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  • 1. Bowden, Jacqueline A.
    et al.
    Delfabbro, Paul
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Miller, Caroline
    Wilson, Carlene
    Parental drinking in Australia: Does the age of children in the home matter?2019In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 38, no 3, p. 306-315Article in journal (Refereed)
    Abstract [en]

    Introduction and Aims Parental role modelling of alcohol use is known to influence alcohol consumption in adolescence and in later life. This study aimed to assess relationships between parental status, child age and alcohol consumption, which have not been well documented. Design and Methods Data were sourced from the 2013 Australian National Drug Strategy Household Survey. Analyses were conducted for 25-55 year olds (n = 11 591) by parental status, gender and age of youngest child in the household, controlling for socio-demographic factors. Results Parents were less likely than non-parents to exceed the alcohol guideline for increased lifetime risk (18.2% vs. 24.2%) and short-term risk: at least weekly (14.2% vs. 21.2%); and at least monthly (27.5% vs. 35.9%). Fathers were just as likely to exceed the guidelines for lifetime risk as other men, but those with children aged 0-2, were less likely to exceed the guideline for short-term risk. Women were least likely to exceed the guideline for lifetime risk if they had children aged 0-2, 6-11 or 15 years and over, or the guideline for short-term risk, if they had children aged 0-2, or 15 years and over in the household. Parents were more likely to report drinking in the home. Discussion and Conclusions Parents were less likely to exceed alcohol guidelines than non-parents, especially mothers whose youngest child was an infant or in high school or older. Consistent with population rates in men, fathers were more likely to exceed alcohol guidelines than mothers, and this excess consumption warrants public health attention.

  • 2. Jiang, Heng
    et al.
    Livingston, Michael
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Turning Point, Australia; University of Melbourne, Australia.
    How financial difficulties interplay with expenditures on alcohol: Australian experience2015In: Journal of Public Health, ISSN 2198-1833, E-ISSN 1613-2238, Vol. 23, no 5, p. 267-276Article in journal (Refereed)
    Abstract [en]

    Aim This study aims to examine the relationship between alcohol expenditure and experience of financial difficulties.

    Subjects and methods Using data from Australian Household Expenditure Survey 2009-10, associations between the proportion of household expenditure spent on alcohol and experience of financial difficulties in Australian households were estimated by logistic and linear regression models.

    Results A positive association was found which suggests that the households that spent a higher percentage of total expenditure on alcohol were over 1.3 times more likely to experience financial difficulties than those households in the lowest alcohol expenditure quintile, while households which had no alcohol expenditure were also more likely to report financial problems compared with the lowest alcohol spending group. The determinants analysis in subcategories suggests that having experienced three or more types of financial difficulties in the last 12 months was related to higher levels of alcohol expenditure. The study also found that households living in rented dwellings and youngest age groups are likely to spend a greater proportion than others of their weekly spending on alcohol and more likely to experience financial difficulty.

    Conclusion Alcohol expenditure makes up a significant proportion of household expenditure and strongly associates with household's financial problems in Australia. Brief interventions to reduce hazardous drinking and policy controls on alcohol availability may mean that such drinkers experience fewer alcohol-related financial problems.

  • 3. Jiang, Heng
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Livingston, Michael
    Callinan, Sarah
    Brennan, Alan
    Doran, Christopher
    Thorn, Michael
    The effects of alcohol pricing policies on consumption, health, social and economic outcomes, and health inequality in Australia: a protocol of an epidemiological modelling study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 6, article id e029918Article in journal (Refereed)
    Abstract [en]

    Introduction Alcohol use and misuse are associated with substantial health and social issues in Australia and internationally. Pricing policy is considered as one of the most effective means to reduce risky drinking and related harms. This protocol paper describes a study that will model and estimate the effects, effectiveness and cost-benefit of alcohol pricing policy initiatives in reducing risky drinking, health and social harms, and health inequalities among subpopulations in Australia.

