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  • 1.
    Ahlberg, Rickard
    et al.
    Örebro University, School of Medical Sciences.
    Skårberg, Kurt
    Örebro University, School of Medical Sciences. Addiction Center.
    Brus, Ole
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health Sciences.
    Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services2016In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 11, no 1, article id 24Article in journal (Refereed)
    Abstract [en]

    Background: A common alternative treatment for substance abuse is auricular acupuncture. The aim of the study was to evaluate the short and long-term effect of auricular acupuncture on anxiety, sleep, drug use and addiction treatment utilization in adults with substance abuse.

    Method: Of the patients included, 280 adults with substance abuse and psychiatric comorbidity, 80 were randomly assigned to auricular acupuncture according to the NADA protocol, 80 to auricular acupuncture according to a local protocol (LP), and 120 to relaxation (controls). The primary outcomes anxiety (Beck Anxiety Inventory; BAI) and insomnia (Insomnia Severity Index; ISI) were measured at baseline and at follow-ups 5 weeks and 3 months after the baseline assessment. Secondary outcomes were drug use and addiction service utilization. Complete datasets regarding BAI/ISI were obtained from 37/34 subjects in the NADA group, 28/28 in the LP group and 36/35 controls. Data were analyzed using Chi-square, Analysis of Variance, Kruskal Wallis, Repeated Measures Analysis of Variance, Eta square (η(2)), and Wilcoxon Signed Ranks tests.

    Results: Participants in NADA, LP and control group improved significantly on the ISI and BAI. There was no significant difference in change over time between the three groups in any of the primary (effect size: BAI, η(2) = 0.03, ISI, η(2) = 0.05) or secondary outcomes. Neither of the two acupuncture treatments resulted in differences in sleep, anxiety or drug use from the control group at 5 weeks or 3 months.

    Conclusion: No evidence was found that acupuncture as delivered in this study is more effective than relaxation for problems with anxiety, sleep or substance use or in reducing the need for further addiction treatment in patients with substance use problems and comorbid psychiatric disorders. The substantial attrition at follow-up is a main limitation of the study.

    Trial registration: Clinical Trials NCT02604706 (retrospectively registered).

  • 2.
    Baker, Jessica H.
    et al.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
    Brosof, Leigh C.
    Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA.
    Munn-Chernoff, Melissa A.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Maes, Hermine H.
    Department of Genetics, Virginia Commonwealth University, Richmond, Virginia, USA.
    Kendler, Kenneth S.
    Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA.
    Associations Between Alcohol Involvement and Drive for Thinness and Body Dissatisfaction in Adolescent Twins: A Bivariate Twin Study2018In: Alcoholism: Clinical and Experimental Research, ISSN 0145-6008, E-ISSN 1530-0277, Vol. 42, no 11, p. 2214-2223Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Alcohol involvement has familial associations with bulimic symptoms (i.e., binge eating, inappropriate compensatory behaviors), with several studies indicating a genetic overlap between the two. It is unclear whether overlapping familial risk with alcohol involvement extends to other eating disorder symptoms. Understanding the genetic overlap between alcohol involvement and other eating disorder symptoms may aid in more targeted interventions for comorbid alcohol use-eating disorder symptoms. Thus, we investigated associations between alcohol involvement and 2 core eating disorder symptoms: drive for thinness and body dissatisfaction in adolescent female and male twins.

    METHODS: We assessed 3 levels of alcohol involvement: alcohol use in the last month, having ever been intoxicated, and alcohol intoxication frequency via self-report. The Eating Disorder Inventory-II assessed drive for thinness and body dissatisfaction. Sex-specific biometrical twin modeling examined the genetic overlap between alcohol involvement and eating disorder symptoms.

    RESULTS: Phenotypic associations between alcohol involvement, drive for thinness, and body dissatisfaction were significantly greater in girls compared with boys. A majority of the associations between alcohol involvement, drive for thinness, and body dissatisfaction in girls, but not boys, met our threshold for twin modeling (phenotypic r > 0.20). Moderate genetic correlations were observed between the 3 aspects of alcohol involvement and drive for thinness. Moderate genetic correlations were observed between alcohol use and intoxication frequency and body dissatisfaction.

    CONCLUSIONS: Together with the literature on alcohol involvement and bulimic symptoms, these findings suggest a generalized association between alcohol involvement and eating disorder symptoms in girls, whereas this association may be symptom specific in boys. Genetic correlations indicate that the amount and direction of this genetic overlap differs across specific symptoms. When intervening on comorbid alcohol involvement and eating disorder symptoms, it may be important to target-specific eating disorder symptoms.

  • 3.
    Baker, Jessica H.
    et al.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA.
    Johnson, Nicole K.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA; Department of Psychology, Illinois Institute of Technology, Chicago Illinois, USA.
    Munn-Chernoff, Melissa A.
    Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Maes, Hermine H.
    Department of Genetics, Virginia Commonwealth University, Richmond Virginia, USA.
    Kendler, Kenneth S.
    Department of Psychiatry, Virginia Commonwealth University, Richmond Virginia, USA.
    Illicit Drug Use, Cigarette Smoking, and Eating Disorder Symptoms: Associations in an Adolescent Twin Sample2018In: Journal of Studies on Alcohol and Drugs, ISSN 1937-1888, E-ISSN 1938-4114, Vol. 79, no 5, p. 720-724Article in journal (Refereed)
    Abstract [en]

    Objective: Twin studies have shown that genetic factors in part explain the established relation between alcohol use (i.e., problematic use or abuse/dependence) and eating disorder symptoms in adolescent and adult females. However, studies have yet to elucidate if there are similar shared genetic factors between other aspects of substance involvement, such as illicit drug use and repeated cigarette smoking.

    Method: For those sex-specific phenotypic correlations above our threshold of.20, we used a behavioral genetic design to examine potential shared genetic overlap between self-reported lifetime illicit drug use and repeated cigarette smoking and the eating disorder symptoms of drive for thinness (DT), bulimia (BU), and body dissatisfaction (BD), as assessed with the Eating Disorder Inventory-II in 16- to 17-year-old female and male twin pairs.

    Results: Only phenotypic correlations with illicit drug use met our threshold for twin modeling. Small to moderate genetic correlations were observed between illicit drug use and BU in both girls and boys and between illicit drug use and in girls.

    Conclusions: Similar etiological factors are at play in the overlap between illicit drug use and certain eating disorder symptoms in girls and boys during adolescence, such that genetic factors are important for covariance. Specifically, illicit drug use was associated with bulimia nervosa symptoms in girls and boys, which parallels previous substance use research finding a genetic overlap between alcohol use and bulimia nervosa symptoms. Future research should prospectively examine developmental trajectories to further understand the etiological overlap between substance involvement and eating disorder symptoms.

  • 4. Bejerot, Susanne
    et al.
    Bejerot, Nils
    Representativitet i en studie av intravenöst missbruk bland arrestanter i Stockholm1984In: SCI: de två första verksamhetsåren / [ed] J. Ewers, J. Hartelius, Markaryd: Scipio , 1984, p. 90-97Chapter in book (Refereed)
  • 5.
    Bejerot, Susanne
    et al.
    Örebro University, School of Medical Sciences. Region Örebro län, Örebro.
    Glans, Martin
    Örebro University, School of Medical Sciences. Psykiatri sydväst, Region Stockholm.
    Fördelar och nackdelar med en legalisering av cannabis i Sverige [Legalization of cannabis - A Swedish perspective]2021In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, article id 20112Article in journal (Refereed)
    Abstract [en]

    While no European country has legalized recreational use of cannabis, several countries, but not Sweden, have decriminalized it. Although we hitherto have a relatively low prevalence of users compared to other countries, Swedish policy is criticized. Strong voices advocate legalization. It is hypothesized that a legalization would minimize adolescent access, ensure quality control, make consumption safer and raise tax revenue. Furthermore, it is assumed to diminish the illicit drug market and drug related crimes. However, the legalization in the US and Canada has instead made cannabis more available to users by innovative marketing and product development, while the illegal market persists. Meanwhile the price of cannabis decreases and potency, which are related to many of the risks, increases. Cannabis-related harms include e.g. cognitive impairment, psychosis and psychosocial problems. The long-term effects from legalization is yet to be seen.

  • 6.
    Berg, Venla
    et al.
    Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland; Population Research Institute, Väestöliitto, Helsinki, Finland.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Khemiri, Lotfi
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Latvala, Antti
    Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland.
    Parental alcohol and drug abuse and offspring mortality by age 10: a population-based register study2022In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 6, p. 933-938Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parental substance abuse (SA) of alcohol and drugs is associated with offspring mortality, including sudden infant death syndrome (SIDS), in infancy, but research on cause-specific mortality and mortality in later childhood is scarce.

    METHODS: Using population-based register data on all births in Sweden in 1973-2013 (N = 4.2 million) and Cox regressions, we examined the associations of mother's and father's SA registered between 2 years before and 12 years after the child birth with offspring all-cause and cause-specific mortality in infancy and childhood.

    RESULTS: Parental SA was associated with increased offspring all-cause and natural-cause mortality in infancy, but not in the neonatal period, and with external-cause mortality in ages 1-9. Risk of SIDS was 130-280% higher in infants with parental SA compared to infants with no parental SA. Adjusting for parental socioeconomic and immigrant status and severe psychiatric disorders, paternal SA was associated with 66% higher mortality due to communicable diseases and infections in infancy, and both maternal and paternal SA were associated with 40-174% higher mortality due to accidents in infancy and in ages 1-9. The associations between parental SA and offspring mortality were similar for male and female offspring.

