications - Considering how managers' characteristics might influence efforts to decrease hazardous alcohol consumption is potentially important when designing future workplace alcohol prevention programmes.

    Originality/value - Several individual factors related to managers' organisational alcohol policy knowledge and inclination to initiate early alcohol interventions were identified, particularly managerial responsibility. However, the association between policy knowledge and inclination to intervene remained strong after accounting for these individual factors. Future studies should explore alternative explanations at the individual and organisational levels.

  • 24.
    Elling, Devy Lysandra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wilson, Martina
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Effectiveness of Combining Organizational Alcohol Policy and Skills Training for Managers to Reduce Hazardous Alcohol Consumption in Swedish Workplaces: Study Protocol for a Cluster Randomized Study2020In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 9, no 8, article id e17145Article in journal (Refereed)
    Abstract [en]

    Background: High alcohol consumption poses risks to individual health and society. Previous alcohol interventions have mainly focused on high-risk consumers or young adults in school-based settings. Since the majority of the adult population is in the workforce, the workplace can be considered a favorable arena for implementing interventions.

    Objective: This protocol describes a project aimed at increasing knowledge of the effectiveness of combining the implementation of an organizational alcohol policy with skills training for managers as a workplace alcohol prevention program, by evaluating the intervention and exploring managers’ perceptions of the intervention.

    Methods: Organizations with at least 100 employees were invited to take part in the project. A total of 11 organizations (744 managers and 11,761 employees) were included in the project. Data are collected through self-administered online surveys at baseline, 12 months, and 24 months. The primary outcome is managers’ inclination to initiate an early alcohol intervention (eg, by initiating a dialogue) when concern regarding employees’ hazardous alcohol consumption arises. The secondary outcomes of interest are managers’ and employees’ organizational alcohol policy knowledge and changes in alcohol consumption, as measured using the Alcohol Use Disorder Identification Test (AUDIT) score. A linear mixed-model framework will be used to model variability on different levels. Primary analysis will follow an intention-to-treat approach. Additionally, managers’ responses from semistructured interviews will be analyzed using thematic analysis to explore managers’ experiences regarding the prevention program.

    Results: This study is ongoing. The overall study start was on January 2018, and the study is planned to end in December 2020. Baseline and 12-month follow-up measurements have been collected.

    Conclusions: This project is designed to evaluate the effectiveness of an alcohol prevention program regarding higher inclination to initiate early alcohol interventions after policy implementation and skills training among managers, compared to the usual practices in the workplace. The results from this study can contribute to increased knowledge about alcohol interventions and future prevention programs in the workplace.

    Trial Registration: ISRCTN17250048; http://www.isrctn.com/ISRCTN17250048

    International Registered Report Identifier (IRRID): DERR1-10.2196/17145

  • 25. Frankl, My
    et al.
    Philips, Björn
    Berggraf, Lene
    Ulvenes, Pål
    Johansson, Robert
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Psychometric properties of the Affect Phobia Test2016In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 57, no 5, p. 482-488Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to make the first evaluation of the psychometric properties of the Affect Phobia Test, using the Swedish translation - a test developed to screen the ability to experience, express and regulate emotions. Data was collected from a clinical sample (N=82) of patients with depression and/or anxiety participating in randomized controlled trial of Internet-based affect-focused treatment, and a university student sample (N=197). The internal consistency for the total score was satisfactory (Clinical sample =0.88/Student sample =0.84) as well as for all the affective domains, except Anger/Assertion (=0.44/0.36), Sadness/Grief (=0.24/0.46) and Attachment/Closeness (=0.67/0.69). Test retest reliability was satisfactory (ICC>0.77) for the total score and for all the affective domains except for Sadness/Grief (ICC=0.04). The exploratory factor analysis resulted in a six-factor solution and did only moderately match the test's original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. As expected, the Affect Phobia test showed negative significant correlations in the clinical group with measures on depression (r(xy)=-0.229; p<0.01) and anxiety (r(xy)=-0.315; p<0.05). The conclusion is that the psychometric properties are satisfactory for the total score of the Affect Phobia Test but not for some of the test's affective domains. Consequently the domains should not be used as subscales. The test can discriminate between individuals who seek help for psychological problems and those who do not.

  • 26. Frankl, My
    et al.
    Philips, Björn
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Psychotherapy role expectations and experiences Discrepancy and therapeutic alliance among patients with substance use disorders2014In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 87, no 4, p. 411-424Article in journal (Refereed)
    Abstract [en]