    Methods and analysis The study is a modelling and epidemiological study using data from various resources, such as survey, previous literatures and response agencies. A number of statistical procedures will be undertaken to evaluate the impact of different alcohol pricing policy initiatives on various outcomes, including alcohol consumption in population subgroups, and health and social problems, and to measure health inequalities and cost-effectiveness of those proposed pricing policies, such as a 10% tax increase on all alcohol beverages or introduction of a minimum unit price.

    Ethics and dissemination The ethics approval of this study was obtained from the College Human Ethics Sub-Committee of the La Trobe University on 9 November 2017 (Ref: S17-206). While examining the heterogeneous effects of price policy across population subgroups, this study will provide the first comprehensive estimates of the likely impacts of alcohol price changes on health inequalities. The study will also provide sophisticated economic analyses of the impact of price policy changes, which is critical information for policy makers and will assist policy makers in directing resources to a more efficient alcohol strategy. Results will be made available to communities and societies, health departments and other researchers.

  • 4.
    Kaltenegger, Helena
    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).
    Impulsivity, risk gambling, and heavy episodic drinking among adolescents: A moderator analysis of psychological health2019In: Addictive Behaviors Reports, ISSN 2352-8532, E-ISSN 2076-3387, 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 riskgambling andHED, and whetherpsychological healthfunctions as amoderator, 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 (15–16years) and second grade of upper secondary school (17–18years) 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.

  • 5. Karriker-Jaffe, Katherine J.
    et al.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Giesbrecht, Norman
    Greenfield, Thomas K.
    Alcohol's Harm to Others: Opportunities and Challenges in a Public Health Framework2018In: Journal of Studies on Alcohol and Drugs, ISSN 1937-1888, E-ISSN 1938-4114, Vol. 79, no 2, p. 239-243Article in journal (Refereed)
    Abstract [en]

    The emergent and growing body of research on alcohol's harm to others (AHTO), or secondhand effects of drinking, has important implications for prevention, intervention, and policy. Those victimized by other drinkers tend to favor effective alcohol policies more than their nonvictimized peers, but often a community's impulse will be to combat AHTO by targeting and stigmatizing individual heavy drinkers, rather than taking a public health approach to reducing harm. Here we discuss opportunities and challenges in selecting ways of reducing AHTO. We make a case for adopting joint public health and individual approaches to reduce AHTO.

  • 6. Kataja, Kati
    et al.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Hakkarainen, Pekka
    Koivula, Petteri
    Tigerstedt, Christoffer
    Hautala, Sanna
    Combining Alcohol with Benzodiazepines or Psychostimulants: Metaphoric Meanings and the Concept of Control in the Online Talk of Polydrug Use2019In: Journal of Psychoactive Drugs, ISSN 0279-1072, E-ISSN 2159-9777, Vol. 51, no 5, p. 473-481Article in journal (Refereed)
    Abstract [en]

    The co-administration of different substances is a widespread practice in the context of hard drug use. Among others, alcohol combined with certain substances produces potentially dangerous interactions. This article explores how people who combine alcohol with benzodiazepines or psychostimulants perceive these practices and how they share their perceptions in Finnish and Swedish online discussions. This is carried out by analyzing discussants’ use of metaphoric expressions. We found that the metaphors given to the use of these substance combinations reflect their pharmacological characteristics. Through that, the metaphors and meanings were different depending on the substance alcohol was combined with. Moreover, we found that, in the realities the metaphors create, the control of use was differently conceptualized. The different aspects of control could be divided into three categories that, however, were not related to any specific substances but overarched all metaphors: 1) controlling pharmacological risks, 2) controlling social appearance and 3) ignoring control. As our findings bring out, often the actual health dangers and risks of the studied substance combinations were bypassed, and the control was rather understood either as a form of socially appropriate behavior or wholly ignored.

