Nordic Studies on Alcohol and Drugs (NAD)
Here you will find short summaries of the articles published in the scientific journal Nordic Studies on Alcohol and Drugs.
This issue of NAD deals with microdosing, alcohol-related maltreatment, gender differences among adolescents with substance abuse problems, media depictions of addiction problems, and the health service needs of users of anabolic androgenic steroids.
Knowledge of the extent of alcohol-related maltreatment of children in Lithuania is limited. The study was based on a content analysis of child protection documents. More than one person with problematic alcohol consumption was identified in over a third of cases. Most often, it was the police (26.6%) or a close relative (16.3) who alerted the child welfare authorities about maltreatment.
What are the similarities and differences in risk factors between boys and girls with addiction problems when they get into outpatient care? The study was based on interview data from 2169 youths over a three-year period from clinics in eleven Swedish cities. Girls came from more difficult family and childhood environments. They also had more likely problems at school, more difficult drug addiction and more serious mental health problems, while boys had much higher crime activity.
Micro dosing of psychedelic drugs is not about intoxication but about increased everyday function. The dosage is often about one tenth of the usual recreational dose. The 21 men in the thirties who participated in the interview study reported mainly positive experiences regarding mood, cognition and creativity.
By analysing articles about addiction problems in daily newspapers in Poland, Italy and Finland, the study points to how reporting trends have changed since the early 1990s. More and more space is given to individuals with addiction problems and to researchers who represent a biomedical approach.
The use of anabolic androgenic steroids can lead to increased muscle mass and strength, but also to unwanted side effects. In Norway, the specialized substance abuse treatment services are responsible for assisting users of anabolic androgenic steroids with health problems. The study points to how healthcare can become more accessible to this group. [The study is published in Norwegian but has an English language abstract]
Thematic issue on alcohol's harm to others
Robin Room, Anne-Marie Laslett and Heng Jiang give a comprehensive critical overview of the historical development of the alcohol’s harm to others approach. They assess an abundance of empirical studies and shed light on how they have tackled issues such as alcohol’s harm to other people or to institutions, with particular attention to causation, attribution and perspective. Johan Edman and Katherine J. Karriker-Jaffe discuss these questions further in their respective commentaries.
Katariina Warpenius and Christoffer Tigerstedt give an account of ways in which alcohol research has grasped and should grasp the kind of harm caused to people and relationships that cannot be studied by explicitly focusing on the drinker. They argue that taking the interactional nature of alcohol-related harm seriously offers a novel cross-cutting perspective to well-established traditions in the alcohol research field.
Ingeborg Rossow and Mats Ramstedt provide a methodological and conceptual critique of the burgeoning field of research that focuses on alcohol’s harm to others. They describe challenges faced by studies of alcohol’s harm to others and propose solutions to these problems.
Alcohol’s harm to others is under-recognised and under-researched, particularly in low and middle-income areas where a disproportionate burden of alcohol harms accrue. Anne-Marie Laslett and co-authors describe a qualitative assessment of various countries’ service responses to alcohol’s harms to others in lower middle income countries.
Riitta Koivula, Christoffer Tigerstedt, Anni Vilkko, Kristiina Kuussaari and Satu Pajala consider issues around older people’s alcohol use and the role of home carers in addressing and managing situations where alcohol use causes difficulties. The professionals brought up their lacking qualifications in alcohol-related issues and the need for support from substance abuse services
Everything in moderation? A mixed methods study on perceptions of parents’ drinking in the presence of children
Janne Scheffels, Inger Synnøve Moan and Elisabet Storvoll use a mixed methods approach to explore attitudes towards parents’ drinking in the presence of their children. Situations expressly described as moderate and positive by adults may even turn out to be negative experiences for the children.
Smokers are in favour of legislation that targets passive smoking, but defend their right to smoke in most public spaces. According to Marianne Lund, smokers opposed most of the proposed tobacco control strategies. Their support may be more important in tobacco control areas that aim to denormalise smoking and where enforcement is more complex. Helen Keane and Tove Sohlberg have written commentaries.
