1
|
Hammarberg SI, Wallhed Finn S, Rosendahl I, Andréasson S, Jayaram-Lindström N, Hammarberg A. Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial. Addiction 2024; 119:86-101. [PMID: 37658776 DOI: 10.1111/add.16325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 07/21/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND AIMS Controlled drinking (CD) is an attractive treatment goal for a large proportion of individuals with alcohol use disorder (AUD), but the availability of treatment methods supporting a goal of CD is scarce. We tested if behavioural self-control training (BSCT) was superior to motivational enhancement therapy (MET) for individuals with AUD with a treatment goal of CD. DESIGN Randomized controlled two-group trial. Follow-ups were conducted at 12 and 26 weeks (primary end-point) after inclusion. SETTING Three specialized dependency care clinics in Stockholm, Sweden. PARTICIPANTS Two hundred and fifty self-referred adults (52% men) fulfilling criteria of AUD (DSM-5) and a stated treatment goal of CD. INTERVENTION AND COMPARATOR BSCT (n = 125), a five-session treatment based on cognitive behavioural therapy versus the active comparator, MET (n = 125), containing four sessions based on Motivational Interviewing. MEASUREMENTS Primary outcome measure was mean weekly alcohol consumption at the 26-week follow-up, adjusted for baseline consumption. CONCLUSIONS A randomized controlled trial found no evidence of a difference between behavioural self-control training and motivational enhancement therapy in reducing weekly alcohol consumption. Both groups substantially reduced consumption and behavioural self-control training was superior in reducing hazardous drinking.
Collapse
Affiliation(s)
- Stina Ingesson Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sara Wallhed Finn
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ingvar Rosendahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Andréasson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| |
Collapse
|
2
|
Östh J, Danielsson AK, Lundin A, Wennberg P, Andréasson S, Jirwe M. Keeping Track of My Drinking - Patient Perceptions of Using Smartphone Applications as a Treatment Complement for Alcohol Dependence. Subst Use Misuse 2023; 59:291-299. [PMID: 37876238 DOI: 10.1080/10826084.2023.2269578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND Alcohol dependence is common, yet highly undertreated. Smartphone applications (apps) have potential to enhance treatment accessibility and effectiveness, however evidence is limited, especially studies focussing on user experiences. The aim was to describe patient perceptions on the usability and acceptability of self-monitoring apps provided as treatment complement for alcohol dependence. METHODS Individual semi-structured interviews were conducted through video or phone calls with 21 participants, recruited from a randomized controlled trial at a dependency clinic in Stockholm. The participants had used two specific apps for self-monitoring consumption ("Glasklart" and "iBAC") during 12 wk prior to the interviews. Data was analyzed using Qualitative Content Analysis. RESULTS Two domains were identified: 1) Smartphone applications as facilitators to treatment, and 2) Barriers to smartphone application use. Using apps within the treatment context was believed to increase the accuracy of the reported consumption. Participants became more aware of their alcohol problem and described the apps as reinforcers that could increase both the motivation to change and the focus on the problem and commitment to treatment. The apps were further described as helpful to control alcohol consumption. However, app usage was constrained by technical problems, unfit app-specific features and procedures, and alcohol-related shame and stigma. DISCUSSION AND CONCLUSIONS Self-monitoring alcohol apps have several beneficial features that can help assess, track, and control alcohol consumption, and improve communication with clinicians. The results indicate they can be useful complements to treatment for patients with alcohol dependence, but their use can be limited by different, foremost technical, issues.