  • 7.
    Kraus, Ludwig
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany; Eötvös-Loránd-Universität, Hungary.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Livingston, Michael
    Pennay, Amy
    Holmes, John
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Long waves of consumption or a unique social generation? Exploring recent declines in youth drinking2019In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392Article in journal (Refereed)
    Abstract [en]

    Background: There is growing evidence for recent declines in adolescent alcohol use in the Western world. While these changes have been subject to scientific debate, the reasons for this downward trend are not yet understood.Method: We consider broader theoretical framings that might be useful in understanding declines in youth drinking. In particular, we reflect on the historical observations of ‘long waves of alcohol consumption’, the ‘Total Consumption Model’, and the ‘Theory of Social Generations’. Based on this, we explore some of the main hypotheses that are presently discussed as possible explanations for changes in youth drinking.Results: We suggest there may have been a change in the social position of alcohol as a social reaction to the negative effects of alcohol, but also emphasize the importance of changes in technology, social norms, family relationships and gender identity, as well as trends in health, fitness, wellbeing and lifestyle behavior. As a result of the interplay of these factors, the ‘devaluation’ of alcohol and the use of it may have contributed to the decrease in youth drinking.Conclusions: For interrupting the recurrent cycle of the ‘long waves of alcohol consumption’, we need to take advantage of the present change in sentiment and “lock in” these changes by new control measures. The model of change presented here hinges on the assumption that the observed change in the position the present young generation takes on alcohol proceeds through the life course, eventually reducing alcohol use in the whole population.

  • 8.
    Landberg, Jonas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institute, Sweden.
    Danielsson, Anna-Karin
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institute, Sweden.
    Fathers’ alcohol use and suicidal behaviour in offspring during youth and young adulthood2019In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, no 6, p. 563-573Article in journal (Refereed)
    Abstract [en]

    Objective

    To examine the association between various indicators of father's alcohol use and suicidal behaviour in offspring during youth and young adulthood.

    Methods

    The study is based on a cohort of 68 910 Swedish citizens who were born between 1970 and 1985 and have fathers who participated in conscription for compulsory military training in 1969/70. Information on fathers’ alcohol use was collected during conscription. Offspring was followed for suicide attempts or completed suicides (through linkage with national registers) from age 12 to end of follow‐up in 2008.

    Results

    After adjustment for confounders, the hazard ratio (HR) for offspring to fathers who were heavy drinkers was 1.4 (95% CI 1.02, 1.93) while the associations turned non‐significant for offspring to fathers who often drank into intoxication, HR 1.14 (0.68, 1.90). The highest risk for suicidal behaviour was found for offspring to fathers who had been apprehended for drunkenness two times or more, or with an alcohol‐related hospitalization, with adjusted HRs of 2.1 (1.4, 3,14) and 1.9 (1.27, 2,85) respectively.

    Conclusion

    Fathers’ alcohol use is associated with increased risk of suicidal behaviour among offspring in youth and young adulthood.

  • 9. Manning, Victoria
    et al.
    Garfield, Joshua B. B.
    Lam, Tina
    Allsop, Steve
    Berends, Lynda
    Best, David
    Buykx, Penny
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Lubman, Dan
    Improved Quality of Life Following Addiction Treatment Is Associated with Reductions in Substance Use2019In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 8, no 9, article id 1407Article in journal (Refereed)
    Abstract [en]

    People seeking treatment for substance use disorders (SUD) ultimately aspire to improve their quality of life (QOL) through reducing or ceasing their substance use, however the association between these treatment outcomes has received scant research attention. In a prospective, multi-site treatment outcome study (Patient Pathways'), we recruited 796 clients within one month of intake from 21 publicly funded addiction treatment services in two Australian states, 555 (70%) of whom were followed-up 12 months later. We measured QOL at baseline and follow-up using the WHOQOL-BREF (physical, psychological, social and environmental domains) and determined rates of SUD treatment success (past-month abstinence or a statistically reliable reduction in substance use) at follow-up. Mixed effects linear regression analyses indicated that people who achieved SUD treatment success also achieved significantly greater improvements in QOL, relative to treatment non-responders (all four domains p < 0.001). Paired t-tests indicated that non-responders significantly improved their social (p = 0.007) and environmental (p = 0.033) QOL; however, their psychological (p = 0.088) and physical (p = 0.841) QOL did not significantly improve. The findings indicate that following treatment, QOL improved in at least some domains, but that reduced substance use was associated with both stronger and broader improvements in QOL. Addressing physical and psychological co-morbidities during treatment may facilitate reductions in substance use.