    ObjectivesThe main aim of the study was to examine how the discrepancy between role expectations prior to psychotherapy and experiences of ongoing psychotherapy related to therapeutic alliance. We hypothesized that a similarity between patient role expectations and experiences would be associated with a stronger alliance. The study also examined whether different dimensions of psychotherapy role expectations predicted retention in psychotherapy. DesignA naturalistic study design was used with data collected prior to therapy and during the first 6months of therapy. MethodPatients with substance use disorders completed the Psychotherapy Expectation Questionnaire-short version (PEX-S) at the time of therapy assessment. A subsample of these patients (n=41; n=24 in individual therapy and n=17 in group therapy) provided data from therapy including psychotherapy experiences (also measured with PEX-S) and therapeutic alliance, measured with Working Alliance Questionnaire-short version. ResultsFor patients in group therapy, discrepancy between role expectations and experiences correlated negatively with alliance. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention. ConclusionThe finding that disconfirmation of patients' role expectations in group therapy were associated with weaker therapeutic alliance highlights the importance of discussing psychotherapy expectations at an early stage in treatment. Expectations characterized by defensiveness predicted worse retention in psychotherapy, which indicates that the PEX-S can be helpful in detecting patients at risk for dropout. Practitioner points <list list-type=bulleted> In targeting a patient's role expectancies prior to treatment, possible discrepancies between patient and therapist are made visible and possible to examine. Clarifying the patient's role expectations and the therapist's rationale might be a first step towards establishing a strong working alliance. Surveying the patient's defensiveness tendencies at the beginning of therapy offers a chance to discuss possible fears and other obstacles concerning therapy. Discrepancy between the patient's role expectations prior to treatment and their actual experiences of psychotherapy render valuable information that can be of use in the therapy process. <doi origin=wiley registered=yes>10.1111/(ISSN)2044-8341</doi

  • 27. Frankl, My
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden .
    Berggraf, Lene
    Philips, Björn
    Affect Phobia Therapy for Mild to Moderate Alcohol Use Disorder: The Cases of "Carey," "Michelle," and "Mary"2019In: Pragmatic Case Studies in Psychotherapy, E-ISSN 1553-0124, Vol. 15, no 3, p. 214-257, article id 1Article in journal (Refereed)
    Abstract [en]

    Affect Phobia Treatment (APT) is based on an integrative theory involving the use of psychodynamic principles for understanding a client’s psychological dynamics, experiential principles for engaging and working with the client’s affect, and behavioral principles of exposure and response prevention for desensitizing the client to the fear of affect. APT’s goal is "to help patients function better by resolving emotional conflict through reducing their avoidance of adaptive, activating emotions" (Osborn et al., 2014). APT has not yet been systematically employed and researched for patients with mild to moderate Alcohol Use Disorder (AUD) together with affect phobia. The present study was designed to begin this process by describing and comparing, both qualitatively and quantitatively, three illustrative, distinctive cases of APT in patients with AUD, assigned the names of "Carey," "Michelle," and "Mary." The focus was on exploring the process by which the different individual patients responded to the multifaceted APT therapy, and hence how the therapist had to adapt the therapy to each particular patient, as outlined in Stiles’ (2009) concept of "appropriate responsiveness."  Following the manual for APT, therapy included 10 weekly sessions of individual psychotherapy. This short length for a therapy like APT, a treatment which usually has no determined session length (McCullough et al., 2003), was designed to make the therapy comparable in length to other therapies for AUD, like Motivational Interviewing. During the whole study period, patients gave weekly reports of their alcohol consumption and craving. In addition, at the beginning and at the end of the study, the patients answered questionnaires measuring affect phobia and psychiatric symptoms. Role expectations and experiences of psychotherapy were also measured. All three patients completed the treatment and the measurement period. No adverse events were reported. The patients had different trajectories of change regarding alcohol consumption, craving, and symptom change. The study showed that 10-session APT was a tolerable treatment for the patients with on-going mild-to-moderate alcohol dependence, who primarily used alcohol as a way of avoiding emotions, but that the therapy worked to different degrees and in different ways for the three patients due to their different presenting patterns of psychiatric symptoms and personality characteristics. Experience in the three cases suggests the advisability of (a) flexible treatment length in accordance to a patient's needs, and (b) complementary treatment strategies beyond APT focusing on reducing alcohol consumption per se for some patients.

  • 28.
    Gustafsson, Nina-Katri
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Developmental alcohol trajectories when price and availability changed2017Report (Other academic)
    Abstract [en]

    Purpose: To identify developmental trajectories for alcohol consumption in southern Sweden in relation to increased availability of cheaper alcohol, and to study the likelihood of belonging to one of the identified trajectory groups. An increase of total consumption was expected to be related to an increase in consumption of spirits due to the nature of the changes. Developmental patterns were assumed to be different in northern Sweden given the distance to the changes.

    Design: 16-80 year olds from general population samples from southern (n=610) and northern (n=575) Sweden were interviewed by telephone before and after changes. Alcohol use trajectories for the years 2003-2006 were identified through longitudinal cluster analysis. Characteristics of clusters – sex, age, income, price expectations, alcohol attitude, alcohol consumption, binge drinking and beverage preferences – were compared.

    Findings: Three developmental trajectories for consumption were identified for each region. Alcohol habits influenced the likelihood of trajectory membership as decreasers on average had a higher initial consumption. An increase in spirits consumption was also observed among overall increasers. Other potential explanations were not linked to trajectories.

    Research implications: Earlier research of the changes was unable to find an overall increase in consumption but these results suggests that some groups changed as expected.

    Originality: Few studies have identified trajectories of alcohol use in relation to policy changes. Studying patterns of change puts the focus on consumption rather than population groups.