    CONCLUSIONS: Child mortality is rare in contemporary Sweden, and parental SA has variable associations with elevated offspring mortality throughout the first 10 years of life, excluding the neonatal period, which is indicative of insufficient recognition of children at risk. Preventive measures should be long-term and targeted to both parental and offspring behaviour.

  • 7.
    Bisback, Athina
    et al.
    Department of Special Needs Education at the Faculty of Psychology and Educational Sciences, Ghent University, 9000 Ghent, Belgium.
    Vanderplasschen, Wouter
    Department of Special Needs Education at the Faculty of Psychology and Educational Sciences, Ghent University, 9000 Ghent, Belgium.
    Colins, Olivier F.
    Örebro University, School of Law, Psychology and Social Work. Department of Special Needs Education at the Faculty of Psychology and Educational Sciences, Ghent University, 9000 Ghent, Belgium.
    Differences in Offending Behaviors, Aggression, Substance Use, and Mental Health Problems between Male Drug Dealers and Non-Drug Dealers in Belgian Youth Detention Centers2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 24, article id 16390Article in journal (Refereed)
    Abstract [en]

    This study investigated whether drug dealing juvenile offenders in Belgium differ from non-drug dealers in levels of violent and non-violent offending behaviors, aggression, substance use, and mental health needs. The current study examined data from 226 16- to 17-year-old male juvenile offenders. Information relating to drug dealing, substance use, and mental health needs were collected through self-report questionnaires. A structured diagnostic interview was used to collect information about past violent and non-violent behaviors. Chi-square tests and multivariate analysis of variance compared non-dealers and dealers and explored if hard-drug dealers and soft-drug dealers differed from each other. Relative to non-drug dealers, drug dealers engaged in more violent offending behaviors, exhibited higher levels of aggression, substance use and oppositional defiant problems, and displayed lower levels of anxiety. Soft- and hard-drug dealers did not differ from each other. To conclude, detained drug dealers are characterized by severe antisocial behavior.

  • 8.
    Brunnberg, Elinor
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Lindén Boström, Margareta
    Örebro University, Department of Health Sciences.
    Berglund, Mats
    Lund University.
    School adjustment, self-rated health and substance use in -16 year old hard-of-hearing students: a comparative study : life and health : young people 20052007Conference paper (Other academic)
  • 9.
    Capusan, Andrea J.
    et al.
    Department of Psychiatry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Bendtsen, Preben
    Department of Medical Specialist and Department of Medicine and Health Sciences, Linköping University, Motala, Sweden.
    Marteinsdottir, Ina
    Centre for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Comorbidity of Adult ADHD and Its Subtypes With Substance Use Disorder in a Large Population-Based Epidemiological Study2019In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 23, no 12, p. 1416-1426Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of the study is to explore the role and possible substance preference in ADHD and subtypes in substance use disorder (SUD).

    Method: Using self-report data on ADHD Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) symptoms and SUD (alcohol, illicit drugs, and nicotine) in 18,167 Swedish twins, aged 20 to 45 years, we obtained odds ratios (OR) from mixed effect logistic regression, controlling for age, sex, education, and nonindependence of twin data.

    Results: Increased ADHD symptoms were significantly associated with increased odds for all SUD. ORs ranged between 1.33 for regular nicotine (95% confidence interval [CI] = [1.12, 1.59]); 2.54 for multiple drug use (95% CI = [2.00, 3.23]), and 3.58 for alcohol dependence (95% CI = [2.86, 4.49]).

    Conclusion: ADHD symptoms and subtypes in the population are associated with increased risks for all SUD outcomes, with no difference between ADHD subtypes, no substance preference, and no sex differences for the comorbidity. Clinicians need to consider ADHD evaluation and treatment as part of management of SUD in adults.

  • 10.
    Davey, Gareth
    et al.
    Research Centre for Languages and Cultures, School of Foreign Languages and Literature, Yunnan Normal University, Kunming, China.
    Zhao, Xiang
    Research Centre for Languages and Cultures, School of Foreign Languages and Literature, Yunnan Normal University, Kunming, China.
    Smoking and the City: A Travelogue in Yuxi2021In: Asia Pacific Journal of Anthropology, ISSN 1444-2213, E-ISSN 1740-9314, Vol. 22, no 1, p. 58-80Article in journal (Refereed)
    Abstract [en]

    We narrate our travel in a city with a prominent tobacco company to contribute to the literature on smoking and place. We show that in Yuxi, the location of the Hongta Group, China’s largest tobacco manufacturer, a smoker’s sense of self and of place is affectively, cognitively and socially tied to the tobacco industry. Tobacco-related symbolism in the city is highly visible and abundant. Smoking and tobacco are enmeshed in the fabric of the city and of people’s lives, an integrated and totalising phenomenon we characterise as ‘rhizomatic smoking’. Hence, we call for ‘rhizomatic tobacco control’ as a new direction for conceptualising the entirety of tobacco in society and for subjecting tobacco control in China to critical scrutiny.

    Download full text (pdf)
    Smoking and the City: A Travelogue in Yuxi
  • 11.
    Edwards, Alexis C.
    et al.
    Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond VA, USA.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Center for Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kendler, Kenneth S.
    Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond VA, USA.
    Early environmental influences contribute to covariation between internalizing symptoms and alcohol intoxication frequency across adolescence2011In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 36, no 3, p. 175-182Article in journal (Refereed)
    Abstract [en]

    The association between alcohol use and internalizing symptoms during adolescence varies across studies, and the causes underlying this association remain unclear. The current study examines the relationship between symptoms of anxiety and depression and intoxication frequency in a sample of Swedish twins assessed longitudinally from ages 13-14 to 19-20. The objectives of the study were to assess the stability of genetic and environmental influences on each trait across adolescence; to investigate whether these traits share genetic and/or environmental liabilities; and to explore quantitative changes in the shared liability over time. We found that the magnitude of genetic influences on internalizing symptoms remained relatively stable across adolescence, while their impact on intoxication frequency was dynamic. Symptoms of anxiety and depression were influenced by unique environmental factors, while both shared and unique environmental factors influenced intoxication frequency. Genetic and environmental innovation and attenuation were observed for both traits. While no significant genetic correlation was observed between traits, unique environmental factors did contribute to a shared liability. This environmental correlation was positive and moderate (r(E)=0.41) in the early assessment, but decreased and changed direction at later waves (r(E)=-.04 to -.01). The genetic and environmental factors underlying internalizing symptoms and intoxication frequency appear to be developmentally dynamic. Early environmental factors contribute to the association between these traits, but this shared liability diminishes across adolescence.

  • 12.
    Garcia-Argibay, Miguel
    Department of Behavioral Science, Faculty of Psychology , National University of Distance Education (UNED) , Madrid , Spain.
    The Relationship Between the Big Five Personality Traits, Impulsivity, and Anabolic Steroid Use2019In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 54, no 2, p. 236-246Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The increase in the prevalence of anabolic-androgenic steroids (AAS) use has been the subject of study in the last decades. Several studies indicated a strong association between the use of AAS and the performance of risky behaviors mediated by factors such as aggression, impulsivity, depression, and anxiety.

    OBJECTIVE: This study aimed to identify differences in personality trait, impulsivity, and the ability to delay gratification between AAS users and non-users that predispose or serve as a buffering mechanism against its usage and whether it is related to an increased likelihood of engaging in infidelity.

    METHODS: Two hundred and twelve male volunteers (88 AAS users), aged between 21 and 36 years (M = 28.22), completed self-report measures of personality, impulsivity, delayed gratification, and attitudes toward infidelity. Multivariate analysis of variance and logistic regression were conducted to establish differences between AAS users and non-users.

    RESULTS: The results showed that AAS users displayed an inability to delay gratification, a greater impulsivity, and a more benevolent attitude toward infidelity. AAS users obtained higher scores on openness and neuroticism, which was larger "off-cycle," although they presented lower scores on extraversion compared to the non-users group. Regression analysis revealed that neuroticism, impulsivity, and delaying gratification scores were significant predictors of AAS usage. In addition, impulsivity functioned as a partial mediator in the relationship between neuroticism and AAS use.

    CONCLUSION: The results of this research highlight a pivotal implication of impulsivity in AAS use in conjunction with neuroticism, openness, and extraversion traits.

  • 13.
    Geidne, Susanna
    et al.
    Örebro University, School of Health Sciences.
    Beckman, Linda
    School of Health Sciences, Örebro University, Örebro, Sweden.
    Edvardsson, Ingrid
    School of Health Sciences, Örebro University, Örebro, Sweden.
    Hulldin, Johanna
    Örebro University, School of Health Sciences.
    Prevalence and risk factors of electronic cigarette use among adolescents: Data from four Swedish municipalities2016In: Nordic Studies on Alcohol and drugs, ISSN 1458-6126, Vol. 33, no 3, p. 225-240Article in journal (Refereed)
    Abstract [en]

    Aims: To assess the prevalence rates and risk factors of electronic cigarette (e-cigarette) use, with special focus on e-cigarettes containing nicotine, among grade 9 students (aged 15–16 years) in four different municipalities in Sweden.

    Methods: A cross-sectional sample of 665 adolescents was collected in April 2014. The data was analysed using binary logistic regression analysis.

    Results: The results show that 26% of adolescents in this study have smoked e-cigarettes (have ever used), while 19% have smoked e-cigarettes with nicotine or do not know whether or not they contained nicotine. The strongest risk factor for ever having used e-cigarettes (any type or with nicotine) was smoking conventional cigarettes. Having tried cigarettes and having tried snus, as well as using or having used alcohol and having smoked a water pipe were also statistically significant risk factors for ever use of any type of e-cigarettes but not for use of e-cigarettes with nicotine. There was no gender difference.