  • 10. 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, ISSN 1929-0748, 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.

  • 11. Pfeiffer-Gerschel, Tim
    et al.
    Schneider, Franziska
    Dammer, Esther
    Braun, Barbara
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung Germany; Eötvös-Loránd-Universität, Hungary.
    Methamphetaminkonsum in Deutschland: Verbreitung und Problemlage2019In: SUCHT, ISSN 0939-5911, E-ISSN 1664-2856, Vol. 65, no 4, p. 241-249Article, review/survey (Refereed)
    Abstract [en]

    Aim: To give a comprehensive and differentiated overview of the methamphetamine (MA) situation in Germany, the paper discusses MA use prevalence, data on seizures and offences in Germany and the EU as well as data on treatment demand in Germany. Methods: Current data regarding drug use prevalence from representative national and regional population studies, seizures and offences as well as wastewater analyses, addiction counselling, treatment and law enforcement are presented. Results: Prevalence rates of 0.6% (lifetime) and 0.2% (past 12 months) point to a limited extent of MA use in the adult general population. However, there is a strong indication of pronounced regional differences, with a far higher prevalence of use in Saxony, Thuringia and Bavaria than in other German regions. Conclusion: There are substantial regional differences in the prevalence of MA use and subsequent problems with a focus on border regions to the Czech Republic. Due to the high burden of MA related issues in these regions, a number of interventions have been initiated, ranging from specific programs for early interventions to structured treatments. To improve the situation in those regions, further support by political as well as social means is necessary.

  • 12. Rehm, Jürgen
    et al.
    Crepault, Jean-Francois
    Hasan, Omer S. M.
    Lachenmeier, Dirk W.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Sornpaisarn, Bundit
    Regulatory Policies for Alcohol, other Psychoactive Substances and Addictive Behaviours: The Role of Level of Use and Potency. A Systematic Review2019In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 16, no 19, article id 3749Article, review/survey (Refereed)
    Abstract [en]

    The object of this contribution based on a systematic review of the literature is to examine to what degree the level of use and potency play a role in regulatory policies for alcohol, other psychoactive substances and gambling, and whether there is an evidence base for this role. Level of use is usually defined around a behavioural pattern of the user (for example, cigarettes smoked per day, or average ethanol use in grams per day), while potency is defined as a property or characteristic of the substance. For all substances examined (alcohol, tobacco, opioids, cannabis) and gambling, both dimensions were taken into consideration in the formulation of most regulatory policies. However, the associations between both dimensions and regulatory policies were not systematic, and not always based on evidence. Future improvements are suggested.

  • 13.
    Samuelsson, Eva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work. Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kristina, Sundqvist
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Det svårfångade problemspelandet – spelares subjektiva tolkningar av Swelogs bedömningsinstrument2019Other (Other (popular science, discussion, etc.))
    Abstract [sv]

    Överdrivet spelande om pengar kan få ekonomiska, känslomässiga och sociala konsekvenser i olika grad. Hur spelare själva upplever bekymren är centralt för huruvida de kommer att försöka förändra sina spelvanor. Men vad är det egentligen vi fångar när vi mäter problemspelande i befolkningen? Vi har undersökt hur spelare som tidigare bedömts ha ett problemspelande tolkar frågorna som användes vid just denna bedömning.