Collapse
Affiliation(s)
- J Östh
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - A K Danielsson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - A Lundin
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - P Wennberg
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - S Andréasson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - M Jirwe
- Department of Health Sciences, Swedish Red Cross University, Huddinge, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
3
|
Nilsen P, Andréasson S. Four decades of screening and brief alcohol intervention research: the peg and the hole. Eur J Public Health 2023; 33:3. [PMID: 36351007 PMCID: PMC9897999 DOI: 10.1093/eurpub/ckac152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Sven Andréasson
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Gunillasdotter V, Andréasson S, Hallgren M, Jirwe M. Exercise as treatment for alcohol use disorder: A qualitative study. Drug Alcohol Rev 2022; 41:1642-1652. [PMID: 36073088 PMCID: PMC9826429 DOI: 10.1111/dar.13527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Exercise is a promising treatment option for individuals with alcohol use disorder, but qualitative studies are lacking. Our aim was to explore experiences of yoga and aerobic exercise among non-treatment-seeking adults with alcohol use disorder. METHODS Semi-structured qualitative interviews (face-to-face or telephone) with 12 participants from a randomised controlled trial. Qualitative content analysis was used to analyse data. RESULTS One main category was identified, motivating and maintaining a lifestyle change, including four generic categories: (i) Initiating factors for lifestyle change, which describes how the concept of a lifestyle change initiated participants change; (ii) Influencing lifestyle change, explains how mood-enhancing effects from exercise influence exercise behaviours; (iii) Influencing physical and mental health, which describes how improvements in physical and mental health influence self-confidence and self-esteem; and (iv) Influencing alcohol consumption, which describes how exercise reduced alcohol cravings and that success in changing exercise behaviours made participants take healthier decisions regarding their alcohol intake. DISCUSSION AND CONCLUSIONS Exercise may help reduce alcohol intake, especially when presented in the context of a lifestyle change. Being able to self-select the type of exercise may increase compliance and optimise these benefits. Intentional planning and positive results from exercise may strengthen the individual's self-efficacy and increase the motivation to change behaviours associated with alcohol consumption.
Collapse
Affiliation(s)
- Victoria Gunillasdotter
- Department of Global Public HealthKarolinska InstitutetStockholmSweden,Centre for Psychiatry Research SwedenStockholm Health ServicesStockholmSweden
| | - Sven Andréasson
- Department of Global Public HealthKarolinska InstitutetStockholmSweden,Centre for Psychiatry Research SwedenStockholm Health ServicesStockholmSweden
| | - Mats Hallgren
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Maria Jirwe
- Department of Health SciencesSwedish Red Cross UniversityHuddingeSweden,Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
| |
Collapse
|
5
|
Welford P, Gunillasdotter V, Andréasson S, Hallgren M. Effects of physical activity on symptoms of depression and anxiety in adults with alcohol use disorder (FitForChange): Secondary outcomes of a randomised controlled trial. Drug Alcohol Depend 2022; 239:109601. [PMID: 35994841 DOI: 10.1016/j.drugalcdep.2022.109601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare the effects of yoga, aerobic exercise, and usual care on anxiety and depressive symptoms in non-treatment seeking adults with AUD. METHOD Parallel, three-group, open-label randomised (1:1:1) controlled trial with blinded follow-up assessment. Non-treatment seeking adults (aged 18-75 years) were recruited via advertisements in a free newspaper in Stockholm, Sweden. All participants had clinician-diagnosed AUD prior to randomisation. This trial excluded those who were physically active, or for whom supervised physical activity was contraindicated. Participants were randomly assigned to 12-weeks of aerobic exercise, yoga, or usual care (telephone counselling). The secondary outcome of interest was the Hospital Anxiety and Depression Scale (HADS), assessed at baseline and 12-week follow-up. Primary analyses consisted of linear regression models and followed intention-to-treat (ITT) principals. RESULTS In total, 140 participants (mean age 53.7 years, SD=11.8) were recruited. Follow-up was completed for 42/45 participants randomised to TAU, 42/49 to aerobic exercise and 43/46 to yoga. ITT analyses included 126 trial participants. There were statistically significant within-group improvements in total HADS in all three intervention groups. Effect sizes for usual care and aerobic exercise were small (Hedges' g=0.48, 95% CI=0.16, 0.80 and g=0.41, 95% CI=0.09, 0.72, respectively), while yoga was associated with a large treatment effect (g=1.06, 95% CI=0.69, 1.43). There were significant between-group differences in these improvements favouring yoga (B=-2.15, 95% CI=-4.16, -0.15, p = .035) relative to usual care, but no significant differences between yoga and aerobic exercise. No injuries were reported. CONCLUSIONS Findings support the recommendation of yoga for non-treatment seeking adults with AUD.