    Conclsuisons: Our result show that the use of ecigarettes tends to cluster with the use of other substances, such as other tobacco products and alcohol. As a relatively large share of the participating adolescents, more than a fourth, had smoked e-cigarettes, this rather new phenomenon requires monitoring as a part of the tobacco control.

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    fulltext
  • 14.
    Glatz, Terese
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Koning, Ina M.
    Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands.
    The Outcomes of an Alcohol Prevention Program on Parents' Rule Setting and Self-efficacy: a Bidirectional Model2016In: Prevention Science, ISSN 1389-4986, E-ISSN 1573-6695, Vol. 17, no 3, p. 377-385Article in journal (Refereed)
    Abstract [en]

    Most adolescents have their first encounter with alcohol in early or middle adolescence. Parents' rule setting about alcohol has been shown to be important to delay the onset and reduce the frequency of adolescents' alcohol drinking, but less is known about the potential role of parents' beliefs about their competence in and ability to influence their adolescents' drinking habits (i.e., parental self-efficacy [PSE], Bandura (Psychological Review, 84, 191-215, 1977). In this study, we examined the direction of influence between parents' rule setting and PSE as outcomes of the program "Prevention of Alcohol use in Students" (PAS), a prevention program aiming to reduce underage drinking by targeting parents and adolescents both separately and in a combined intervention. We tested two mediation processes in which the program would (a) have a direct effect on PSE, which in turn would increase parents' rule setting or (b) have a direct effect on parents' rule setting, which in turn would increase PSE. To examine these processes, we used a sample of 2562 parent-adolescent dyads (age 12 at baseline), followed annually over 3 years. The results showed that the combined intervention increased PSE via an increase in parents' rule setting. No significant effect of the intervention on rules about alcohol via PSE was found. This is the first study to test the mediation processes involving PSE and parental rule setting in an experimental context where parenting practices are being actively changed. The results suggest that giving parents concrete advice on how to deal with alcohol drinking in their adolescents and at the same time helping adolescents to develop healthy attitudes about alcohol drinking have a positive influence on parents' self-efficacy.

    Download full text (pdf)
    The Outcomes of an Alcohol Prevention Program on Parents’ Rule Setting and Self-efficacy: A Bidirectional Model
  • 15.
    Gyllencreutz, Emelie
    et al.
    Clinical Neuroscience, University of Gothenburg Institute of Neuroscience and Physiology, Skövde, Sweden .
    Aring, Eva
    Clinical Neuroscience, University of Gothenburg Institute of Neuroscience and Physiology, Skövde, Sweden.
    Landgren, Valdemar
    Gillberg Neuropsychiatry Centre, University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden.
    Landgren, Magnus
    Gillberg Neuropsychiatry Centre, University of Gothenburg Institute of Neuroscience and Physiology, Göteborg, Sweden.
    Andersson Grönlund, Marita
    Clinical Neuroscience, University of Gothenburg Institute of Neuroscience and Physiology, Skövde, Sweden.
    Thinner retinal nerve fibre layer in young adults with foetal alcohol spectrum disorders2021In: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 105, no 6, p. 850-855Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/AIMS: Ophthalmological abnormalities such as ptosis, strabismus, refractive errors and optic nerve hypoplasia have been reported in foetal alcohol spectrum disorders (FASD). The purpose of this study was to investigate whether retinal thickness, retinal nerve fibre layer (RNFL) and optic disc area (ODA) differ between individuals with FASD and healthy controls.

    METHODS: Best-corrected visual acuity (BCVA) in terms of logarithm of the minimum angle of resolution (logMAR), refraction, and fundus variables measured by optical coherence tomography were obtained from 26 young adults with FASD (12 women, median age 23 years) and 27 controls (18 women, median age 25 years).

    RESULTS: The total thickness of the peripapillary RNFL was significantly lower in the FASD group than in controls; median (range) in the right/left eye was 96.5 (60-109)/96 (59-107) µm in the FASD group and 105 (95-117)/103 (91-120) µm among controls (p=0.001 and p=0.0001). Macular RNFL and retinal thickness measurements from the FASD group were also lower in most of the nine ETDRS areas, except for the central parts. Median (range) BCVA in the best eye was 0.00 (-0.1-0.3) logMAR in the FASD group and 0.00 (-0.2-0.0) logMAR in controls (p=0.001). No significant differences between the groups were found regarding ODA or refraction.

    CONCLUSION: Significant differences in peripapillary and macular RNFL, retinal thickness and BCVA were found in this group of young adults with FASD compared with healthy controls. However, there were no differences in the size of the optic disc.

  • 16.
    Gyllencreutz, Emelie
    et al.
    Department of Ophthalmology, Region Västra Götaland, Skaraborg Hospital, Skövde, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Aring, Eva
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden.
    Landgren, Valdemar
    Department of Psychiatry, Region Västra Götaland, Skaraborg Hospital, Skövde, Sweden; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Landgren, Magnus
    Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Region Västra Götaland, Skaraborg Hospital, Mariestad, Sweden.
    Andersson Grönlund, Marita
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden.
    Visual perception problems and quality of life in young adults with foetal alcohol spectrum disorders2022In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 100, no 1, p. e115-e121Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate visual perception problems (VPPs), health-related quality of life (HRQoL) and vision-related quality of life (VRQoL) in young adults with foetal alcohol spectrum disorders (FASD) and to compare the results with healthy controls.

    Methods: Thirty young adults with FASD (13 female; mean age 23 years) and 29 controls (20 female; mean age 25 years) participated. Five areas of VPPs were assessed by a structured history-taking. In the FASD group, VPPs were investigated both in childhood (mean age 8 years) and in early adulthood in a prospective follow-up. Health-related quality of life (HRQoL) was investigated with the Pediatric Quality of Life Inventory™ (PedsQL) and VRQoL with the 25-item Visual Function Questionnaire (VFQ-25).

    Results: Visual perception problems (VPPs) in at least one area were reported by 16/30 FASD participants (53%) and 1/29 controls (3%) (p = 0.0001, Fisher's exact test), with a similar rate in the same individuals in childhood as in early adulthood (8/27 and 15/27, respectively p = 0.09, McNemar's test). PedsQL total score was lower in the FASD group (n = 20; median: 83; 95% confidence interval (CI) 76-88) compared with controls (n = 29; median: 91; 95% CI 90-95; p = 0.0001, Mann-Whitney U-test). VFQ-25 subscale general vision indicated lower VRQoL in the young adults with FASD (n = 19; median: 80; 95% CI 80-100) compared with controls (n = 29; median: 100; 95% CI 100-100; p = 0.003).

    Conclusion: Young adults with FASD in the present study had more VPPs and worse VRQoL and HRQoL than healthy controls. In the FASD group, VPPs were reported in childhood as well as in early adulthood.

  • 17.
    Kelly, Adrian B.
    et al.
    Centre for Inclusive Education, Queensland University of Technology, Brisbane, Australia; School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia; Centre for Child Health and Well-being (Childhood Adversity, Mental Health, and Resilience Theme), Queensland University of Technology, Brisbane, Australia.
    Munnings, Andrew
    School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia.
    Zhao, Xiang
    Örebro University, School of Behavioural, Social and Legal Sciences. School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia.
    Rowland, Bosco
    School of Psychology and Centre for Social and Early Emotional Development, Deakin University, Melbourne, Australia; Faculty of Medicine and the Eastern Health Clinical School, Monash University, Melbourne, Australia.
    Laurens, Kristin R.
    Centre for Inclusive Education, Queensland University of Technology, Brisbane, Australia; School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia; Centre for Child Health and Well-being (Childhood Adversity, Mental Health, and Resilience Theme), Queensland University of Technology, Brisbane, Australia.
    Campbell, Marilyn
    Centre for Inclusive Education, Queensland University of Technology, Brisbane, Australia; School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia.
    Williams, Joanne
    School of Health, Swinburne University of Technology, Melbourne, Australia.
    Bailey, Jen A.
    Social Developmental Research Group, University of Washington, Seattle, WA, USA.
    Killingly, Callula
    Centre for Inclusive Education, Queensland University of Technology, Brisbane, Australia; School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia.
    Abimanyi-Ochom, Julie
    School of Health and Social Development, Deakin University, Melbourne, Australia.
    Kremer, Peter
    School of Exercise and Nutrition Sciences and Centre for Sport Research, Deakin University, Melbourne, Australia.
    Toumbourou, John W.
    School of Psychology and Centre for Social and Early Emotional Development, Deakin University, Melbourne, Australia.
    Polydrug use in Australian 12-14 year olds from 2006 to 2017: an examination of drug use profiles, emotional control problems, and family relationship characteristics2023In: Australian journal of psychology, ISSN 0004-9530, E-ISSN 1742-9536, Vol. 75, no 1, article id 2174705Article in journal (Refereed)
    Abstract [en]

    Objective: This study examined the nature and prevalence of polydrug use in 12–14 year old Australians.

    Method: Three Australian school surveys (2006, n=4091; 2009, n=5635; 2017, n=1539; age 12–14 years) spanning 11 years were used. Substances included alcohol, tobacco, cannabis, inhalant, and other illicit substances. Risk factors included depressed mood, low emotional control, poor family management and conflict, and academic performance. Latent class analysis was used to discern classes. Regression analyses were used to test the association of risk factors with classes.

    Results: Consistent across surveys, there was a class of adolescents who engaged in wide-ranging polydrug use, with prevalences ranging from 0.44% (2006) to 1.78% (2017). Emotional control problems, low academic performance, and poor family management were elevated in the polydrug class.

    Conclusion: A small proportion of 12–14-year-old adolescents engage in polydrug use. Interventions focusing on family risks and emotional control problems may be beneficial.