  • 14.
    Samuelsson, Eva
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Wennberg, Peter
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Sundqvist, Kristina
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Gamblers’ (mis-)interpretations of Problem Gambling Severity Index items: Ambiguities in qualitative accounts from the Swedish Longitudinal Gambling Study2019In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 36, no 2, p. 140-160Article in journal (Refereed)
    Abstract [en]

    The Problem Gambling Severity Index (PGSI) is a screening instrument frequently used to identify risk and problem gambling. Even though the PGSI has good psychometric properties, it still produces a large proportion of misclassifications. Aims: To explore possible reasons for misclassifications in problem gambling level by analysing previously classified moderate-risk gamblers’ answers to the PGSI items, in relation to their own current and past gambling behaviours. Methods: Semi-structured telephone interviews were conducted with 19 participants reporting no negative consequences from gambling. They were asked the PGSI questions within an eight-year time frame (2008 to 2016). Ambiguous answers to PGSI items were subject to content analysis. Results: Several answers to the PGSI items contained ambiguities and misinterpretations, making it difficult to assess to what extent their answers actually indicated any problematic gambling over time. The item about feelings of guilt generated accounts rather reflecting self-recrimination over wasting money or regretting gambling as a meaningless or immoral activity. The item concerning critique involved mild interpretations such as being ridiculed for buying lottery tickets or getting comments for being boring. Similar accounts were given by the participants irrespective of initial endorsement of the items. Other possible reasons for misclassifications were related to recall bias, language difficulties, selective memory, and a tendency to answer one part of the question without taking the whole question into account. Conclusions: Answers to the PGSI can contain a variety of meanings based on the respondents’ subjective interpretations. Reports of lower levels of harm in the population should thus be interpreted with caution. In clinical settings it is important to combine use of screening instruments with interviews, to be able to better understand gamblers’ perceptions of the gambling behaviour and its negative consequences.

  • 15.
    Stenius, Kerstin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Balancing welfare and market logics: Procurement regulations for social and health services in four Nordic welfare states2019In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126Article in journal (Refereed)
    Abstract [en]

    Aim: In increasingly market-oriented welfare regimes, public procurement is one of the most important instruments of influencing who produces which services. This article analyses recent procurement regulations in four Nordic countries from the point of view of addiction treatment. The implementation of public procurement in this field can be viewed as a domain struggle between the market logic and the welfare logic. By comparing the revision of the regulations after the 2014 EU directives in Denmark, Finland, Norway, and Sweden, we identify factors affecting the protection of a welfare logic in procurement. We discuss the possible effects of different procurement regulations for population welfare and health. Data and theoretical perspective: The study is based on the recently revised procurement laws in the four countries, and adherent guidelines. The analysis is inspired by institutional logics, looking at patterns of practices, interests, actors, and procurement as rules for practices. Results: Procurement regulations are today markedly different in the four countries. The protection of welfare and public health aspects in procurement – strongest in Norway – is not solely dependent on party political support. Existing service providers and established steering practices play a crucial role.  Conclusion: In a situation where market steering has become an established practice and private providers are strongly present, it can be difficult to introduce strong requirements for protection of welfare and population health in procurement of social services.

  • 16.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    One model to rule them all? Governing images in the shadow of the disease model of addiction2018In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 37, no 6, p. 726-728Article in journal (Other academic)
    Abstract [en]

    Treatment providers demonstrate a quite strong support for a disease model of addiction, particularly so in the United States. However, conceptions vary and the problems may be perceived as primarily a disease, moral or social problems, or a combination of these (Barnett et al. in press). This commentary discusses the ongoing and dynamic process of defining addiction problems and notes that non-medical perspectives often appear in the shadow of and tend to oppose the disease model that stands quite inviolable – i.e., like the One Ring to rule them all by citing The Lord of the Rings. Recent changes in the Swedish Addiction treatment system, well known for its social perspective on the nature and handling of addiction problems, are highlighted to demonstrate that the world may be changing, or not. It is argued that there cannot be just one model. 