Collapse
Affiliation(s)
- Paul Welford
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Victoria Gunillasdotter
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden; Centre for Psychiatry Research, Sweden, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Services, 114 35 Stockholm, Sweden
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden; Centre for Psychiatry Research, Sweden, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Services, 114 35 Stockholm, Sweden
| | - Mats Hallgren
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
| |
Collapse
|
6
|
Nadkarni A, Bhatia U, Bedendo A, de Paula TCS, de Andrade Tostes JG, Segura-Garcia L, Tiburcio M, Andréasson S. Brief interventions for alcohol use disorders in low- and middle-income countries: barriers and potential solutions. Int J Ment Health Syst 2022; 16:36. [PMID: 35934695 PMCID: PMC9358825 DOI: 10.1186/s13033-022-00548-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Global alcohol consumption and harmful use of alcohol is projected to increase in the coming decades, and most of the increase will occur in low- and middle-income countries (LMICs); which calls for cost-effective measures to reduce alcohol exposure in these countries. One such evidence based measure is screening and brief intervention (BI) for alcohol problems. Some of the characteristics of BI make them a particularly appealing choice of interventions in low-resource settings. However, despite evidence of effectiveness, implementation of BI in LMICs is rare. In this paper we discuss barriers to implementation of BI in LMICs, with examples from Latin America and India. Key barriers to implementation of BI in LMICs are the lack of financial and structural resources. Specialized services for alcohol use disorders are limited or non-existent. Hence primary care is often the only possible alternative to implement BI. However, health professionals in such settings generally lack training to deal with these disorders. In our review of BI research in these countries, we find some promising results, primarily in countries from Latin America, but so far there is limited research on effectiveness. Appropriate evaluation of efficacy and effectiveness of BI is undermined by lack of generalisability and methodological limitations. No systematic and scientific efforts to explore the implementation and evaluation of BI in primary and community platforms of care have been published in India. Innovative strategies need to be deployed to overcome supply side barriers related to specialist manpower shortages in LMICs. There is a growing evidence on the effectiveness of non-specialist health workers, including lay counsellors, in delivering frontline psychological interventions for a range of disorders including alcohol use disorders in LMICs. This paper is intended to stimulate discussion among researchers, practitioners and policy-makers in LMICs because increasing access to evidence based care for alcohol use disorders in LMICs would need a concerted effort from all these stakeholders.
Collapse
Affiliation(s)
- Abhijit Nadkarni
- Centre for Global Mental Health (CGMH), Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK. .,Addictions Research Group, Sangath, Porvorim, Goa, India.
| | - Urvita Bhatia
- Addictions Research Group, Sangath, Porvorim, Goa, India.,Department of Psychology, Health and Professional Development at Oxford Brookes University, Oxford, UK
| | - Andre Bedendo
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Brazil.,Department of Health Sciences, Faculty of Sciences, University of York, York, UK
| | | | - Joanna Gonçalves de Andrade Tostes
- Center for Research, Intervention and Evaluation on Alcohol & Drugs (CREPEIA), Department of Psychology, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Lidia Segura-Garcia
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain.,Clincal Psychology and Health Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Marcela Tiburcio
- Department of Social Sciences in Health, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
7
|
Gunillasdotter V, Andréasson S, Jirwe M, Ekblom Ö, Hallgren M. Effects of exercise in non-treatment seeking adults with alcohol use disorder: A three-armed randomized controlled trial (FitForChange). Drug Alcohol Depend 2022; 232:109266. [PMID: 35033949 DOI: 10.1016/j.drugalcdep.2022.109266] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Most individuals with alcohol use disorder (AUD) do not seek treatment. Stigma and the desire to self-manage the problem are likely explanations. Exercise is an emerging treatment option but studies in non-treatment seeking individuals are lacking. We compared the effects of aerobic exercise, yoga, and treatment as usual (phone-based support) on alcohol consumption in non-treatment seeking adults with AUD. METHODS Three-group parallel, single blind, randomized controlled trial. 140 physically inactive adults aged 18-75 diagnosed with AUD were included in this community-based trial. Participants were randomized to either aerobic exercise (n = 49), yoga (n = 46) or treatment as usual (n = 45) for 12-weeks. The primary study outcome was weekly alcohol consumption at week 13 (Timeline Follow-back). RESULTS A significant decrease in weekly alcohol consumption was seen in all three groups: aerobic exercise (mean ∆ = - 5.0, 95% C = - 10.3, - 3.5), yoga group (mean ∆ = - 6.9, 95% CI = - 10.3, - 3.5) and TAU (mean ∆ = - 6.6, 95% CI = - 8.8, - 4.4). The between group changes were not statistically significant at follow-up. Per-protocol analyzes showed that the mean number of drinks per week reduced more in both TAU (mean ∆ = - 7.1, 95% CI = - 10.6, - 3.7) and yoga (mean ∆ = - 8.7, 95% CI = - 13.2, - 4.1) compared to aerobic exercise (mean ∆ = - 1.7, 95% CI = - 4.4, 1. 0), [F(2, 55) = 4.9, p = 0.011]. CONCLUSIONS Participation in a 12-week stand-alone exercise program was associated with clinically meaningful reductions in alcohol consumption comparable to usual care (phone counseling) by an alcohol treatment specialist.