  • 18.
    Kennedy, Beatrice
    et al.
    Örebro University, School of Medical Sciences. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Ruoqing, Chen
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Valdimarsdottir, Unnur
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Department of Epidemiology and Public Health, University College London, London, UK; Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Low stress resilience in late adolescence and risk of smoking, high alcohol consumption and drug use later in life2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 6, p. 469-501Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While compromised stress resilience constitutes a recognised risk factor for somatic and psychiatric disease development in general, the knowledge about how individual variation in vulnerability to stress may specifically influence the long-term risks of disadvantageous health behaviours is limited.

    METHODS: In this Swedish cohort study, we aimed to investigate the association between stress resilience in late adolescence and adult use of addictive substances. We included 9381 men with information on psychological stress resilience measured during military conscription examinations, who later responded to an extensive health survey (mean age 34.0±7.2 years) including detailed information on substance use. We modelled continuous outcomes using linear regression, binary outcomes with logistic regression and other categorical outcomes with multinomial logistic regression.

    RESULTS: We found that low stress resilience in adolescence conferred increased risks of all studied measures of addictive behaviour. After adjusting for childhood socioeconomic information, low stress resilience was associated with adult current regular smoking (relative risk ratio: 5.85, 95% CI 4.32 to 7.93), higher nicotine dependence scores (beta: 0.76, 95% CI 0.29 to 1.23), hazardous use of alcohol (>14 alcoholic drink-equivalents per week, OR: 1.72, 95% CI 1.37 to 2.16), DSM-IV criteria for alcohol dependence (OR: 1.74, 95% CI 1.35 to 2.25), and drug use (OR: 1.77, 95% CI 1.51 to 2.08). The results remained largely unchanged after further adjustments for adult educational attainment and occupation as well as for additional conscription covariates.

    CONCLUSION: Low stress resilience in late adolescence appears to be associated with an increased risk of disadvantageous and addictive health behaviours in adulthood.

  • 19.
    Khemiri, Lotfi
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Butwicka, Agnieszka
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway; Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland.
    Tideman, Magnus
    Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden; School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    D'Onofrio, Brian M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
    Latvala, Antti
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Parental substance use disorder and risk of intellectual disability in offspring in Sweden: a national register study2023In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 63, article id 102170Article in journal (Refereed)
    Abstract [en]

    Background: Intellectual disability (ID) is a disorder with unknown aetiology in many cases. Maternal alcohol use is a known risk factor for ID, but less is known about the importance of maternal and paternal substance use disorder (SUD) and risk of ID in offspring.

    Methods: Data from multiple nationwide registers were used to create a cohort of children born from January 01, 1978 to December 31, 2002. All participants were born in Sweden, had available parental identification information and did not emigrate or die before age 12 (n = 1,940,820). Logistic regression modelling was performed with exposure defined as having a parent who received any SUD diagnosis, including alcohol use disorder (AUD) and drug use disorder (DUD). The outcome was registration of diagnosis of any form of ID. First, we analysed the risk of ID if parental SUD was registered prior to childbirth with stepwise adjustment of multiple covariates. Second, the effect of timing of SUD diagnosis in relation to childbirth was analysed.

    Findings: Of 37,410 offspring with parental SUD registered prior to birth, 3.0% (n = 1110) had any form of ID compared to 1.2% (n = 23,168) of those 1,903,410 individuals without parental SUD prior birth. Parental SUD prior birth was associated with an increased risk of any form of ID (Odds Ratio [OR]: 2.3 [2.2-2.5]), with ORs similar for maternal (OR: 2.3 [2.1-2.5]) and paternal SUD (OR: 2.3 [2.1-2.5]). These ORs were reduced but remained statistically significant after adjusting for parental education, migration, psychiatric comorbidity, and co-parent SUD (OR parental SUD: 1.6 [1.5-1.8]; OR maternal SUD: 1.4 [1.2-1.5]; OR paternal SUD: 1.6 [1.5-1.7]). Parental SUD was associated with increased risk of ID in offspring irrespective of timing of diagnosis, but if mothers or fathers were diagnosed with AUD during pregnancy (OR maternal AUD: 5.0 [3.1-8.2]; OR paternal AUD: 2.8 [2.2-3.6]), the risk was significantly greater than if the AUD diagnosis was first registered after childbirth (OR maternal AUD: 1.9 [1.8-2.0]; OR paternal AUD: 1.6 [1.6-1.7]).

    Interpretation: Both paternal and maternal SUD were associated with an increased risk of ID in offspring, with greatest risk observed when AUD was diagnosed during pregnancy. Possible mechanisms may involve shared genetic and environmental factors, including toxic effects from alcohol intake. These findings have clinical implications in suggesting that parental SUD in either parent represents a possibly modifiable risk factor to consider when developing prevention, diagnostics and treatment programs for children with ID.

  • 20.
    Khemiri, Lotfi
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    D'Onofrio, Brian M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jayaram-Lindström, Nitya
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden.
    Latvala, Antti
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
    Association of parental substance use disorder with offspring cognition: a population family-based study2020In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 115, no 2, p. 326-336Article in journal (Refereed)
    Abstract [en]

    AIMS: To assess whether parental substance use disorder (SUD) is associated with lower cognitive ability in offspring, and whether the association is independent of shared genetic factors.

    DESIGN: A population family-based cohort study utilizing national Swedish registries. Linear regression with increased adjustment of covariates was performed in the full population. In addition, the mechanism of the association was investigated with children-of-sibling analyses using fixed-effects regression with three types of sibling parents with increasing genetic relatedness (half-siblings, full siblings and monozygotic twins).

    SETTING AND PARTICIPANTS: A total of 3 004 401 people born in Sweden between 1951 and 1998.

    MEASUREMENTS: The exposure variable was parental SUD, operationalized as having a parent with life-time SUD diagnosis or substance-related criminal conviction in the National Patient Register or Crime Register, respectively. Outcomes were cognitive test score at military conscription and final school grades when graduating from compulsory school. Covariates included in the analyses were sex, birth year, parental education, parental migration status and parental psychiatric comorbid diagnoses.

    FINDINGS: In the full population, parental SUD was associated with decreased cognitive test stanine scores at conscription [4.56, 95% confidence interval (CI) = 4.55-4.57] and lower Z-standardized school grades (-0.43, 95% CI = -0.43 to -0.42) compared to people with no parental SUD (cognitive test: 5.17, 95% CI = 5.17-5.18; grades: 0.09, 95% CI = 0.08-0.09). There was evidence of a dose-response relationship, in that having two parents with SUD (cognitive test: 4.17, 95% CI = 4.15-4.20; grades: -0.83, 95% CI = -0.84 to -0.82) was associated with even lower cognitive ability than having one parent with SUD (cognitive test: 4.60, 95% CI = 4.59-4.60; grades: -0.38, 95% CI = -0.39 to -0.380). In the children-of-siblings analyses when accounting for genetic relatedness, these negative associations were attenuated, suggestive of shared underlying genetic factors.

    CONCLUSIONS: There appear to be shared genetic factors between parental substance use disorder (SUD) and offspring cognitive function, suggesting that cognitive deficits may constitute a genetically transmitted risk factor in SUD.

  • 21.
    Landgren, Valdemar
    et al.
    Psychiatry, Skaraborg Hospital Skövde, Skövde, Sweden; Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.
    Svensson, Leif
    Pediatrics, Skaraborg Hospital Mariestad, Mariestad, Sweden.
    Gyllencreutz, Emelie
    Ophthalmology, Skaraborg Hospital Skövde, Skövde, Sweden; Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Aring, Eva
    Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.
    Andersson Grönlund, Marita
    Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.
    Landgren, Magnus
    Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden; Pediatrics, Skaraborg Hospital Mariestad, Mariestad, Sweden.
    Fetal alcohol spectrum disorders from childhood to adulthood: a Swedish population-based naturalistic cohort study of adoptees from Eastern Europe2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 10, article id e032407Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fetal alcohol spectrum disorders (FASD) are a global health concern. To further understand FASD in adulthood is a major public health interest.

    OBJECTIVE: To describe the clinical characteristics of young adults with FASD adopted from orphanages to a socially more favourable and stable rearing environment as children.

    DESIGN: Prospective observational cohort study SETTING: Western Sweden PARTICIPANTS: A population-based cohort of 37 adoptees diagnosed with FASD in childhood.

    OUTCOME MEASURES: Assessment consisted of clinical evaluations of social, medical, psychiatric, neuropsychological, adaptive and ophthalmological status by a physician, ophthalmologist, orthoptist and psychologist.

    RESULTS: Out of 37 adoptees with FASD, 36 (15 females) were evaluated at a median age of 22 years (range 18-28) and a mean follow-up time of 15.5 years (range 13-17). Twenty (56%) were dependent on social support. Sexual victimisation was reported by nine (26%). In 21 individuals with fetal alcohol syndrome, growth restriction in height and head circumference of approximately -1.8 SD persisted into adulthood. Of 32 examined, 22 (69%) had gross motor coordination abnormalities. High blood pressure was measured in nine (28%). Ophthalmological abnormalities were found in 29 of 30 (97%). A median IQ of 86 in childhood had declined significantly to 71 by adulthood (mean difference: 15.5; 95% CI 9.5-21.4). Psychiatric disorders were diagnosed in 88%, most commonly attention deficit hyperactivity disorder (70%). Three or more disorders were diagnosed in 48%, and 21% had attempted suicide. The median Clinical Global Impression-Severity score was 6 = 'severely ill'.

    CONCLUSION: Major cognitive impairments, psychiatric morbidity, facial dysmorphology, growth restriction and ophthalmological abnormalities accompanies FASD in adulthood. Recognition of FASD in childhood warrants habilitation across the lifespan.