  • 17.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Antonsson, Erik
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The Swedish Addiction Treatment System: Government, Steering and Organisation. Technical Report2019Report (Other academic)
    Abstract [en]

    Welfare systems in Sweden and internationally have gone through major changes regarding modes of operation and means of government in New Public Management (NPM) reforms, which have sought to balance autonomy and control. There is a lively debate about NPM, but research is scarce. NPM indicates improved performances but also unintended consequences and inconsistencies concerning ideas, demands on the services and performance incentives – such as tensions between medical and social professional autonomy and knowledge on the one hand and administrative control, auditing and a growing bureaucracy (e.g., procurement, inspections, documentation) on the other. The research project used addiction treatment with different organisations and professions as a case for studying the impact of NPM on the daily work in regional health care and municipal social services organisations.

    We charted the broad steering and organisation of addiction treatment. We analysed the extent to which tendencies of NPM have conveyed advantages or created conflicting logics by comparing addiction treatment in three regions and six municipalities with varying degrees of NPM. The study used official statistics, documents, interviews and a web survey. A total of 85 interviews were made with 93 individual state, regional and local policy-makers and officials (including the previously unstudied procurers) and public and private care providers (managers and treatment professionals) in 2017–2018. The interviews formed the basis for a web survey among professionals in Sweden in 2019. Purchasing addiction services was further examined by observing a large procurement process, by organising a workshop with Nordic procurement experts, and by interviewing civil servants in Finland, Denmark and Norway.

    The study shows how addiction treatment is governed and organised, highlighting developments over time with special emphasis on various NPM features. The interviews addressed advantages and tensions in the daily work and if and how professionals seek to adapt to new, perhaps inconsistent, demands. The web survey allows for comparisons across organisations and professional groups. This technical report presents the background and aims of the study and describes in detail the Swedish study setting, and the study design, methods and data sources used.

  • 18.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The new privatized market: A question of ideology or pragmatism within the Swedish addiction treatment system?2019In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 53, no 5, p. 776-792Article in journal (Refereed)
    Abstract [en]

    Given its traditions of universal welfarism and social democracy, Sweden had already scored unexpectedly high on New Public Management by the 1980s. Health and welfare services remain primarily tax‐funded, but the production of care is increasingly transferred to a competitive quasi-market. To what extent can this development be understood in terms of right‐wing governments, and to what extent in terms of other, socioeconomic and pragmatic factors? We examined this question through official statistics on providers of institutional addiction care since 1976, and through the total expenditure and purchases by local‐level municipal social services of interventions for substance users in Sweden in 1999, 2004, 2009, and 2014. We have analyzed the distribution across publicand private providers within the addiction treatment system, and whether national developments and local differences across the 290 municipalities—which bear the major treatment responsibility—can be understood in terms of local‐level political majority, population size, and local wealth. The share of purchased services has remained stable, but the treatment system shows increasing financial turnover and an increasing share of for‐profit providers among producers of purchased care, especially in outpatient treatment. While venture capital enterprises emerged as a new actor, non‐governmental organizations lost out in importance. Bourgeois government correlated with larger shares of purchasing and purchases from for‐profit providers. However, purchasing on a market dominated by for‐profit providers has also become the “new normal”, regardless of ideology, and recent years have shown a reversed effect of left‐wing municipalities purchasing more services than right‐wing governments. Pragmatic reasons also influence local‐level purchasing.

  • 19.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). National Institute for Health and Welfare, Finland.
    Why Research Should Pay Attention to Effects of Marketization of Addiction Treatment Systems2019In: Journal of Studies on Alcohol and Drugs, ISSN 1937-1888, E-ISSN 1938-4114, no Supplement 18, p. 31-39Article in journal (Refereed)
    Abstract [en]

    Objective:

    Researchers generally assume that addiction treatment systems can be viewed as entities and planned with the citizens’ best interests in mind. We argue that another steering principle, the market logic, has permeated many Western World treatment systems but is neglected in research. We demonstrate how it may affect system-level planning, service provision, and the service users.