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  • 29. Hildebrand Karlén, Malin
    et al.
    Stålheim, Jonas
    Berglund, Kristina
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Autistic Personality Traits and Treatment Outcome for Alcohol Use Disorders2021In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 209, no 9, p. 665-673Article in journal (Refereed)
    Abstract [en]

    The importance of personality traits for the outcome of psychiatric treatment, including treatment for alcohol use disorder (AUD), has been widely acknowledged. Also, research on autism spectrum disorders has evolved in recent years, emphasizing that the behavioral traits within these neuropsychiatric disorders exist on a dimension both within and outside the boundaries of psychopathology. In the present study, the relationship between personality traits associated with autistic functioning and level of alcohol use among patients before and after concluded AUD treatment was investigated. The participants (n = 165, diagnosed with AUD) were part of a longitudinal project on AUD treatment. Data from personality questionnaires (Structured Clinical Interview of Personality Disorders II and Temperament and Character Inventory) were used to assess autistic personality traits (APTs) based on behavior within Wing's triad, which were related to background and treatment outcome. The chosen APT items illustrated a personality functioning with an emphasis on social interaction and rigidity. Only certain included questions were indicative of still having a problematic drinking pattern 2.5 years after treatment entry, which adhered to phobic, obsessive-compulsive, and schizoid personality traits, as well as rigidity/stubbornness. Albeit with modest influence, the degree of APTs was associated with heavier drinking at treatment entry, and symptoms relating to social interaction and rigidity were associated with still having a problematic drinking pattern 2.5 years after treatment entry. A higher degree of such traits may result in having problems taking advice from others and establishing treatment alliance, important parts of treatment efficacy, making assessment of such traits relevant to clinicians.

  • 30. Kallmen, Hakan
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Leifman, Hakan
    Bergman, Hans
    Berman, Anne H.
    Alcohol Habits in Sweden during 1997-2009 with Particular Focus on 2005 and 2009, Assessed with the AUDIT: A Repeated Cross-Sectional Study2011In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 17, no 2, p. 90-96Article in journal (Refereed)
    Abstract [en]

    Aim: This study aimed to survey the changes in alcohol habits during a period with the European Union legal practices. Methods: Alcohol habits in Sweden were surveyed in the general Swedish population at four timepoints, in 1997, 2001, 2005 and 2009, using the 10-item AUDIT questionnaire. Design: Four separate randomly drawn cross-sectional samples of 1,250 individuals were surveyed at each timepoint. Results: An average of 70% of the sampled individuals responded to the AUDIT questionnaire. Men had higher total AUDIT scores than women in 2005 and 2009, but scores increased among women 61-71 years old and decreased among men 61-71 years old. Younger men and women 17-27 years old decreased their AUDIT-C consumption scores by almost 20% between 2005 and 2009. An analysis of problem drinkers (+8 for men/+6 for women) indicated that a larger proportion of elderly women drank moderately in 2009 compared with 2005, but fewer elderly women drank hazardously. Conclusions: Earlier increases in drinking levels between 1997 and 2001 may reflect a latent high demand that was restricted by low availability. When availability due to European Union harmonization increased, alcohol consumption followed suit. After a period of adaptation, alcohol consumption appears to have stabilized.

  • 31.
    Kaltenegger, Helena C.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Brolin Låftman, Sara
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Health Equity Studies (CHESS).
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Impulsivity, risk gambling, and heavy episodic drinking among adolescents: A moderator analysis of psychological health2019In: Addictive Behaviors Reports, ISSN 2352-8532, Vol. 10, article id 100211Article in journal (Refereed)
    Abstract [en]

    Introduction

    Adolescence is associated with an increased inclination for risk behaviors, like gambling and heavy episodic drinking (HED). While impulsivity is a well-documented risk factor, the purpose of this study is to explore if there are variables modulating this association. The study examined the effects of impulsivity and psychological health on risk gambling and HED, and whether psychological health functions as a moderator, i.e., protective factor.

    Methods

    Data was extracted from the Stockholm School Survey, collected in 2014 and 2016 among students in the ninth grade of primary school (15–16 years) and second grade of upper secondary school (17–18 years) in Stockholm (n = 21,886). Impulsivity, psychological problems, risk gambling, HED, and a number of sociodemographic control variables were measured using self-report data. The statistical method was binary logistic regression.

    Results

    Results showed that risk gambling (3.4%) and HED (22.8%) were prevalent among Swedish pupils. Impulsivity and—to a weaker extent—psychological problems as well as several sociodemographic variables were risk factors for risk gambling and HED. Furthermore, psychological problems negatively moderated the association between impulsivity and HED among girls.

    Conclusions

    This study supports evidence that impulsivity represents a risk factor for risk behaviors, and—contrary to the a priori hypothesis—indicates that the association between impulsivity and HED in female students might be attenuated by the presence of psychological problems. Prevention measures should particularly address adolescents exhibiting the mentioned risk factors and aim at reducing psychological problems, but not necessarily target the adolescents showing impulsivity and psychological problems simultaneously.