Solbjørg Makalani Myrtveit and colleagues investigate whether participation in the introductory week at Norwegian universities is associated with risky drinking. They also investigate whether risky drinking is associated with academic performance.
Many Danes drink so much that it is detrimental to their health. As they are at risk of suffering diseases which can lead to hospitalisation on somatic wards, hospitals are ideal arenas for identifying individuals whose alcohol consumption is excessive. Rikke Hellum, Lene Bjerregaard and Anette Søgaard Nielsen identify potential factors that influence whether or not nurses talk to patients about their alcohol consumption on somatic wards. They also examine whether a screening project may affect the nurses’ readiness to talk about alcohol use with their patients.
Several studies have shown that personality disorders are frequently occurring among patients with substance use disorders. Ingebjørg Aspeland Lien and Espen Ajo Arnevik explore whether personality problems might be assessed among SUD patients in early stages of treatment.
Lesbian, gay and bisexual (LGB) young people are at increased risk to develop alcohol-related problems compared to heterosexuals. Valeria Verrastro and colleagues describe alcohol use patterns in relation to alcohol expectancies, internalised sexual stigma and sensation seeking and to highlight the specific risk factors that sexual minority subgroups face.
This study by Johanna Nordmyr, Anna K. Forsman and Karin Österman explores associations between structural and functional aspects of social networks and relationships (social ties) among individuals exhibiting problematic alcohol use and problem gambling, respectively. Functional aspects of individual-level social ties appear to be more relevant when studying problematic alcohol use or problem gambling, similarly to other forms of mental health problems.
Filip Roumeliotis investigates how empowerment and democratic participation are conceptualized in the drug prevention program ‘Communities that Care’. The analysis is based on 13 publications written by program developers and other collaborators. He argues that the program may exert ‘ideological closure’ on the ability of communities to speak in properly political terms through disciplining communities into a common language that assert primacy of a (particular brand of) scientific reasoning.
Josefin Månsson describes and analyses how cannabis is constructed in Swedish print media, and asks whether this has changed over time. The Swedish print media generally has a crime-centred and deterrent approach towards cannabis, with prohibition at the heart of the reporting. International events do however introduce discursive alternatives. It remains to be seen if these new ways of writing about cannabis will strengthen or challenge traditional Swedish prohibitionist constructions.
Use of coercion against pregnant women who misuse substances was legalised in Norway in 1996. Siv Merete Myra and colleagues explored whether an attachment between the mother and her unborn child was possible in a context of coercion as experienced from the woman’s perspective. They found that involuntary detention enabled safety for and connection with the unborn child. Within this context, the pregnant substance-abusing women’s own relational experiences and developmental histories represent the most significant barrier for their ability to bond with the expected child.
In their study, Susan Cronin, Siobhan Murphy and Ask Elklit examined the relationship between alcohol misuse and different types of childhood maltreatment in a sample of young adults. A significant relationship was found between childhood maltreatment and alcohol misuse. This relationship was significantly stronger for maltreated women, which identifies a gap in the literature. High associations between maltreatment and alcohol misuse in females may suggest alcohol is used as a coping strategy following childhood maltreatment.
Is vaping prevalent among Swedish adolescents? Susanna Geidne and colleagues found that one out of four Swedish grade 9 students have tried e-cigarettes. They also found that the use of e-cigarettes tended to cluster with the use of other substances, such as other tobacco products and alcohol. The article is commented on by Karl E. Lund and Jaana M. Kinnunen.
Per Binde has studied gambling-related harm and crime in the workplace. In his outline of key prevention and response measures to problem gambling, he includes substance use and gambling policy, problem gambling awareness, attention to signs of gambling-related harm, control functions, appropriate responses to harmful gambling, and rehabilitation. According to Binde, the workplace should play a greater role in the universal, selective and indicated prevention of problem gambling
Research shows that the risk of overdose mortality among marginalized drug users is particularly high during the first weeks after discharge from inpatient treatment. Elin Berg investigated whether there might be a connection between marginalization and treatment culture to understand fatale overdoses after discharge from inpatient treatment. The case study is focused on a single individual and his treatment process in Norway. The case shows that there may be a relationship between marginality, treatment culture and overdose mortality. Cultural and structural aspects of the treatment system put subject in an empty and risky situation that probably contributed to his death.