  • 22.
    Larsson, Matz
    Hjärt–lungfysiologiska kliniken, Universitetssjukhuset Örebro, Örebro; Kliniskt centrum för hälsofrämjande vård, Lunds universitet, Lund.
    Nikotin, alkohol och opioider samverkar vid beroendeutveckling: [Nicotine, alcohol and opioids - three interacting substances]2022In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 119, p. 4-5, article id 20212Article in journal (Refereed)
    Abstract [sv]

    Nicotine users are at greater risk of developing alcohol dependence. Conversely, alcohol is often consumed when young people test tobacco. The prevalence of smokers is high among alcohol dependent individuals and people who overconsume alcohol get more nicotine withdrawal symptoms when trying to quit tobacco and are less likely to succeed. Alcohol as well as smoking provides a high burden of disease, and combined use often causes multiplier damage effects. Alcohol dependent persons die more often from smoking-related illness than from alcohol. Nicotine cessation is more successful if alcohol advice is included. Cross-tolerance and other interactions between nicotine and opioids increase the likelihood of dependence. Tobacco smokers need higher opioid doses against pain. Despite evidence of association between smoking and chronic pain, understanding of causality is limited. Smoking is associated with an increased risk of opioid dependence. Nicotine is recognized as an important underlying factor. Further research in humans concerning the interactions between nicotine and opioids is urgent. Treatment of nicotine dependence in the medical management of opioid dependence seems promising, but at what point in the course - simultaneously, shortly after, or far behind - has yet to be determined.

  • 23.
    Larsson, Matz
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Cardiology-Lung Clinic, Örebro University Hospital, Örebro, Sweden.
    Damberg, Mattias
    Primärvård, psykiatri och habiliteringsverksamhet stab, Region Västmanland, Västerås, Sweden.
    Tobaksberoende2017In: Läkemedelsboken, Läkemedelsverket , 2017Chapter in book (Other academic)
  • 24.
    Latvala, Antti
    et al.
    Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    D'Onofrio, Brian M
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
    Jayaram-Lindström, Nitya
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Association of parental substance misuse with offspring substance misuse and criminality: a genetically informed register-based study2022In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 52, no 3, p. 496-505Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Genetically informed studies have provided mixed findings as to what extent parental substance misuse is associated with offspring substance misuse and antisocial behavior due to shared environmental and genetic factors.

    METHODS: We linked data from nationwide registries for a cohort of 2 476 198 offspring born in Sweden 1958-1995 and their parents. Substance misuse was defined as International Classification of Diseases diagnoses of alcohol/drug use disorders or alcohol/drug-related criminal convictions. Quantitative genetic offspring-of-siblings analyses in offspring of monozygotic and dizygotic twin, full-sibling, and half-sibling parents were conducted.

    RESULTS: Both maternal and paternal substance misuse were robustly associated with offspring substance misuse [maternal adjusted hazard ratio (aHR) = 1.83 (95% confidence interval (CI) 1.80-1.87); paternal aHR = 1.96 (1.94-1.98)] and criminal convictions [maternal aHR = 1.56 (1.54-1.58); paternal aHR = 1.66 (1.64-1.67)]. Additive genetic effects explained 42% (95% CI 25-56%) and 46% (36-55%) of the variance in maternal and paternal substance misuse, respectively, and between 36 and 44% of the variance in substance misuse and criminality in offspring. The associations between parental substance misuse and offspring outcomes were mostly due to additive genetic effects, which explained 54-85% of the parent-offspring covariance. However, both nuclear and extended family environmental factors also contributed to the associations, especially with offspring substance misuse.

    CONCLUSIONS: Our findings from a large offspring-of-siblings study indicate that shared genetic influences mostly explain the associations between parental substance misuse and both offspring substance misuse and criminality, but we also found evidence for the contribution of environmental factors shared by members of nuclear and extended families.

  • 25.
    Latvala, Antti
    et al.
    Department of Public Health, University of Helsinki, Helsinki, Finland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    D'Onofrio, Brian M.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington IN, USA.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Cognitive ability and risk for substance misuse in men: genetic and environmental correlations in a longitudinal nation-wide family study2016In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 111, no 10, p. 1814-1822Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the association in males between cognitive ability in late adolescence and subsequent substance misuse-related events, and to study the underlying genetic and environmental correlations.

    Design: A population-based longitudinal study with three different family-based designs. Cox proportional hazards models were conducted to investigate the association at the individual level. Bivariate quantitative genetic modelling in (1) full brothers and maternal half-brothers, (2) full brothers reared together and apart and (3) monozygotic and dizygotic twin brothers was used to estimate genetic and environmental correlations.

    Setting: Register-based study in Sweden.

    Participants: The full sample included 1 402 333 Swedish men born 1958-91 and conscripted at mean age 18.2 [standard deviation (SD) = 0.5] years. A total of 1 361 066 men who had no substance misuse events before cognitive assessment at mandatory military conscription were included in the Cox regression models, with a follow-up time of up to 35.6 years.

    Measures Cognitive ability was assessed at conscription with the Swedish Enlistment Battery. Substance misuse events included alcohol- and drug-related court convictions, medical treatments and deaths, available from governmental registries.

    Findings: Lower cognitive ability in late adolescence predicted an increased risk for substance misuse events [hazard ratio (HR) for a 1-stanine unit decrease in cognitive ability: 1.29, 95% confidence interval (CI) = 1.29-1.30]. The association was somewhat attenuated within clusters of full brothers (HR = 1.21, 95% CI = 1.20-1.23). Quantitative genetic analyses indicated that the association was due primarily to genetic influences; the genetic correlations ranged between -0.39 (95% CI = -0.45, -0.34) and -0.52 (95% CI -0.55, -0.48) in the three different designs.

    Conclusions: Shared genetic influences appear to underlie the association between low cognitive ability and subsequent risk for substance misuse events among Swedish men.

  • 26.
    Maghsoudlou, Siavash
    et al.
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden.
    Cnattingius, Sven
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Solna, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Aarabi, Mohsen
    Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
    Semnani, Shahriar
    Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
    Wikström, Anna-Karin
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden; Department of Women’s and Children ’s Health, Uppsala University, Uppsala, Sweden.
    Bahmanyar, Shahram
    Clinical Epidemiology Unit & Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institute Solna, Stockholm, Sweden.
    Opium use during pregnancy and risk of preterm delivery: A population-based cohort study2017In: PLOS ONE, E-ISSN 1932-6203, Vol. 12, no 4, article id e0176588Article in journal (Refereed)
    Abstract [en]

    Background: Use of narcotic or "recreational" drugs has been associated with adverse pregnancy outcomes such as preterm delivery. However, the associations might be confounded by other factors related to high-risk behaviours. This is the first study to investigate the association between traditional opium use during pregnancy and risk of preterm delivery.

    Method and findings: We performed a population-based cohort study in the rural areas of the Golestan province, Iran between 2008 and 2010. We randomly selected 920 women who used (usually smoked) opium during pregnancy and 920 women who did not. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the associations between the opium use during pregnancy and preterm delivery and adjustment was made for potential confounding factors. This study shows compared with non-use of opium and tobacco, use of only opium during pregnancy was associated with an increased risk of preterm delivery (OR = 1.56; 95% CI 1.05-2.32), and the risk was more than two-fold increased among dual users of opium and tobacco (OR = 2.31; 95% CI 1.37-3.90). We observed that opium use only was associated with a doubled risk for preterm caesarean delivery (OR = 2.05; 95% CI 1.10-3.82) but not for preterm vaginal delivery (OR = 1.25; 95% CI 0.75-2.07). Dual use of opium and tobacco was associated with a substantially increased risk of vaginal preterm delivery (OR = 2.58; 95% CI 1.41-4.71).

    Conclusions: Opium use during pregnancy among non-tobacco smokers is associated with an increased risk of preterm caesarean delivery, indicating an increased risk of a compromised foetus before or during labour. Women who use both opium and smoked during pregnancy have an increased risk of preterm vaginal delivery, indicating an increased risk of spontaneous preterm delivery.

  • 27.
    Martin, Cederlöf
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sjölander, Arvid
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Östberg, Per
    Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Lundström, Sebastian
    Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden; Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Gothenburg, Sweden.
    Kelleher, Ian
    Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    A longitudinal study of adolescent psychotic experiences and later development of substance use disorder and suicidal behavior2017In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 181, p. 13-16Article in journal (Refereed)
    Abstract [en]

    Introduction: Psychotic experiences are associated with later substance use disorder and suicidal behavior, but individual psychotic experiences have not been examined in a longitudinal data set. Also, the potential dose-response relationship between these phenomena remains unknown.

    Method: Cohort study including 9242 adolescents who participated in The Child and Adolescent Twin Study in Sweden (CATSS). At ages 15 and/or 18, seven psychotic experiences (auditory and visual hallucinations, and five delusions) were assessed via questionnaires. Outcomes at follow-up were physician-assigned diagnoses of substance use disorder and suicide attempts ascertained from the Swedish Patient Register. Associations were estimated with Cox regressions and expressed as hazard ratios.

    Results: All psychotic experiences were associated with later substance use disorder and/or suicide attempts, with hazard ratios ranging from 1.6 to 3.0. A dose-response relationship was observed between psychotic experiences and later substance use disorder, and suicide attempt.

    Discussion: Auditory and visual hallucinations as well as delusions in adolescence are associated with later development of substance use disorder and suicide attempt, and there is a dose-response relationship between the load of psychotic experiences and these adverse outcomes. Clinicians should assess subclinical hallucinations as well as delusions in psychiatric evaluations of adolescents.