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  • 32.
    Kaltenegger, Helena C.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. LMU University Hospital Munich, Germany.
    Doering, Sabrina
    Gillberg, Christopher
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Lundström, Sebastian
    Low prevalence of risk drinking in adolescents and young adults with autism spectrum problems2021In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 113, article id 106671Article in journal (Refereed)
    Abstract [en]

    Individuals with Autism Spectrum Disorder (ASD) have high rates of comorbidity. Research on concurrent substance use (disorder) in ASD, however, is scarce and findings have been inconsistent. This study aims at assessing the prevalence of risk drinking in adolescent and young adult twins with and without autism spectrum problems. Data from a Swedish longitudinal nationwide twin study were analyzed. Across three age groups of 15- (N = 10,050), 18- (N = 7,931) and 24-year-olds (N = 2,882) prevalence rates of risk drinking were compared between twins with and without an ASD proxy diagnosis and between different ASD subgroups based on comorbid proxies for attention-deficit/hyperactivity disorder (ADHD) and/or Learning Disorder (LD). ASD, ADHD, and LD were assessed using the Autism-Tics, ADHD, and other Comorbidities inventory (A-TAC), and risk drinking was captured by the Alcohol Use Disorders Identification Test (AUDIT; age 18 and 24) and another set of self-report questions (age 15). In each age group, the prevalence of risk drinking in ASD was lower than in individuals without ASD, yet increasing continuously with age. Exploratory subgroup ASD analyses showed a trend towards risk drinking being more common among individuals with co-existing ADHD or LD problems than among those without comorbidity, although sample sizes were too small to draw any certain conclusions. This study indicates low prevalence of risk drinking in adolescents and young adults with autism spectrum problems and highlights the need for further research on alcohol use in individuals with ASD and comorbid disorders.

  • 33.
    Kaltenegger, Helena C.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University Hospital, LMU Munich, Germany.
    Philips, Björn
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Autistic traits in mentalization-based treatment for concurrent borderline personality disorder and substance use disorder: Secondary analyses of a randomized controlled feasibility study2020In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 61, no 3, p. 416-422Article in journal (Refereed)
    Abstract [en]

    Autism is suggested to be a dimensional construct and often represents a comorbid state. However, research on the clinical implications of the presence of autistic traits is scarce. This study aimed to investigate the impact of subclinical autistic traits in mentalization-based treatment (MBT) for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Based on the data of a randomized controlled feasibility study by Philips, Wennberg, Konradsson, and Franck (2018), secondary analyses were conducted. It was tested, if patients' (N = 46) levels of autistic traits were associated with treatment outcome measured in the course of and after treatment using interviews and self-report measures. Participants' autistic traits were not associated with the change in the severity of BPD throughout and at the end of the treatment. However, results showed associations between autistic traits and the change in patients' consumption of alcohol in the course of MBT. Furthermore, there was an association between autistic traits and the change in mentalizing capacity at the end of MBT, indicating that elevated autistic traits were associated with an improvement in mentalizing capacity. Autistic traits on a subclinical level do not appear to be a complicating factor in MBT for concurrent BPD and SUD. On the contrary, in terms of mentalizing capacity autistic traits might be associated with a larger potential for improvement or facilitate treatment outcome. Further research is needed to explore the role of higher autistic traits in treatment of this special patient group.

  • 34. Kjällmén, Håkan
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Sohlberg, Tove
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Larsson, Matz
    Effects of a School Tobacco Policy on Student Smoking and Snus Use2020In: Health behavior and policy review, ISSN 2326-4403, Vol. 7, no 4, p. 358-365Article in journal (Refereed)
    Abstract [en]

    Objective: A school tobacco policy (STP) commonly is used to reduce smoking among adolescents, but the effectiveness of such programs is unclear. We evaluated the impact of an STP on tobacco use in 4 schools.

    Methods: The study included 4 intervention and 4 control schools, located in the inner city of Stockholm, Sweden. Schools self-selected for assignment to either an intervention program or a comparison group. In total, the study was comprised of 2671 students in grades 9 and 11, ages 15 to 18, and 1998 students (75%) responded to the questionnaire. We used a repeated cross-sectional design with assessment of tobacco use prevalence before implementation of the STP in 2016 and after 2 years under the program, in 2018.

    Results: Two years after the STP, the intervention school in grade 9 showed a lower prevalence (13.5% vs 1.6%) in the proportion of students who reported smoking (χ2 = 4.54; p < .05) whereas the proportion reporting snus use was practically unchanged. We found no statistically significant impact of the STP for grade 11.

    Conclusions: The results are promising with regard to smoking, when the STP is implemented in early adolescence.

  • 35. Källmen, Håkan
    et al.
    Sinadinovic, Kristina
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Berman, Anne
    Risky drinking of alcohol in Sweden: a randomized population survey comparing web- and  paper-based self-report2011In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, Vol. 28, no 2, p. 123-130Article in journal (Refereed)
    Abstract [en]

    AIMS – This study compared data quality and response rates for the Alcohol Use Disorders Identification Test (AUDIT) in a web-based versus in a paper-and-pencil format survey. SETTING – Subjects were randomised to one of two parallel samples, one web-based and the other paper-based. Data were collected during 2009. RESULTS – The web-based format yielded a lower response rate compared to the paper version (26.2% vs. 53.6%), internal consistency was quite similar (0.82 vs. 0.77), while the mean AUDIT scores were higher in the web-based format for both men and women. Conclusions – Future studies should focus on methods for combining different administration methods in order to maximize response rates.