Aistė Lengvenytė, Robertas Strumila and Jurgita Grikinienė have studied the use of cognitive enhancers among medical students in Lithuania.They wanted to determine the reasons for usage and evaluate the contributing factors such as socio-demographic characteristics, stress levels, sleep quality and knowing somebody who has used a neuro-enhancing drug. In Lithuania, 1 of 12 medical students report having used neuro-enhancing drugs. Male students reported three times higher prevalence rates than females.
What kind of information do individuals in treatment for alcohol problems find should be available before treatment start? Anette Søgaard Nielsen and Annette Elkjær Ellermann found that by far the most participants rated information about the content of treatment as a priority. Individuals seeking and entering treatment for alcohol problems require information about the treatment itself and what it contains before they start treatment. This is in stark contrast to the kind of information that treatment seekers currently find, such as the opening hours of the treatment centre and similar practicalities. The article is followed with three commentaries by Jessica Storbjörk, Katja Kuusisto and Morten Hesse.
In Russia the paradigm of alcoholism as a disease is still in contrast to the general perception of alcoholics as weak-willed. Laura Lyytikäinen studied alcoholism and recovery in Russia by looking at the Russian Alcoholics Anonymous online group. The online community creates a space for engagement with AA’s 12-Step program and service work of supporting other alcoholics in recovery in the context of Russia, where face-to-face AA groups and other recovery programmes are scarce. When the state cannot deliver the services for problem drinkers or recovering alcoholics, people may turn to the Internet to find alternative information and social support.
Thematic issue on gambling and gender
Elaine M. Nuske, Louise Holdsworth and <b>Helen Breen examine the relation between significant life events, social connections and gambling among Australian female gamblers. Pierre Bourdieu’s and Robert D. Putnam’s theories on social capital are used to understand women’s gambling engagement and gambling-related problems.
Johanna Järvinen-Tassopoulos analyses the relation between gender and addiction in short online narratives written by Finnish female problem gamblers. The women’s problematic gambling behaviour casts light on relationships and the gendered roles within the family. The qualitative data gives also an insight into female problem gamblers’ relation to drinking.
Ulla Romild, Jessika Svensson and Rachel Volberg use the Swedish Longitudinal Gambling Study (SWELOGS) data to study past-year gambling participation (cf. frequency and forms of gambling) by gender among 16 to 84-year-old respondents. Different clusters are identified representing various forms of gambling participation and indicating gender and socio-demographic differences between and within them.
Robert Edgren and colleagues explore the association between at-risk gambling, problem gambling, risky alcohol consumption, tobacco smoking, poor mental health and loneliness among 15 to 28-year-old Finnish males and females. The data is derived from the Finnish Gambling Survey 2011. The study also reviews the meanings of risky behaviours among adolescents and emerging adults and the impact of gender and age in the development of problems.
Johan Edman and Josefine Berndt study the medicalisation of gambling in Sweden by comparing discussion protocols and parliamentary bills from the early 1970s to the early 2010s. The political handling of the gambling problem reveals the process of medicalisation of misuse, but it also points out major social and economic changes in the Swedish society.
In their analyses of a large sample of Swedes (N=104316), Ludwig Kraus and colleagues assessed the association between social status variables and aggression when controlling for volume of alcohol consumption and episodic heavy drinking (EHD), tested whether social status moderates the association between volume or EHD and verbal as well as physical aggression, and investigated whether EHD moderates the effect of volume on aggression. They found that groups of lower educated and nonmarried individuals experience verbal or physical aggression over and above different levels of consumption.
Tiina Räsänen and colleagues explored the relationship between gambling and violent behaviour and attitudes towards violence among 14- and 16-year-old Finnish adolescents. They found that both gambling frequency and the number of gambling-related harms were linked to violent behaviour as well as to positive attitudes towards violence. Adolescents who engaged in gambling on a daily basis and/or experienced gambling harms had the highest risk.