  • 28.
    Nylander, Ingrid
    et al.
    Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden.
    Todkar, Aniruddha
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Granholm, Linnea
    Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden.
    Vrettou, Maria
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bendre, Megha
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Boon, Wout
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Andershed, Henrik
    Örebro University, School of Law, Psychology and Social Work.
    Tuvblad, Catherine
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, University of Southern California, Los Angeles, USA.
    Nilsson, Kent W.
    Centre for Clinical Research, Västerås Central Hospital, Västerås, Sweden.
    Comasco, Erika
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Evidence for a Link Between Fkbp5/FKBP5, Early Life Social Relations and Alcohol Drinking in Young Adult Rats and Humans2017In: Molecular Neurobiology, ISSN 0893-7648, E-ISSN 1559-1182, Vol. 54, no 8, p. 6225-6234Article in journal (Refereed)
    Abstract [en]

    Alcohol misuse has been linked to dysregulation of stress, emotion, and reward brain circuitries. A candidate key mediator of this association is the FK506-binding protein (FKBP5), a negative regulator of the glucocorticoid receptor. The aim of the present study was to further understand the Fkbp5/FKBP5-related genetic underpinnings underlying the relationship between early life social relations and alcohol drinking. The effect of maternal separation and voluntary alcohol drinking on Fkbp5 expression was investigated in the brain of young adult rats, whereas the interaction effect of the functional FKBP5 single nucleotide polymorphism rs1360780 genotype and parent-child relationship on problematic drinking was examined in young adult humans. In rats, Fkbp5 expression in the nucleus accumbens and ventral tegmental area, core regions of the reward system, was affected in a region-dependent manner and in opposite direction by maternal separation and alcohol drinking. Fkbp5 expression in the cingulate cortex was affected by the combined effect of maternal separation and alcohol drinking. In humans, the TT genotype, in the presence of a poor relationship between the child and parents, was associated with problematic drinking behavior. The present findings suggest that Fkbp5 expression in mesocorticolimbic dopaminergic regions associates with early life stress-mediated sensitivity to alcohol drinking and that FKBP5 genotype interacts with parent-child relationship to influence alcohol drinking. These findings are the first to point to a role of FKBP5 in propensity to alcohol misuse and call for studies of the underlying molecular mechanisms to identify potential drug targets.

  • 29.
    Pergolizzi, Joseph
    et al.
    Pain Medicine, NEMA Research, Inc., Naples, USA.
    LeQuang, Jo Ann K.
    Scientific Communications, NEMA Research, Inc., Naples, USA.
    Vortsman, Eugene
    Opiate Task Force, Northwell Health, Long Island Jewish Medical Center, New York, USA.
    Magnusson, Peter
    Örebro University, School of Medical Sciences.
    El-Tallawy, Salah N.
    Anesthesia and Pain Management, Faculty of Medicine Minia University and National Cancer Institute, Cairo University, Cairo, EGY; Anesthesia, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, SAU.
    Wagner, Morgan
    Entrepreneur Program, NEMA Research, Inc., Naples, USA.
    Salah, Rania
    Medicine, Alfaisal University College of Medicine, Riyadh, SAU.
    Varrassi, Giustino
    Pain Medicine, Paolo Procacci Foundation, Rome, ITA.
    The Emergence of the Old Drug Captagon as a New Illicit Drug: A Narrative Review2024In: Cureus, E-ISSN 2168-8184, Vol. 16, no 2, article id e55053Article, review/survey (Refereed)
    Abstract [en]

    First developed in the 1960s in Europe and approved briefly for use in the United States, fenethylline (sold as Captagon, one of its early trade names) is now a prominent drug of abuse in the Eastern Mediterranean Region. The drug was withdrawn from the United States market because of side effects that included hallucinations, visual distortions, and psychosis; it has also been linked to rare cases of myocardial infarction, seizures, and delusions. The chemical synthesis of fenethylline is straightforward and inexpensive. Manufactured in clandestine labs in Southern Europe and the Middle East, these amphetamines had been used by affluent Middle Eastern young people for recreation or study aids. Captagon has periodically emerged as a drug used in combat and conflict, and it was implicated in the 2015 riots in Paris. It has been described as "chemical courage" for combatants giving them focus, energy, and endurance in battle situations. Captagon is addictive but no cases of direct captagon-associated mortality have been reported. The use of drugs in war is nothing new, but captagon is also used heavily in the civilian population in war-torn areas to help them cope with food insecurity and maintain courage in dangerous situations. Captagon production and distribution drives the Syrian economy, but the drug's use is limited to certain regions and is rarely seen in North America. The drug is available online, but product may be contaminated with the inclusion of procaine, caffeine, or other substances.

  • 30.
    Podéus, Henrik
    et al.
    Department of Biomedical Engineering (IMT), Linköping University, Linköping, Sweden.
    Simonsson, Christian
    Department of Biomedical Engineering (IMT), Linköping University, Linköping, Sweden; Center for Medicine Imaging and Visualization Science (CMIV), Linköping University, Linköping, Sweden.
    Nasr, Patrik
    Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden; Wallenberg Center for Molecular Medicine, Linköping University, Linköping, Sweden.
    Ekstedt, Mattias
    Center for Medicine Imaging and Visualization Science (CMIV), Linköping University, Linköping, Sweden; Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden.
    Kechagias, Stergios
    Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden.
    Lundberg, Peter
    Center for Medicine Imaging and Visualization Science (CMIV), Linköping University, Linköping, Sweden; Department of Radiation Physics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Lövfors, William
    Örebro University, School of Medical Sciences. Department of Biomedical Engineering (IMT), Linköping University, Linköping, Sweden; Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Cedersund, Gunnar
    Örebro University, School of Medical Sciences. Department of Biomedical Engineering (IMT), Linköping University, Linköping, Sweden; Center for Medicine Imaging and Visualization Science (CMIV), Linköping University, Linköping, Sweden; Inflammatory Response and Infection Susceptibility Centre (iRiSC), Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    A physiologically-based digital twin for alcohol consumption-predicting real-life drinking responses and long-term plasma PEth2024In: npj Digital Medicine, E-ISSN 2398-6352, Vol. 7, no 1, article id 112Article in journal (Refereed)
    Abstract [en]

    Alcohol consumption is associated with a wide variety of preventable health complications and is a major risk factor for all-cause mortality in the age group 15-47 years. To reduce dangerous drinking behavior, eHealth applications have shown promise. A particularly interesting potential lies in the combination of eHealth apps with mathematical models. However, existing mathematical models do not consider real-life situations, such as combined intake of meals and beverages, and do not connect drinking to clinical markers, such as phosphatidylethanol (PEth). Herein, we present such a model which can simulate real-life situations and connect drinking to long-term markers. The new model can accurately describe both estimation data according to a χ2 -test (187.0 < Tχ2 = 226.4) and independent validation data (70.8 < Tχ2 = 93.5). The model can also be personalized using anthropometric data from a specific individual and can thus be used as a physiologically-based digital twin. This twin is also able to connect short-term consumption of alcohol to the long-term dynamics of PEth levels in the blood, a clinical biomarker of alcohol consumption. Here we illustrate how connecting short-term consumption to long-term markers allows for a new way to determine patient alcohol consumption from measured PEth levels. An additional use case of the twin could include the combined evaluation of patient-reported AUDIT forms and measured PEth levels. Finally, we integrated the new model into an eHealth application, which could help guide individual users or clinicians to help reduce dangerous drinking.

  • 31.
    Sarkisyan, Daniil
    et al.
    Uppsala University, Uppsala, Sweden.
    Hussain, Muhammad Z.
    Government Degree College, Multan, Pakistan.
    Watanabe, Hiroyuki
    Uppsala University, Uppsala, Sweden.
    Kononenko, Olga
    Uppsala University, Uppsala, Sweden; Bogomoletz Institute of Physiology, Kyiv, Ukraine.
    Bazov, Igor
    Uppsala University, Uppsala, Sweden.
    Zhou, Xingwu
    Uppsala University, Uppsala, Sweden.
    Yamskova, Olga
    Uppsala University, Uppsala, Sweden.
    Krishtal, Oleg
    Bogomoletz Institute of Physiology, Kyiv, Ukraine.
    Karpyak, Victor M.
    Mayo Clinic, Rochester, USA.
    Yakovleva, Tatiana
    Uppsala University, Uppsala, Sweden.
    Bakalkin, Georgy
    Uppsala University, Uppsala, Sweden.
    Downregulation of the endogenous opioid peptides in the dorsal striatum of human alcoholics2015In: Frontiers in Cellular Neuroscience, E-ISSN 1662-5102, Vol. 9, article id 187Article in journal (Refereed)
    Abstract [en]

    The endogenous opioid peptides dynorphins and enkephalins may be involved in brain-area specific synaptic adaptations relevant for different stages of an addiction cycle. We compared the levels of prodynorphin (PDYN) and proenkephalin (PENK) mRNAs (by qRT-PCR), and dynorphins and enkephalins (by radioimmunoassay) in the caudate nucleus and putamen between alcoholics and control subjects. We also evaluated whether PDYN promoter variant rs1997794 associated with alcoholism affects PDYN expression. Postmortem specimens obtained from 24 alcoholics and 26 controls were included in final statistical analysis. PDYN mRNA and Met-enkephalin-Arg-Phe, a marker of PENK were downregulated in the caudate of alcoholics, while PDYN mRNA and Leu-enkephalin-Arg, a marker of PDYN were decreased in the putamen of alcoholics carrying high risk rs1997794 C allele. Downregulation of opioid peptides in the dorsal striatum may contribute to development of alcoholism including changes in goal directed behavior and formation of a compulsive habit in alcoholics.