  • 36. Källmen, Håkan
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Bergman, Hans
    Psychometric properties and norm data of the Swedish version of the NEO-PI-R2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 5, p. 311-314Article in journal (Refereed)
    Abstract [en]

    Background: Internationally, the NEO Personality Inventory-Revised (NEO-PI-R) is a well established questionnaire for assessment of personality in accordance with the Five Factor Model. The instrument has been translated into many languages including Swedish. Aim: The aim of this study was to make a psychometric evaluation of the Swedish version of NEO-PI-R based on a sample from the general population. Methods: Postal questionnaires were sent to a random sample of 1250 persons (n = 766 responders). Results and conclusions: The test showed satisfactory internal consistency in the broad factors as well as the facets. A factor analysis indicated that the factors were similar but not identical to those obtained in American studies. In sum, The Swedish version of the NEO-PI-R shows satisfactory psychometric properties and the instrument will continue to be a valuable tool in psychological research and in clinical practice.

  • 37. Källmén, Håkan
    et al.
    Berman, Anne H.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Elgán, Tobias H.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Alcohol habits in Sweden during 1997-2018: a repeated cross-sectional study2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 8, p. 522-526Article in journal (Refereed)
    Abstract [en]

    Aims: This study describes changes in alcohol habits in age and gender strata among the Swedish general population during the 21-year period following the Swedish EU membership in 1995.

    Methods: The Alcohol Use Disorders Identification Test (AUDIT) was distributed as a postal questionnaire to randomly selected cross-sectional samples every fourth year, starting in 1997.

    Results: Six samples were included in this study. A comparison between 2014 and 2018 showed a tendency to decreasing average total AUDIT scores, particularly among men and in the youngest age group (Cohen’s d = 0.28).

    Conclusion: The results should be understood in the context of declining response rates in this type of survey.

  • 38. Källmén, Håkan
    et al.
    Elgán, Tobias H.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Berman, Anne H.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden; Stockholm County Council, Sweden.
    Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) in relation to Alcohol Use Disorder (AUD) severity levels according to the brief DSM-5 AUD diagnostic assessment screener2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 7, p. 397-400Article in journal (Refereed)
    Abstract [en]

    Aims: The Alcohol Use Disorders Identification Test (AUDIT) is a well-established and widely used screening instrument. It has been shown that AUDIT has good criterion validity in relation to alcohol abuse and dependence according to DSM-IV, but it has not yet been validated following the introduction of the DSM-5 diagnostic system. The aim of this study was to evaluate concurrent validity for the AUDIT in relation to self-reported DSM-5 severity levels for Alcohol Use Disorder (AUD) in a Swedish general population sample.

    Methods: A postal questionnaire, containing the AUDIT and the 13-item brief DSM-5 AUD diagnostic assessment screener, was sent to a random sample of 1,500 persons drawn from the Swedish population, aged between 17 and 80 years and having a public residence address in Sweden. To evaluate the concurrent validity of AUDIT in relation to DSM-5 severity criteria for AUD, a Receiver Operating Characteristics (ROC) curve analysis was conducted.

    Results: Area under the curve (AUROC) showed excellent differentiation between AUD or not, mild (.93), moderate (.92) and severe (.99). Higher individual AUDIT scores were associated with more severe levels of AUD according to the DSM-5 screener. The optimal cutoff scores approximate earlier research on the DSM-IV and were identified as 5, 7 and 13 points, respectively, for mild, moderate and severe AUD.

    Conclusions: Our findings indicate that AUDIT is a valid screener for detecting concurrent AUD at three severity levels in the Swedish general population.

  • 39. Källmén, Håkan
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Ramstedt, M.
    Hallgren, M.
    Changes in alcohol consumption between 2009 and 2014 assessed with the AUDIT2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 4, p. 381-384Article in journal (Refereed)
    Abstract [en]

    Background: Alcohol habits in Sweden, assessed as sales and estimates of unrecorded consumption, have changed since joining the EU. Earlier studies using the Alcohol Use Disorders Identification Test (AUDIT) showed that reported consumption is consistent with sales data, which makes it possible to assess consumption according to sex and age. Aims: This study reports the changes in alcohol habits between 2009 and 2014, a period starting a couple of years after Sweden joined the EU. Method: The AUDIT was sent to a random sample of the Swedish population aged between 17 and 80 years old. Results: No statistically significant changes were shown in six age and sex groups. Conclusions: Alcohol habits have stabilised in Sweden but on a higher consumption level than before.