Collapse
Affiliation(s)
- Victoria Gunillasdotter
- Epidemiology of Psychiatric Conditions, Substance use and Social Environment (EPiCSS), Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden; Centre for Psychiatry Research, Sweden, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Services, 114 35 Stockholm, Sweden
| | - Sven Andréasson
- Epidemiology of Psychiatric Conditions, Substance use and Social Environment (EPiCSS), Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden; Centre for Psychiatry Research, Sweden, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Services, 114 35 Stockholm, Sweden
| | - Maria Jirwe
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Huddinge, Sweden; Department of Health Sciences, the Swedish Red Cross University College, 14121 Huddinge, Sweden
| | - Örjan Ekblom
- Swedish School of Sport and Health Science (GIH), Lidingövägen 1, 114 33 Stockholm, Sweden
| | - Mats Hallgren
- Epidemiology of Psychiatric Conditions, Substance use and Social Environment (EPiCSS), Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden.
| |
Collapse
|
8
|
Johansson M, Berman AH, Sinadinovic K, Lindner P, Hermansson U, Andréasson S. Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial. J Med Internet Res 2021; 23:e29666. [PMID: 34821563 PMCID: PMC8663526 DOI: 10.2196/29666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear. Objective This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers. Methods A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment. Results During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (−3.84, 95% Cl −6.53 to −1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%). Conclusions In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions. Trial Registration ClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726
Collapse
Affiliation(s)
- Magnus Johansson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Anne H Berman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Kristina Sinadinovic
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Philip Lindner
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Ulric Hermansson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
9
|
Johansson M, Sinadinovic K, Gajecki M, Lindner P, Berman AH, Hermansson U, Andréasson S. Internet-based therapy versus face-to-face therapy for alcohol use disorder, a randomized controlled non-inferiority trial. Addiction 2021; 116:1088-1100. [PMID: 32969541 PMCID: PMC8247312 DOI: 10.1111/add.15270] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/08/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Most people with alcohol use disorder (AUD) are never treated. Internet-based interventions are effective in reducing alcohol consumption and could help to overcome some of the barriers to people not seeking or receiving treatment. The aim of the current study was to compare internet-delivered and face-to-face treatment among adult users with AUD. DESIGN Randomized controlled non-inferiority trial with a parallel design, comparing internet-delivered cognitive-behavioural therapy (ICBT) (n = 150) with face-to-face CBT (n = 151), at 3- and 6-month follow-ups. SETTING A specialized clinic for people with AUD in Stockholm, Sweden. Participants were recruited between 8 December 2015 and 5 January 2018. PARTICIPANTS A total of 301 patients [mean age 50 years, standard deviation (SD) = 12.3] with AUD, of whom 115 (38%) were female and 186 (62%) were male. INTERVENTION AND COMPARATOR Participants were randomized in blocks of 20 at a ratio of 1 : 1 to five modules of therapist-guided ICBT or to five modules of face-to-face CBT, delivered over a 3-month period. The same treatment material and the same therapists were used in both groups. MEASUREMENTS The primary outcome was standard drinks of alcohol consumed during the previous week at 6-month follow-up, analysed according to intention-to-treat. The pre-specified non-inferiority limit was five standard drinks of alcohol and d = 0.32 for secondary outcomes. RESULTS The difference in alcohol consumption between the internet and the face-to-face group was non-inferior in the intention-to-treat analysis of data from the 6-month follow-up [internet = 12.33 and face-to-face = 11.43, difference = 0.89, 95% confidence interval (CI) = -1.10 to 2.88]. The secondary outcome, Alcohol Use Disorder Identification Test score, failed to show non-inferiority of internet compared with face-to-face in the intention-to-treat analysis at 6-month follow-up (internet = 12.26 and face-to-face = 11.57, d = 0.11, 95% CI = -0.11 to 0.34). CONCLUSIONS Internet-delivered treatment was non-inferior to face-to-face treatment in reducing alcohol consumption among help-seeking patients with alcohol use disorder but failed to show non-inferiority on some secondary outcomes.