  • 32.
    Schölin, Lisa
    et al.
    Nursing Studies, School of Health in Social Science, University of Edinburgh, Edinburgh, UK; Public Health Institute, John Moores University, Liverpool, UK.
    Hughes, Karen
    Public Health Wales, Cardiff University, Cardiff, UK.
    Bellis, Mark A.
    Public Health Wales, Cardiff University, Cardiff, UK.
    Eriksson, Charli
    Örebro University, School of Health Sciences.
    Porcellato, Lorna
    Public Health Institute, John Moores University, Liverpool, UK.
    Exploring practices and perceptions of alcohol use during pregnancy in England and Sweden through a cross-cultural lens2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 3, p. 533-537Article in journal (Refereed)
    Abstract [en]

    Background: Qualitative studies have aimed to understand why some women continue to drink during pregnancy; however, there is a lack of comparative cross-cultural research. We aimed to explore perceptions and practices of alcohol use during pregnancy in England and Sweden.

    Methods: Semi-structured interviews were conducted with 21 parents in Merseyside, England and 22 parents in Örebro County, Sweden. Interviews were audio recorded, transcribed verbatim and translated. Data were analyzed using thematic analysis.

    Results: The majority of women in both countries abstained from alcohol when they found out they were pregnant, despite alcohol being part of many social contexts before pregnancy. Nine of the seventeen English women drank at some point during pregnancy, typically on special occasions. Most parents felt women should modify their alcohol intake when they become mothers, though several English parents argued that responsible motherhood did not necessarily equate to abstinence. Swedish parents held strong opinions against drinking during pregnancy and argued that any amount of alcohol could harm the foetus. English parents' opinions were divided; some were skeptical of whether low to moderate drinking was associated with risks.

    Conclusions: Practices and attitudes towards alcohol use during pregnancy and views on foetal rights and responsibilities of pregnant women differed in England and Sweden. Shared social norms around drinking may be shaped within the policy context of pregnancy drinking guidelines, determining whether women consume alcohol or not.

  • 33.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Berglund, Kristina
    Psychology, Göteborgs universitet, Göteborg, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences.
    Sellin, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Predictors for Abstinence in Socially Stable Women Receiving Treatment for Alcohol Use Disorder2022In: Alcoholism Treatment Quarterly, ISSN 0734-7324, E-ISSN 1544-4538, Vol. 40, no 2, p. 244-257Article in journal (Refereed)
    Abstract [en]

    There is a knowledge gap about predictors of treatment outcomes in alcohol use disorder (AUD) in socially stable women. This study examined factors that may predict abstinence 12 months after the end of treatment for AUD in socially stable women. Fifty-seven women with AUD participated in 12-month follow-up. Information about sociodemographic, alcohol-related, psychiatric symptoms, psychological functioning, and participants' treatment goals and ability to change alcohol habits were gathered from structured interviews and self-report instruments. Predictors for abstinence at the 12-month follow up were calculated by univariable and multivariable logistic regression models. Significant predictors for abstinence were having no history of childhood abuse (OR: 8.13; 95%CI: 2.22-29.75; p < .01) and a goal of abstinence at the end of treatment (OR: 15.17; 95%CI: 3.45-66.69; p < .001). Most participants (>60%) achieved their goals of abstinence or low-risk drinking. The results highlight the significance of identifying patients with experiences of childhood abuse, since such experiences may adversely affect the outcome of AUD treatment. Our findings also emphasize the importance of patients' own goals of abstinence, since it resulted in the most stable outcome. Treatment could, therefore, also focus on motivating individuals to aim for abstinence.

  • 34.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences.
    Björk, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Berglund, Kristina
    University of Gothenburg, Göteborg, Sweden.
    Berggren, UB
    University of Gothenburg, Göteborg, Sweden.
    Balldin, JB
    University of Gothenburg, Göteborg, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Fahlke, CF
    University of Gothenburg, Göteborg, Sweden.
    Individuals with onset of excessive drinking in late adulthood: Do they differ from the early onset group in psychiatric symptoms and personality characteristics?2016Conference paper (Refereed)
  • 35.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences.
    Björk, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Berglund, Kristina
    University of Gothenburg.
    Berggren, Ulf
    University of Gothenburg.
    Balldin, Jan
    University of Gothenburg.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Fahlke, Claudia
    University of Gothenburg.
    Differences in psychiatric symptoms and personality characteristics appear to be more pronounced between early and late onset of excessive drinking than between genders2016Conference paper (Refereed)
  • 36.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Sellin, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Berglund, Kristina
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Berggren, Ulf
    Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.
    Balldin, Jan
    Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences.
    Fahlke, Claudia
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    The Importance of Age at Onset of Excessive Alcohol Use with Regard to Psychiatric Symptoms and Personality Characteristics2017In: Alcoholism Treatment Quarterly, ISSN 0734-7324, E-ISSN 1544-4538, Vol. 35, no 4, p. 328-343Article in journal (Refereed)
    Abstract [en]

    Psychiatric symptoms and personality characteristics were studied in men (n=252) and women (n=86) as they commenced treatment for excessive alcohol use. The Addiction Severity Index, Symptom Check List, and Temperament and Character Inventory were used. ANOVA with early/late onset and gender as covariates showed significantly lower scores for psychiatric symptoms and more mature personality characteristics in the late-onset group compared to early onset. Men described more depression and anxiety, and women higher persistence. Results indicate the importance of considering age at onset of excessive alcohol use when patients enter treatment because different treatment approaches may be required.

  • 37.
    Schückher, Fides
    et al.
    Örebro University, School of Medical Sciences.
    Sellin, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Fahlke, Claudia
    Engström, Ingemar
    Örebro University, School of Medical Sciences.
    The Impact of Childhood Maltreatment on Onset Age of Alcohol Use Disorder in Women Seeking Treatment2018Conference paper (Refereed)
  • 38.
    Schückher, FS
    et al.
    Örebro University, School of Medical Sciences.
    Sellin, TS
    Örebro University Hospital. Örebro University, School of Medical Sciences.
    Engström, IE
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Berglund, KB
    Department of Psychology, University of Gothenburg, Göteborg, Sweden.
    History of childhood abuse is associated with less positive treatment outcomes in socially stable women with alcohol use disorder2020Conference paper (Refereed)
  • 39.
    Siikaluoma, Lara
    et al.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Stenberg, Erik
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department Surgery.
    Raoof, Mustafa
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department Surgery.
    Prevalence of and Risk Factors Associated with Alcohol Overconsumption at 2 Years After Bariatric Surgery2022In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 32, no 7, p. 1-6Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Alcohol overconsumption remains one of the adverse effects associated with bariatric surgery. Many previous studies have used subjective methods to evaluate the prevalence of alcohol overconsumption. In 2018, Örebro University Hospital started to use phosphatidylethanol 16:0/18:1 (PEth) as a screening tool pre- and postbariatric surgery. Research exploring alcohol use after bariatric surgery assessed with PEth is scarce.

    AIM: The aim of this study is to evaluate the prevalence of alcohol overconsumption in bariatric surgery patients measured 2 years postoperatively with PEth and to identify possible risk factors associated with alcohol overconsumption.

    METHODS: This was a register-based retrospective, observational cohort study with PEth results collected from medical records at Örebro University Hospital. Patients who underwent bariatric surgery between January 2016 and June 2019 and who were registered in the Scandinavian Obesity Surgery Registry (SOReg) were included.

    RESULTS: PEth results from 410 bariatric surgery patients were identified. PEth values significantly increased from baseline to the postoperative follow-up (from 3.0% before surgery to 8.3% at the 2-year follow-up). In a univariate logistic regression analysis, the associated risk factors were found to be male sex (odds ratio, OR 2.14), older age (OR 1.06), and hypertension (OR 3.32).

    CONCLUSION: The prevalence of alcohol overconsumption measured with PEth 2 years after bariatric surgery was 8.3% and was associated with male sex, older age, and hypertension. More studies are needed to validate the results of this study because it is not known whether PEth values are affected by bariatric surgery.

  • 40.
    Skårberg, Kurt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Troubled social background of male anabolic-androgenic steroid abusers in treatment2007In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 2, p. 20-Article in journal (Refereed)
    Abstract [en]

    Background

    The aim of this study was to investigate the social background and current social situation of male abusers of anabolic-androgenic steroids (AAS).

    Methods

    We compared thirty-four AAS-abusing patients from an Addiction Centre (AC) with two groups, 18 users and 259 non-users of AAS from a public gym in Orebro, Sweden. The study is based on semi-structured interviews and questionnaires.

    Results

    Histories of a troubled childhood as well as current social disadvantage were both more frequent among the AAS users. Users also reported poor relationships with their parents and almost half of them had experienced physical or mental abuse. The AC group's experiences from school were mostly negative, and included concentration problems, boredom and learning difficulties. Their current circumstance included abuse of other drugs, battering of spouses and other criminality such as assault, illegal possession of weapons and theft.

    Conclusion

    In conclusion, this study shows that abusers of AAS often have a troubled social background. This underlines the importance of making a thorough social assessment as a part of the treatment programme. The results of the study may help in directing appropriate questions relevant to the abuse of AAS.

  • 41.
    Skårberg, Kurt
    et al.
    Örebro University, School of Health and Medical Sciences. Addiction Centre, Örebro County Council, Örebro, Sweden.
    Nyberg, Fred
    Department of Pharmaceutical Bioscience, Uppsala University, Uppsala, Sweden .
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Is there an association between the use of anabolic-androgenic steroids and criminality?2010In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 16, no 4, p. 213-219Article in journal (Refereed)
    Abstract [en]

    Aims The aim of this study was to improve our understanding of the proposed association between anabolic-androgenic steroids (AAS) and criminality.

    Methods: The study was based on interviews and criminality data involving 32 users of AAS who had sought treatment for AAS-related problems at a psychiatric addiction clinic in Sweden. A score derived from the number of crimes, their level of severity and the relevant time periods was computed to allow comparisons between subgroups sorted according to type and timing of drug use.