  • 40. Källmén, Håkan
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Ramstedt, Mats
    Hallgren, Mats
    The psychometric properties of the AUDIT: a survey from a random sample of elderly Swedish adults2014In: BMC Public Health, E-ISSN 1471-2458, Vol. 14, p. 672-Article in journal (Refereed)
    Abstract [en]

    Background: Increasing alcohol consumption and related harms have been reported among the elderly population of Europe. Consequently, it is important to monitor patterns of alcohol use, and to use a valid and reliable tool when screening for risky consumption in this age group. The aim was to evaluate the internal consistency reliability and construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in elderly Swedish adults, and to compare the results with the general Swedish population. Another aim was to calculate the level of alcohol consumption (AUDIT-C) to be used for comparison in future studies. Methods: The questionnaire was sent to 1459 Swedish adults aged 79-80 years with a response rate of 73.3%. Internal consistency reliability, were assessed using Cronbach alpha, and confirmatory factor analysis assessed construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in elderly population as compared to a Swedish general population sample. Results: The results showed that AUDIT was more reliable and valid among the Swedish general population sample than among the elderly and that Item 1 and 4 in AUDIT was less reliable and valid among the elderly. Conclusions: While the AUDIT showed acceptable psychometric properties in the general population sample, it's performance was of less quality among the elderly respondents. Further psychometric assessments of the AUDIT in elderly populations are required before it is implemented more widely.

  • 41.
    Ledberg, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Estimating the size of hidden populations from register data2014In: BMC Medical Research Methodology, E-ISSN 1471-2288, Vol. 14, p. 58-Article in journal (Refereed)
    Abstract [en]

    Background: Prevalence estimates of drug use, or of its consequences, are considered important in many contexts and may have substantial influence over public policy. However, it is rarely possible to simply count the relevant individuals, in particular when the defining characteristics might be illegal, as in the drug use case. Consequently methods are needed to estimate the size of such partly 'hidden' populations, and many such methods have been developed and used within epidemiology including studies of alcohol and drug use. Here we introduce a method appropriate for estimating the size of human populations given a single source of data, for example entries in a health-care registry. Methods: The setup is the following: during a fixed time-period, e. g. a year, individuals belonging to the target population have a non-zero probability of being registered. Each individual might be registered multiple times and the time-points of the registrations are recorded. Assuming that the population is closed and that the probability of being registered at least once is constant, we derive a family of maximum likelihood (ML) estimators of total population size. We study the ML estimator using Monte Carlo simulations and delimit the range of cases where it is useful. In particular we investigate the effect of making the population heterogeneous with respect to probability of being registered. Results: The new estimator is asymptotically unbiased and we show that high precision estimates can be obtained for samples covering as little as 25% of the total population size. However, if the total population size is small (say in the order of 500) a larger fraction needs to be sampled to achieve reliable estimates. Further we show that the estimator give reliable estimates even when individuals differ in the probability of being registered. We also compare the ML estimator to an estimator known as Chao's estimator and show that the latter can have a substantial bias when applied to epidemiological data. Conclusions: The population size estimator suggested herein complements existing methods and is less sensitive to certain types of dependencies typical in epidemiological data.

  • 42. Molander, Olof
    et al.
    Månsson, Viktor
    Berman, Anne H.
    Grant, Jon E.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden; Inland Norway University of Applied Sciences, Norway.
    Assessing Gambling Disorder Using Semistructured Interviews or Self-Report? Evaluation of the Structured Clinical Interview for Gambling Disorder Among Swedish Gamblers2023In: Assessment (Odessa, Fla.), ISSN 1073-1911, E-ISSN 1552-3489, Vol. 30, no 8, p. 2387-2397Article in journal (Refereed)
    Abstract [en]

    The Structured Clinical Interview for Gambling Disorder (SCI-GD) has the potential to bridge a diagnostic clinical gap, but psychometric evaluations have been scarce, in particular in relation to self-reported diagnostic criteria. This study analyzed existing data, including Swedish gamblers (N = 204) from treatment- and help-seeking contexts, self-help groups, and the general population, who were interviewed with the SCI-GD and completed self-report measures. The results indicated that fewer individuals fulfilled the diagnostic criteria for gambling disorder (GD) with the SCI-GD (n = 110, 54%), compared to a self-report Diagnostic and Statistical Manual of Mental Disorders:5th Edition (DSM-5) questionnaire on GD (n = 145, 71%; p < .001). Agreement between interviews and self-reported criteria was generally low (Fleiss kappa range: 0.31–0.52; r range: 0.35–0.55). A Rasch analysis showed that specific diagnostic criteria varied in difficulty, indicating a general pattern of higher item difficulty for the SCI-GD compared to self-reported DSM-5 criteria. Both the SCI-GD and the self-reported DSM-5 criteria performed well in terms of internal consistency, convergent, and discriminant validity. We conclude that the SCI-GD is a reliable and valid diagnostic tool to assess GD among individuals with various gambling behavior patterns. Further research-related and clinical implications are discussed. 

  • 43. Molander, Olof
    et al.
    Volberg, Rachel
    Månsson, Viktor
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden.
    Berman, Anne H.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden; Stockholm Region Health Services, Sweden; Uppsala University, Sweden.
    Development of the Gambling Disorder Identification Test: Results from an international Delphi and consensus process2021In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 30, no 2, article id e1865Article in journal (Refereed)
    Abstract [en]

    Objectives: Diverse instruments are used to measure problem gambling and Gambling Disorder intervention outcomes. The 2004 Banff consensus agreement proposed necessary features for reporting gambling treatment efficacy. To address the challenge of including these features in a single instrument, a process was initiated to develop the Gambling Disorder Identification Test (GDIT), as an instrument analogous to the Alcohol Use Disorders Identification Test and the Drug Use Disorders Identification Test.