    Method:

    We draw on an ongoing Swedish study, with some Nordic references, using several data sources: (1) public statistics on treatment expenditures and purchases; (2) interviews with service users (n = 36) and their service providers (n = 23) on different market features; (3) an observation of a large public procurement process concluding framework agreements based on competitive tendering; (4) interviews with officials involved with steering of the system and procurement (n = 16); (5) a workshop on procurement in the Nordic countries (n = 11 participants); and (6)77 interviews with professionals, managers, and elected representatives.

    Results:

    We outline seven propositions that call for further research attention: public procurement, as regulated in the European Union, is not suitable for addiction treatment; marketization challenges democracy, equity, needs assessment, and treatment planning; marketization causes new accountability problems and idle monitoring; marketization causes fragmentation and obstructs coordination and continuity of care; marketization causes unification of services and favors big bureaucratically sophisticated providers; treatment professionals’ values are downplayed when a mistrust-based market logic replaces a trust- and needs-based logic; and marketization marginalizes treatment professionals and service users by limiting discretion.

    Conclusions:

    Findings point toward the importance of acknowledging and mitigating market principles in treatment systems to safeguard needs assessments and planning that serve the interests of the service users and the public.

  • 20. Thor, Siri
    et al.
    Karlsson, Patrik
    Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Landberg, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden; The Swedish Council for Information on Alcohol and Other Drugs, Sweden.
    Social Inequalities in Harmful Drinking and Alcohol-Related Problems Among Swedish Adolescents2019In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 54, no 5, p. 532-539Article in journal (Refereed)
    Abstract [en]

    Aims

    The study aims to examine how socio-economic status (SES) among youth is related to binge-drinking and alcohol-related problems using three SES indicators: (i) SES of origin (parental education level), (ii) SES of the school environment (average parental education level at student’s school) and (iii) SES of destination (academic orientation).

    Methods

    Cross-sectional data on upper secondary students (n= 4448) in Sweden. Multilevel logistic and negative binomial regression were used to estimate the relationship between each SES indicator and binge-drinking and alcohol-related problems, respectively.

    Results

    Only SES of destination was significantly associated with binge-drinking, with higher odds for students in vocational programmes (OR= 1.42, 95% CI= 1.13–1.80). For the second outcome, SES of destination (rr=1.25; 95%CI=1.08–1.45) and SES of the school environment (rr=1.19, 95% CI=1.02–1.39) indicated more alcohol-related problems in vocational programmes and in schools with lower-educated parents. After adjustment for drinking patterns, the relationship remained for SES of the school environment, but became non-significant for SES of destination.

    Conclusion

    Our results suggest that the SES gradient among youth is stronger for alcohol-related problems than for harmful drinking. By only focusing on SES differences in harmful alcohol use, researchers may underestimate the social inequalities in adverse alcohol-related outcomes among young people. Our findings also support the notion that the environment young people find themselves in matters for social inequalities in alcohol-related harm.

  • 21.
    Törrönen, Jukka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Safe, funny and frightening drinking situations from children’s viewpoint: Comparing recalled childhood stories about others’ drinking in Scandinavia2019In: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 67, p. 34-42Article in journal (Refereed)
    Abstract [en]

    The article analyzes retrospective childhood stories related to others’ drinking (N = 336). The stories have been told in a focus group context in Finland and Sweden. Hence, they are stories about the past that have been constructed in the present. The retrospective childhood stories are analyzed from the perspective of emotions, seen as relational and situational sociocultural constructions, by paying attention to what kind of contact and emotional responses children develop to others’ drinking in specific situations. The analysis demonstrates how in an intoxicated-oriented drinking culture the presence of alcohol may signify something outside the bounds of everyday life, in the case of which children develop an ambiguous contact with drinking in which many kinds of positive or negative emotions can emerge, such as love, fun, fear, shame or curiosity. In the Finnish narratives, children’s emotional socialization to drinking is regulated by situations of heavy domestic drinking, festive drinking and moderate routine drinking at home. In the Swedish narratives, children’s emotional socialization to drinking is governed by festive situations, moderate routine drinking at home and meal drinking. Fear dominates the Finnish participants’ recalled childhood stories, whereas fun is the most common emotion in the stories from Sweden. The differences between Finnish and Swedish emotions recalled from childhood in relation to drinking may reflect differences in these culture’s drinking practices and/or social interaction norms. The article demonstrates how adults’ childhood memories on drinking provide an important ‘indirect’ source to get knowledge on children’s ways of experiencing and responding to others’ drinking in various situations.