Collapse
Affiliation(s)
- Magnus Johansson
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Kristina Sinadinovic
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Mikael Gajecki
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Anne H. Berman
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
- Department of PsychologyUppsala UniversityUppsalaSweden
| | - Ulric Hermansson
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Sven Andréasson
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| |
Collapse
|
10
|
Stockwell T, Andréasson S, Cherpitel C, Chikritzhs T, Dangardt F, Holder H, Naimi T, Sherk A. Time for carefully tailored set of alcohol policies to reduce health-care burden and mitigate potential unintended consequences? Drug Alcohol Rev 2020; 40:17-18. [PMID: 33029826 DOI: 10.1111/dar.13185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada.,Department of Psychology, University of Victoria, Victoria, Canada
| | - Sven Andréasson
- Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Frida Dangardt
- University of Gothenburg, Sahlgrenska University Hospital Gothenburg, Goteborg, Sweden
| | - Harold Holder
- Pacific Institute for Research and Evaluation, Prevention Research Center, Calverton, USA
| | - Timothy Naimi
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| |
Collapse
|
11
|
Wallhed Finn S, Andréasson S, Hammarberg A. Treatment of Alcohol Dependence in Primary Care Compared With Outpatient Specialist Treatment: Twelve-Month Follow-Up of a Randomized Controlled Trial, With Trajectories of Change. J Stud Alcohol Drugs 2020; 81:300-310. [PMID: 32527382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE The purpose of this study was to investigate if brief treatment for alcohol dependence in primary care with the 15-method was as effective as specialist addiction care. In addition, we sought to investigate trajectories for change of alcohol consumption. METHOD This study was a randomized controlled noninferiority trial, between-groups parallel design, with a noninferiority limit of 50 g of alcohol per week. A total of 288 adults fulfilling ICD-10 criteria for alcohol dependence were randomized to treatment in primary care or specialist outpatient care at a university addiction clinic. The primary outcome was change in weekly alcohol consumption at the 12-month follow-up. Secondary outcomes were heavy drinking days, severity of dependence, consequences of drinking, psychological health, quality of life, satisfaction with treatment, and biomarkers. Trajectories were investigated using change in World Health Organization drinking risk levels. RESULTS The intention-to-treat analysis (n = 231) showed that the estimated weekly alcohol consumption in primary care was 18.2 g (95% CI [14.9, 51.3]) higher compared with specialist care (p = .28). Noninferiority was not demonstrated as the confidence interval exceeded the noninferiority limit. The secondary outcomes showed no differences between primary care and specialist care except that patients randomized to specialist care were more satisfied with treatment. The analyses of trajectories showed the main part of change in consumption occurred from baseline to the 6-month follow-up and was maintained to the 12-month follow-up. CONCLUSIONS Although noninferiority could not be demonstrated, based on similar trajectories and sustained reduction of alcohol use, this study indicates brief treatment of alcohol dependence in primary care with the 15-method is a feasible and promising approach.