    Methods: Gambling experts from 10 countries participated in an international two-round Delphi (n = 61; n = 30), rating 30 items proposed for inclusion in the GDIT. Gambling researchers and clinicians from several countries participated in three consensus meetings (n = 10; n = 4; n = 3). User feedback was obtained from individuals with experience of problem gambling (n = 12) and from treatment-seekers with Gambling Disorder (n = 8).

    Results: Ten items fulfilled Delphi consensus criteria for inclusion in the GDIT (M >= 7 on a scale of 1-9 in the second round). Item-related issues were addressed, and four more items were added to conform to the Banff agreement recommendations, yielding a final draft version of the GDIT with 14 items in three domains: gambling behavior, gambling symptoms and negative consequences.

    Conclusions: This study established preliminary construct and face validity for the GDIT.

  • 44. Molander, Olof
    et al.
    Volberg, Rachel
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden .
    Månsson, Viktor
    Berman, Anne H.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden; Stockholm County Council, Sweden; Stockholm Center for Dependency Disorders, Sweden.
    Development of the Gambling Disorder Identification Test (G-DIT): Protocol for a Delphi Method Study2019In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 8, no 1, article id e12006Article in journal (Refereed)
    Abstract [en]

    Background: Research on the identification and treatment of problem gambling has been characterized by a wide range of outcome measures and instruments. However, a single instrument measuring gambling behavior, severity, and specific deleterious effects is lacking. Objective: This protocol describes the development of the Gambling Disorder Identification Test (G-DIT), which is a 9-to 12-item multiple-choice scale with three domains: gambling consumption, symptom severity, and negative consequences. The scale is analogous to the widely used Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). Methods: The G-DIT is developed in four steps: (1) identification of items eligible for the G-DIT from a pool of existing gambling measures; (2) presentation of items proposed for evaluation by invited expert researchers through an online Delphi process and subsequent consensus meetings; (3) pilot testing of a draft of the 9- to 12-item version in a small group of participants with problem gambling behavior (n= 12); and (4) evaluation of the psychometric properties of the final G-DIT measure in relation to the existing instruments and self-reported criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), among individuals with problem gambling and nonproblematic recreational gambling behaviors (n= 600). This protocol article summarizes step 1 and describes steps 2 and 3 in detail. Results: As of October 2018, steps 1-3 are complete, and step 4 is underway. Conclusions: Implementation of this online Delphi study early in the psychometric development process will contribute to the face and construct validity of the G-DIT. We believe the G-DIT will be useful as a standard outcome measure in the field of problem gambling research and serve as a problem-identification tool in clinical settings.

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  • 45. Molander, Olof
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden; Inland Norway University of Applied Sciences, Norway.
    Assessing severity of problem gambling – confirmatory factor and Rasch analysis of three gambling measures2023In: International Gambling Studies, ISSN 1445-9795, E-ISSN 1479-4276, Vol. 23, no 3, p. 403-417Article in journal (Refereed)
    Abstract [en]

    The comparative psychometric properties of self-report measures for gambling are insufficiently evaluated, in particular regarding factor structure and item response properties. Confirmatory factor and Rasch analyses were tested for three widely used gambling measures assessing problem gambling and related constructs, that is, the Problem Gambling Severity Index (PGSI), the Problem and Pathological Gambling Measure (PPGM), and the NORC Diagnostic Screen for Gambling Problems (NODS). Psychometric data was analyzed, including help-seeking and recreational gambling samples (N = 598). Compared to the PPGM and the NODS, the PGSI performed worse in the confirmatory factor analysis, and showed poor fit for the theoretically assumed unidimensional model. The Rasch analysis indicated that the PPGM had an adequate difficulty range (i.e. lowest to highest item difficulty) to detect gambling problems across a severity continuum. Compared to the PPGM, the PGSI and NODS had smaller item difficulty ranges, indicating detection of higher gambling severity problems. We conclude that using the PGSI for detection of low severity problems, such as at-risk gambling, might be problematic. The PPGM can be used in general populations and clinical contexts to detect problem gambling and pathological gambling. The NODS is suitable for use in clinical samples for identification of pathological gambling. 

  • 46. Molander, Olof
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Berman, Anne H.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. Karolinska Institutet, Stockholm, Sweden; Stockholm County Council, Stockholm, Sweden; Stockholm Center for Dependency Disorders, Stockholm, Sweden.
    The Gambling Disorders Identification Test (GDIT): Psychometric Evaluation of a New Comprehensive Measure for Gambling Disorder and Problem Gambling2023In: Assessment (Odessa, Fla.), ISSN 1073-1911, E-ISSN 1552-3489, Vol. 30, no 1, p. 225-237Article in journal (Refereed)
    Abstract [en]