    Results: The criminal activity level increased for 69% of the individuals after having started to use drugs. This was particularly obvious in the group who had started its involvement with drugs by using AAS. Crimes of violence and weapon offences showed a great increase in incidence after drug use had been initiated. The study also showed a significant decrease in criminality after treatment, particularly among individuals who had started their drug use with AAS.

    Conclusions: The results suggest that there is an association between the use of AAS and criminality, especially with regard to crimes of violence and weapon offences, and that this criminality may be enhanced when AAS are combined with other drugs of abuse.

  • 42.
    Skårberg, Kurt
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nyberg, Fred
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    The development of multiple drug use among anabolic-androgenic steroid users: six subjective case reports2008In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 3, p. 24-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The inappropriate use of anabolic androgenic steroids (AAS) was originally a problem among athletes but AAS are now often used in nonsport situations and by patients attending regular addiction clinics. The aim of this study was to improve understanding of the development of multiple drug use in patients seeking treatment at an addiction clinic for AAS-related problems. METHODS: We interviewed six patients (four men and two women) with experience of AAS use who were attending an addiction clinic for what they believed were AAS-related problems. The patients were interviewed in-depth about their life stories, with special emphasis on social background, substance use, the development of total drug use and subjective experienced psychological and physical side effects. RESULTS: There was significant variation in the development of drug use in relation to social background, onset of drug use, relationship to AAS use and experience of AAS effects. All patients had initially experienced positive effects from AAS but, over time, the negative experiences had outweighed the positive effects. All patients were dedicated to excess training and took AAS in combination with gym training, indicating that the use of these drugs is closely related to this form of training. Use of multiple drugs was common either in parallel with AAS use or serially. CONCLUSIONS: The study shows the importance of understanding how AAS use can develop either with or without the concomitant use of other drugs of abuse. The use of AAS can, however, progress to the use of other drugs. The study also indicates the importance of obtaining accurate, comprehensive information about the development of AAS use in designing treatment programmes and prevention strategies in this area.

  • 43.
    Virtanen, Suvi
    et al.
    Institute of Criminology and Legal Policy, University of Helsinki, Finland; Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, Ralf
    Karolinska Institutet, Stockholm, Sweden.
    Lundström, Sebastian
    Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.
    D'Onofrio, Brian M.
    Karolinska Institutet, Stockholm, Sweden; Indiana University, Bloomington, USA.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Karolinska Institutet, Stockholm, Sweden.
    Suvisaari, Jaana
    National Institute for Health and Welfare, Helsinki, Finland.
    Mataix-Cols, David
    Karolinska Institutet, Stockholm, Sweden; Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Lichtenstein, Paul
    Karolinska Institutet, Stockholm, Sweden.
    Latvala, Antti
    Institute of Criminology and Legal Policy, University of Helsinki, Finland; Karolinska Institutet, Stockholm, Sweden.
    Longitudinal Associations of Childhood Internalizing Psychopathology With Substance Misuse: A Register-Based Twin and Sibling Study2020In: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 60, no 5, p. 593-603Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The pathways from internalizing psychopathology to substance misuse remain largely unclear. We estimated associations between childhood internalizing problems and subsequent substance misuse in two family-based samples. We also investigated sex differences and the role of externalizing comorbidity.

    METHOD: We studied associations of childhood internalizing psychopathology with register-based substance misuse after age 13. Sample 1 included all individuals born in Sweden 1984-2000 (N=1,768,516). Depressive and anxiety disorders were included as register-based ICD-9/10 diagnoses before age 13. Sample 2 was a sub-sample within the population sample, the Child and Adolescent Twin Study in Sweden (CATSS) twin cohort (n=12,408; born 1992-1998), with mood and anxiety problems assessed at age 9/12 by parents. In both samples, substance misuse was defined as an ICD-9/10 alcohol/drug use disorder or an alcohol/drug-related criminal conviction until December 2013. To account for familial effects, stratified analyses were conducted within siblings and twin pairs.

    RESULTS: In the population sample, both depressive (HR=2.75 [95% CI: 2.36-3.20]) and anxiety disorders (HR=1.52 [1.35-1.73]) were associated with substance misuse. Childhood mood problems (HR=2.28 [1.69-3.08]) were associated with substance misuse in the CATSS sample. The associations were partially explained by familial factors, and comorbid externalizing disorders explained the associations in men but not in women.

    CONCLUSION: Childhood mood problems were associated with substance misuse but familial factors shared by siblings partially explained the associations. The relationship of anxiety with substance misuse was complex and depended on measurement and the type of anxiety disorder. Internalizing problems may be especially important for substance misuse risk in women.

  • 44.
    Vrettou, Maria
    et al.
    Department of Neuroscience, Science for Life Laboratory, BMC, Uppsala University, Uppsala, Sweden.
    Nilsson, Kent W.
    Centre for Clinical Research Västerås, Västmanland County Hospital Västerås, Uppsala University, Uppsala, Sweden.
    Tuvblad, Catherine
    Örebro University, School of Law, Psychology and Social Work. Department of Psychology, University of Southern California, Los Angeles, USA.
    Rehn, Mattias
    Centre for Clinical Research Västerås, Västmanland County Hospital Västerås, Uppsala University, Uppsala, Sweden.
    Åslund, Cecilia
    Centre for Clinical Research Västerås, Västmanland County Hospital Västerås, Uppsala University, Uppsala, Sweden.
    Andershed, Anna-Karin
    Örebro University, School of Law, Psychology and Social Work.
    Wallén-Mackenzie, Åsa
    Department of Organismal Biology, Uppsala University, Uppsala, Sweden.
    Andershed, Henrik
    Örebro University, School of Law, Psychology and Social Work.
    Hodgins, Sheilagh
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montreal, Canada.
    Nylander, Ingrid
    Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
    Comasco, Erika
    Department of Neuroscience, Science for Life Laboratory, BMC, Uppsala University, Uppsala, Sweden.
    VGLUT2 rs2290045 genotype moderates environmental sensitivity to alcohol-related problems in three samples of youths2019In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 28, no 10, p. 1329-1340Article in journal (Refereed)
    Abstract [en]

    The importance of Vesicular Glutamate Transporter 2 (VGLUT2)-mediated neurotransmission has been highlighted in studies on addiction-related phenotypes. The single nucleotide polymorphism rs2290045 in VGLUT2 has been associated with alcohol dependence, but it is unknown whether or how this association is affected by environmental factors. The present study determined whether the association of alcohol-related problems with the rs2290045 in the VGLUT2 gene was modified by negative and positive environmental factors. Three samples were included: a clinical sample of 131 adolescents followed from age 17 to 22; a general population sample of 1794 young adults; and a general population sample of 1687 adolescents followed from age 14 to 17. DNA was extracted from saliva and the rs2290045 (T/C) was genotyped. Alcohol-related problems were assessed using the Alcohol Use Disorders Identification Test. Stressful life events (SLE) and parenting were assessed by questionnaires. Gene-environment interactions were investigated using a dual statistical approach. In all samples (effect sizes 0.6-6.2%), and consistent with the differential susceptibility framework, T carriers exposed to SLE reported more alcohol-related problems if they had experienced poor parenting, and lower alcohol-related problems if they had received supportive parenting. T carriers not exposed to SLE reported higher alcohol-related problems if they had received supportive parenting and lower alcohol-related problems if they had received poor parenting. Among CC carriers, alcohol-related problems did not vary as a function of negative and positive environmental factors. In conclusion, in three samples of youths, alcohol-related problems were associated with an interaction of VGLUT2 rs2290045, SLE, and parenting.

  • 45.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Department of Physiotherapy, University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Engman, Kjell Ola
    Sörmland County Council, Medical Advisory Committee, Nyköping, Sweden.
    Arne, Mats
    Centre for Clinical Research, Region Värmland, Karlstad, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Larsson, Matz
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Health Promotion Centre, Lund University, Lund, Sweden; The Heart, Lung and Physiology Clinic, Örebro University Hospital, Örebro, Sweden.
    Spirometry to increase smoking cessation rate: A systematic review2019In: Tobacco Induced Diseases, E-ISSN 1617-9625, Vol. 17, article id 31Article, review/survey (Refereed)
    Abstract [en]

    INTRODUCTION: Addressing tobacco use is an important issue in general health care. In order to improve smoking cessation advice, spirometry values can be displayed to the smoker to demonstrate possible lung function impairment. The estimate of so-called lung age may show a decrease in lung function associated with smoking. It has been suggested that performing spirometry on patients who smoke but are asymptomatic can be a useful way to show the adverse effects of smoking. The aim of this systematic review was to determine if providing spirometry results in combination with smoking cessation counselling can increase smoking cessation rates compared to what is achieved through counselling alone.

    METHODS: In this systematic review, we included randomized controlled trials (RCTs) evaluating smoking cessation interventions for adult smokers. The systematic search was performed in PubMed, Medline, Cochrane Library, Cinahl, Embase, Amed and PsycInfo.

    RESULTS: The literature search resulted in 946 studies, which, after reading by two independent reviewers, were reduced to seven trials that matched the inclusion criteria. Two RCTs showed significant improvement in smoking cessation when giving patients feedback on spirometry results in combination with smoking cessation counselling, compared to patients who received only smoking cessation counselling. In both studies, the spirometry results were expressed as lung age. In the other five studies no difference was found. Five further published study protocols for ongoing RCT studies in the field have been found, and therefore this systematic overview will likely need to be updated within a few years.

    CONCLUSIONS: Few studies have been undertaken to examine the efficacy of spirometry in increasing smoking quit rates. Studies conducted to date have shown mixed results, and there is currently limited evidence in the literature that smoking cessation counselling that includes feedback from spirometry and a demonstration of lung age promotes quit rates.

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