Collapse
Affiliation(s)
- Sara Wallhed Finn
- Department of Global Public Health, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Anders Hammarberg
- Department of Clinical Neurosciences, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| |
Collapse
|
12
|
Wallhed Finn S, Andréasson S, Hammarberg A. Treatment of Alcohol Dependence in Primary Care Compared With Outpatient Specialist Treatment: Twelve-Month Follow-Up of a Randomized Controlled Trial, With Trajectories of Change. J Stud Alcohol Drugs 2020. [DOI: 10.15288/jsad.2020.81.300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sara Wallhed Finn
- Department of Global Public Health, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Anders Hammarberg
- Department of Clinical Neurosciences, Karolinska Institutet, Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| |
Collapse
|
13
|
Nilsson T, Norström T, Andréasson S, Guldbrandsson K, Allebeck P, Leifman H. Effects of Local Alcohol Prevention Initiatives in Swedish Municipalities, 2006-2014. Subst Use Misuse 2020; 55:1008-1020. [PMID: 32024412 DOI: 10.1080/10826084.2020.1720246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Several components of the Swedish alcohol policy, e.g., pricing and availability, weakened when Sweden joined the EU in 1995. To counteract the possible negative effects of this, emphasis was placed on the local level as an important arena of alcohol prevention. Thus, considerable efforts were made to strengthen alcohol prevention in Swedish municipalities. Objectives: The aim of this study was to examine whether local alcohol prevention reduced consumption and alcohol-related harm in Swedish municipalities. Methods: Alcohol prevention was monitored using a composite measure called the Alcohol Prevention Magnitude Measure (APMM), with subcategories of staff and budget, inspections and licenses, policy, activities, and cooperation. APMM and its categories were analysed in relation to alcohol consumption and harm over time, 2006-2014. A fixed effects model was used with 63% (N=182, consumption) and 71% (N=207, harm) of 290 Swedish municipalities, respectively, included in the analyses. Results: The main results suggest that when APMM increases with 1 percent, the alcohol-related mortality decreases with 0.26 percent, controlled for changes in population size, median income, unemployment, and post-secondary education. In light of this result, the estimated effect of APMM on alcohol consumption (sales) is small (0.02 percent decrease); possible explanations for this are discussed in the article. Conclusion: The overall results indicate that local alcohol prevention initiatives in Sweden have reduced some forms of alcohol-related harm, not least alcohol-related mortality, during the period 2006-2014. Further studies are needed to assess the generalizability of the present study.
Collapse
Affiliation(s)
- Tony Nilsson
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Solna, Sweden.,The Swedish Council for Information on Alcohol and Other Drugs (CAN)
| | - Thor Norström
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Solna, Sweden.,Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Sven Andréasson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Karin Guldbrandsson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.,The Public Health Agency of Sweden, Solna, Sweden
| | - Peter Allebeck
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Håkan Leifman
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Solna, Sweden
| |
Collapse
|
14
|
Andréasson S. Policies to Reduce the Secondhand Harms of Alcohol: A Commentary on Nayak et al. (2019). J Stud Alcohol Drugs 2019; 80:282-283. [PMID: 31250791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- Sven Andréasson
- Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden
| |
Collapse
|
15
|
Affiliation(s)
- Sven Andréasson
- Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden
| |
Collapse
|
16
|
Danielsson AK, Lundin A, Andréasson S. Using mobile phone technology to treat alcohol use disorder: study protocol for a randomized controlled trial. Trials 2018; 19:709. [PMID: 30594232 PMCID: PMC6311064 DOI: 10.1186/s13063-018-3137-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/15/2018] [Indexed: 01/17/2023] Open
Abstract
Background A primary concern within the healthcare system is to make treatment more accessible as well as attractive for the great majority of alcohol-dependent people who feel reluctant to participate in the treatment programs available. This paper presents the protocol for a randomized controlled trial (RCT) to test the efficacy of two different technical devices (mobile phone application and breathalyzer) on alcohol consumption. Methods The study is a three-armed RCT with follow-ups 3 and 6 months after randomization. In total, 375 adults (age 18+ years) diagnosed with alcohol use disorder (AUD) will be invited to participate in a 3-month intervention. The primary outcome is the number of days with heavy drinking, defined as four or more standard drinks (12 g alcohol/drink) and measured by the timeline follow back (TLFB) and Alcohol Use Disorder Identification Test (AUDIT) instruments at 3-month and 6-month follow-up. Secondary outcome measures include weekly alcohol consumption, measured by the TLFB, AUDIT, and phosphatidylethanol in blood values at 3-month and 6-month follow-up (number of days with blood alcohol concentration levels exceeding 60 mg/100 ml). Discussion Improving ways of collecting data on alcohol consumption, as well as the treatment system with regards to AUD, is of vital importance. Mobile phone technology, with associated applications, is widely recognized as a potentially powerful tool in the prevention and management of disease. This study will provide unique knowledge regarding the use of new technology as instruments for measuring alcohol consumption and, also, as a possible way to decrease it. Trial registration ISRCTN, ISRCTN14515753. Registered on 31 May 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-3137-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna-Karin Danielsson