    The novel gambling disorder identification test (GDIT) was recently developed in an international Delphi and consensus process. In this first psychometric evaluation, gamblers (N = 603) were recruited from treatment- and support-seeking contexts (n = 79 and n = 185), self-help groups (n = 47), and a population sample (n = 292). Participants completed self-report measures, a GDIT retest (n = 499), as well as diagnostic semistructured interviews assessing gambling disorder (GD; n = 203). The GDIT showed excellent internal consistency reliability (α = .94) and test-retest reliability (6-16 days, intraclass correlation coefficient = 0.93). Confirmatory factor analysis yielded factor loadings supporting the three proposed GDIT domains of gambling behavior, gambling symptoms, and negative consequences. Receiver operator curves and clinical significance indicators were used to estimate GDIT cut-off scores in relation to recreational (<15) and problem gambling (15-19), any GD (≥20), mild GD (20-24), moderate GD (25-29), and severe GD (≥30). The GDIT can be considered a valid and reliable measure to identify and predict GD severity, as well as problem gambling. In addition, the GDIT improves content validity in relation to an international research agreement concerning features of gambling outcome measures, known as the Banff Consensus Agreement.

  • 47. Molander, Olof
    et al.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. Karolinska Institutet, Sweden; Inland Norway University of Applied Sciences, Norway.
    Dowling, Nicki A.
    Berman, Anne H.
    Assessing gambling disorder using frequency- and time-based response options: A Rasch analysis of the gambling disorder identification test2024In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 33, no 1, article id e2018Article in journal (Refereed)
    Abstract [en]

    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.

  • 48. Noorbakhsh, Simasadat
    et al.
    Shams, Jamal
    Lotfi-Lelahloo, Reza
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Kallmen, Hakan
    An Empirical Study of the Cut-Off Point for the Iranian Version of Alcohol Use Disorders Identification Test (AUDIT)2018In: Asia Pacific Journal of Medical Toxicology, ISSN 2322-2611, Vol. 7, no 3, p. 75-78Article in journal (Refereed)
    Abstract [en]

    Background: AUDIT is constructed to be able to identify hazardous drinking and less severe alcohol-related problems. The original AUDIT was shown to have a cut-off score of 8 and above for identifying hazardous or harmful alcohol consumption. The aim of this study was to establish the optimal cut-off point of the Persian version of Alcohol Use Disorders Identification Test (AUDIT) in psychiatric out-patients.

    Methods: Participants were a sample of consecutive patients at Imam Hossein Hospital (Tehran/Iran). They consisted of 99 patients, 49 of them diagnosed with alcohol dependency and 50 patients randomly selected from a sample of patients using alcohol but with other primary diagnoses. All statistics including means and standard deviations as well as medians and interquartile range were calculated in SPSS 24 software environment.

    Results: A Receiver Operating Curve analysis showed that by using a 20-point cut-off, the AUDIT had an optimal combination of sensitivity (.92) and specificity (.74). The rate of discrimination was .88.

    Conclusions: Given the high sensitivity and acceptable specificity of the AUDIT, the test can be used as an effective instrument for identification of alcohol use disorders in the Persian psychiatric out-patient population. Furthermore, the receiver operating curve found in this study resembles the one found in previous studies despite the differences in alcohol cultures between Iran and countries with higher alcohol consumption.

  • 49. Osth, J.
    et al.
    Danielsson, A. K.
    Lundin, A.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Andreasson, S.
    Jirwe, M.
    Keeping Track of My Drinking - Patient Perceptions of Using Smartphone Applications as a Treatment Complement for Alcohol Dependence2024In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 59, no 2, p. 291-299Article in journal (Refereed)
    Abstract [en]

    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.

  • 50. Palm, Anna
    et al.
    Olofsson, Niclas
    Danielsson, Ingela
    Skalkidou, Alkistis
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Högberg, Ulf
    Motivational interviewing does not affect risk drinking among young women: A randomised, controlled intervention study in Swedish youth health centres2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 6, p. 611-618Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to analyse risk and binge drinking at 12-month follow-up in young women with risk drinking who received motivational interviewing compared with controls.

    Methods: Young women attending Swedish youth health centres were randomised into intervention or control groups. The intervention group members were asked about their alcohol consumption by a midwife/social worker using the Alcohol Use Disorders Identification Test Consumption. A score of 5 was used as the cut-off value for risk drinking. Participants with risk drinking in the intervention group received motivational interviewing within the same visit. Participants in the control group had a regular visit with a midwife/social worker and answered the same questions about alcohol consumption in a questionnaire after their visit. A questionnaire with the same questions was administered to participants 12 months after baseline.

    Results: Of 1445 eligible young women, 1051 (73%) consented to randomisation and were enrolled in the study. The follow-up rate was 54%. There was a significant decrease in risk- and binge drinking, from baseline to follow-up, in both the intervention and the control groups. Generalised estimating equation analyses demonstrated no significant effect between groups. Of participants who did not have risk drinking at baseline, about 20% in both groups had developed high-risk drinking by the 12-month follow-up.

    Conclusions: No significant differences in risk drinking between young women who received motivational interviewing and controls were found. There was a large intra-individual mobility in young women's risk drinking behaviour. This highlights the importance of finding reliable screening tools that can capture the mobility in drinking behaviour in youth. More research is needed before recommendations can be made.

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