Swedish municipalities carry out a variety of alcohol prevention activities, but there is little knowledge of how these have developed over time, due partly to the lack of tools for monitoring prevention activities locally. In this study Tony Nilsson, Håkan Leifman and Sven Andréasson develop an Alcohol Prevention Magnitude Measure (APMM) based on local data, and analyse the development of local alcohol prevention by using APMM. The results reveal that local alcohol prevention in Sweden, as measured by the APMM, has increased generally between 2006 and 2010 as a result of more local policies and activities.
The national Opiate Maintenance Treatment (OMT) program in Norway started officially in 1998. Edle Ravndal and Grethe Lauritzen investigate the prevalence of live OMT patients in the total sample after 10 years, and compare the outcome of primarily substance abuse, anxiety and depression among OMT patients versus non-OMT patients. The OMT-group reported to a larger extent more anxiety and depression throughout the total observation period than the non OMT participants. Use of heroin and criminality were significantly reduced in both groups, but the OMT patients had more difficulties in reducing the use of benzodiazepines and cannabis.
The treatment of prison inmates in the Nordic countries has been described as humane and welfare-oriented. Janne Henriette Ingarsdotter Helgesen explores how key actors working in 13 substance treatment units in Norwegian prisons assess the responsibilities, working methods and goal attainment of these units, and how their descriptions fit the idea of a Nordic exceptionalism. The main pattern that emerges from this study supports that welfare orientation and ideas about therapy and rehabilitation are priorities in work with imprisoned substance users in substance
In their perspective article, Mihal Miovsky and colleagues seek to identify, describe and explain important events in shaping the historical context where the Czech education in addiction science and conception of addictology were developed. Because of the Iron Curtain, Czech practitioners had to develop their own concept of addiction and ideas on training psychotherapists so they could not be labelled western or anti-state, or be subject to intense state control.
In our editorial Matilda Hellman deliberates differences between basic and applied research. In the social sciences researchers have become specialised experts inhabiting narrow compartments of knowledge production. What does this mean for the future alcohol and drug research?
<b>Ole Rogeberg</b> discusses how a public health approach sometimes fails to capture several concerns seen as important by recent drug policy reform movements, such as the full harms of illegal markets, the subjectively valued consumption of intoxicants, the dysfunctionality of current policy processes in the drug field and the value of the knowledge gained from policy experiments. Commentaries by Thomas Babor and Robin Room.
In Scandinavia, the use of the psychoactive plant khat is widely seen as a social and health problem exclusively affecting the Somali immigrant population. Johan Nordgren has analysed the khat abuse discourse as it is presented in evaluation reports describing projects initiated by the social services to reduce khat abuse. According to Nordgren, overreliance on cultural explanations overlooks socioeconomic issues and that the focus should be on potentially problematic patterns of khat use rather than Somali immigrants in general.
In this exploratory study, Mats Ekendahl and Patrik Karlsson analyse how Swedish adults trust and perceive risk information regarding alcohol, cigarettes and wet snuff (“snus”) provided by public authorities. The study suggests that attitudes on risk information are substance-specific and associated in complex ways with gender, age, education and experience of own substance use. The study indicates that the general population in Sweden receives what is seen as an adequate amount of knowledge from public authorities, and finds it consistent and trustworthy.
Combining survey and register-based data, Line Schou and Gunn Birkelund have studied whether there are differences in alcohol-related sickness absence according to socioeconomic status and family situation among young employees in Norway. They have also assessed whether differences can be attributed mainly to differences. The authors found that alcohol-related sickness absence is more common among people who are single and without children, and more common among men than women. With the exception of income, socioeconomic factors do not seem to be important. The differences between groups appeared to be only partly a result of different drinking patterns.
Using an ethnographic approach, Birgitta Ander and colleagues have explored arenas of adolescent binge drinking in small Swedish towns and the meanings these have for young persons. The focus of the article is on space and place, and on the geography of underage drinking. The authors found that adolescent binge drinkers have moved away from street and other outdoor drinking arenas to home environments, where they feel they have more control over their party location and participants.