  • 22.
    Törrönen, Jukka
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Roumeliotis, Filip
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Criminology.
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Stockholm University, Faculty of Social Sciences, Department of Social Work.
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT, Institut für Therapieforschung, Germany.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). La Trobe University, Australia.
    Why are young people drinking less than earlier? Identifying and specifying social mechanisms with a pragmatist approach2019In: International Journal of Drug Policy, ISSN 0955-3959, Vol. 64, p. 13-20Article in journal (Refereed)
    Abstract [en]

    Recent surveys have found a strong decrease in alcohol consumption among young people and this trend has been identified in European countries, Australia and North America. Previous research suggests that the decline in alcohol consumption may be explained by changes in parenting style, increased use of social media, changes in gender identities or a health and fitness trend. We use qualitative interviews with drinking and non-drinking young people from Sweden (N = 49) to explore in what way and in what kinds of contexts these explanations may hold true and how they alone or together may explain declining alcohol consumption among young people. By using the pragmatist approach, we pay attention to what kinds of concerns, habits, practices, situations and meanings our interviewees relate to adolescents' low alcohol consumption or decline in drinking. By analyzing these matters, we aim to specify the social mechanisms that have reduced adolescents' drinking. Our paper discovers social mechanisms similar to previous studies but also a few that have previously been overlooked. We propose that the cultural position of drinking may have changed among young people so that drinking has lost its unquestioned symbolic power as a rite of passage into adulthood. There is less peer pressure to drink and more room for competing activities. This opening of a homogeneous drinking culture to the acceptance of differences may function as a social mechanism that increases the success of other social mechanisms to reduce adolescents' drinking. Furthermore, the results of the paper suggest a hypothesis of the early maturation of young people as more individualized, responsible, reflective, and adult-like actors than in earlier generations. Overall, the paper provides hypotheses for future quantitative studies to examine the prevalence and distribution of the identified social mechanisms, as well as recommends directions for developing effective interventions to support young people's healthy lifestyle choices.

  • 23. Wallander, Lisa
    et al.
    Blomqvist, Jan
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Fat Words or Useful Concepts? Consensus and Variation in Conceptions of Problematic Drinking in Contemporary Sweden2019In: Contemporary Drug Problems, ISSN 0091-4509, E-ISSN 2163-1808, Vol. 46, no 3, p. 241-264Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to bring to light the meanings attributed to four concepts denoting problematic drinking—"alcoholism," "alcohol dependence," "alcohol misuse," and "risky drinking"—and to investigate whether individuals' preferences for using these concepts vary depending on their demographic characteristics, their stakeholder group membership, and their own drinking habits. These questions were examined by means of a vignette experiment, in which Swedish social workers, health care staff, journalists, researchers, and the general public (n = 863) read a series of 10 randomly constructed fictitious cases (vignettes; n = 8,630) and made judgments about which of the four concepts best portrayed the case descriptions. Results based on multilevel multinomial logistic regression showed that alcoholism was the concept chosen for the "heaviest" and most problematic drinking, whereas risky drinking was most often employed to describe moderate drinking habits that resulted in few negative consequences. The concepts alcohol misuse and alcohol dependence were positioned between alcoholism and risky drinking, and while misuse was linked to drinking large quantities and to more negative consequences, dependence was more frequently used to describe vignettes that involved depictions of craving. Moreover, the respondents' conceptual choices were affected by their own gender, age, drinking habits, and stakeholder group membership. Taken together, the study's findings reveal both consensus and variation in the respondents' choice of concepts, indicating that while these concepts may to some extent be employed for making meaningful distinctions between different types of problematic drinking, there is substantial variation in the way the concepts are employed.

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