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

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

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

Background  Incorporating clinicians’ perspectives is essential for the successful implementation of novel interventions in health care. This study aimed to explore clinicians’ experiences of using smartphone-derived data in alcohol dependency treatment, and factors affecting implementation into routine care.

Methods  Two focus group discussions were conducted in April 2023, including 10 clinicians working at a specialist addiction clinic in Stockholm, Sweden. The clinicians had various levels of experience using smartphone-based data, which was available through two online portals, as part of a randomised controlled trial evaluating two smartphone-based interventions. Data were analysed using Thematic Framework Analysis, guided by Normalisation Process Theory.

Results  Two main themes were identified: The patient as the driving force and Cultivating commitment, competence and credibility. The first theme highlighted a person-centred approach that permeated the practice and how the patients’ engagement with the app-based interventions guided the clinicians’ own involvement. Benefits of the interventions for both patients (i.e., increased awareness and control) and clinicians (i.e. supportive during treatment sessions) were also acknowledged. Clinicians believed that the interventions offered an opportunity for patients to become more actively involved in treatment and noted that clinician access to the app-derived data was less important. The second theme covered clinician discussions on the need for support and guidance to make better use of the interventions, continuity in the work, and additional work time. Moreover, the use of external portals made the intervention less accessible. Potential risks and concerns with the interventions were raised, including technical instability and data security.

Discussion and conclusions  The results of this study indicate that a breathalyser-coupled and a drink-counting smartphone application have potential to be supportive complements to alcohol dependency treatment. According to the clinicians, the app-based interventions enhanced patient accountability in the change process and supported treatment delivery. To be effectively implemented into routine care, using a person-centred approach is key, as well as ensuring optimal conditions for clinicians to effectively use the systems. Technical issues constitute a barrier to acceptance, why technical robustness must be ensured.

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.

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

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

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

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

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