What happened to the ‘first generation’ of drug Swedish users? In this Swedish language article <b>Susanne Alm</b> documents the social exclusion of drug users in Swedish society using a large data set of persons born in Stockholm in 1953 (Stockholm Birth Cohort Study). Very few of those with drug problems in their youth were able to establish a firm position in society in the long run. The article is followed by three commentaries in Swedish and Norwegian by Jessica Storbjörk, Edle Ravndal and Heini Kainulainen.
Based on 91 qualitative interviews and 6 months of observations in 12 prisons, in Denmark, Finland, Norway and Sweden, the authors study how prisoners experience drug treatment, control and sanctions. Hedda Giertsen, Per-Åke Nylander, Vibeke Asmussen Frank, Torsten Kolind and Jouni Tourunen found that staff relations are regarded as more important than treatment methods, while controls and sanctions are seen as a part of everyday life in prison.
Based on a year of participant observation this article describes life in an open illicit drug milieu in a Norwegian city. Trond Erik Grønnestad and Philip Lalander found that frequenting this stigmatized place with its everyday rituals is an expression of the need for dignity and human understanding among people who are regarded as urban outcasts.
Elke Emmers, Geertruida Elsiena Bekkering and Karin Hannes present an overview of recent systematic reviews, summarising the evidence on the effectiveness of prevention strategies that target substance misusing adolescents. There is a small but consistent positive effect of school-based prevention programmes.
In this cross-national focus group study Paolo Guidi and Matteo Di Placido ask thirty-five social workers employed in public social services in Stockholm, Malmö (Sweden), and Genoa (Italy) to assess and discuss a vignette story of underage alcohol consumption. The authors found that Italian social workers are in general more concerned and interventionist than are their Swedish colleagues who view teenage alcohol consumption as common behaviour.
How extensive is the non medical use of anabolic-androgenic steroids in the Nordic countries? Is it a public health problem? The analysis by <b>Dominic Sagoe</b> and colleagues included 32 studies that provided original data on 48 lifetime prevalence rates based on a total of 233,475 inhabitants from all five Nordic countries. Three commentaries are also available by Rafn Jónsson and Bilgrei och Sandøy with a reply from Sagoe och Pallesen. Kerstin Stenius also discusses the topic in her editorial.
The transition to adulthood tends to entail changes in consumption of alcohol and drugs. In this Norwegian longitudinal panel study, Christer Hyggen and Torild Hammer study the relationship between cannabis and alcohol use in relation to adult roles and responsibilities.
The population study by Torleif Halkjelsvik and Elisabet Storvoll use the AUDIT intrument to estimate the the proportion of the Norwegian population that according to the World Health Organization (WHO) guidelines should be followed up by primary health care, based on three levels of risk drinking. They found that 17% scored whithin these risk categories. (Abstract in English, article in Norwegian)
Allmänläkare är nyckelpersoner i bestämmandet av vad som betraktas som spelproblem. Författarna visar hur skillnaderna i problemdefinitioner verkar vara relaterade till vem som vårdar och hur spelandet regleras i tre länder: Finland, Frankrike och Tyskland. De pekar på hur viktigt det är att ha kulturell känslighet då man skapar rekommendationer för sociala interventioner. Studien baserar sig på fokusgruppsintervjuer.
Ulrika Haggård and her co-authors identify factors that promote or hinder implementation of a multicomponent Responsible Beverage Service programme in Swedish municipalities. Suggestions on how to elude some of the hindering factors are proposed, e.g. to develop long-time financial plans, to provide better information about the RBS program in full, and to stress the importance of collaboration between representatives from the municipalities, police authorities and owners of on-licenced premises.
This Finnish study by Harri Sarpavaara explores the meanings substance-abusing clients attach to family and friendships during motivational interviewing (MI) sessions in Probation Service. It is suggested that the meaning of significant others should not be overlooked in MI and other substance abuse treatment.