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Andreas Lundin
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Center for Psychiatric Research, Stockholm, Sweden
| |
Collapse
|
17
|
Stockwell T, Sherk A, Norström T, Angus C, Ramstedt M, Andréasson S, Chikritzhs T, Gripenberg J, Holder H, Holmes J, Mäkelä P. Estimating the public health impact of disbanding a government alcohol monopoly: application of new methods to the case of Sweden. BMC Public Health 2018; 18:1400. [PMID: 30577827 PMCID: PMC6303908 DOI: 10.1186/s12889-018-6312-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 12/07/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Government alcohol monopolies were created in North America and Scandinavia to limit health and social problems. The Swedish monopoly, Systembolaget, reports to a health ministry and controls the sale of all alcoholic beverages with > 3.5% alcohol/volume for off-premise consumption, within a public health mandate. Elsewhere, alcohol monopolies are being dismantled with evidence of increased consumption and harms. We describe innovative modelling techniques to estimate health outcomes in scenarios involving Systembolaget being replaced by 1) privately owned liquor stores, or 2) alcohol sales in grocery stores. The methods employed can be applied in other jurisdictions and for other policy changes. METHODS Impacts of the privatisation scenarios on pricing, outlet density, trading hours, advertising and marketing were estimated based on Swedish expert opinion and published evidence. Systematic reviews were conducted to estimate impacts on alcohol consumption in each scenario. Two methods were applied to estimate harm impacts: (i) alcohol attributable morbidity and mortality were estimated utilising the International Model of Alcohol Harms and Policies (InterMAHP); (ii) ARIMA methods to estimate the relationship between per capita alcohol consumption and specific types of alcohol-related mortality and crime. RESULTS Replacing government stores with private liquor stores (Scenario 1) led to a 20.0% (95% CI, 15.3-24.7) increase in per capita consumption. Replacement with grocery stores (Scenario 2) led to a 31.2% (25.1-37.3%) increase. With InterMAHP there were 763 or + 47% (35-59%) and 1234 or + 76% (60-92%) more deaths per year, for Scenarios 1 and 2 respectively. With ARIMA, there were 850 (334-1444) more deaths per year in Scenario 1 and 1418 more in Scenario 2 (543-2505). InterMAHP also estimated 10,859 or + 29% (22-34%) and 16,118 or + 42% (35-49%) additional hospital stays per year respectively. CONCLUSIONS There would be substantial adverse consequences for public health and safety were Systembolaget to be privatised. We demonstrate a new combined approach for estimating the impact of alcohol policies on consumption and, using two alternative methods, alcohol-attributable harm. This approach could be readily adapted to other policies and settings. We note the limitation that some significant sources of uncertainty in the estimates of harm impacts were not modelled.
Collapse
Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research (CISUR), Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research (CISUR), Social Dimensions of Health Program, University of Victoria, Victoria, BC Canada
| | - Thor Norström
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | | | - Mats Ramstedt
- The Swedish Council for Information on Alcohol and Other Drugs (CAN), Stockholm, Sweden
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Tanya Chikritzhs
- Health Sciences, National Drug Research Institute, Curtin University, Perth, Australia
| | - Johanna Gripenberg
- Department of Clinical Neuroscience, Stockholm Prevents Alcohol and Drug Problems (STAD), Karolinska Institutet, Stockholm, Sweden
| | - Harold Holder
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA USA
| | | | - Pia Mäkelä
- National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
18
|
Fahlke C, Andréasson S. [Not Available]. Lakartidningen 2018; 115:E67R. [PMID: 30325472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Claudia Fahlke
- Psykologiska institutionen - Göteborg, Sweden Psykologiska institutionen - Göteborg, Sweden
| | - Sven Andréasson
- Beroendecentrum Stockholm - Riddargatan 1 Stockholm, Sweden - , Sweden
| |
Collapse
|
19
|
Andréasson S. [Not Available]. Lakartidningen 2018; 115:E7EU. [PMID: 30325474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Sven Andréasson
- Beroendecentrum Stockholm - Riddargatan 1 Stockholm, Sweden - , Sweden
| |
Collapse
|
20
|
Hallgren M, Vancampfort D, Lundin A, Andersson V, Andréasson S. New steps for treating alcohol use disorder: the emerging importance of physical exercise. Psychopharmacology (Berl) 2018; 235:2771-2773. [PMID: 30112576 DOI: 10.1007/s00213-018-5002-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/10/2018] [Indexed: 02/17/2023]
Affiliation(s)
- Mats Hallgren
- Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Andreas Lundin
- Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden
| | | | - Sven Andréasson
- Karolinska Institutet, Department of Public Health Sciences, Stockholm, Sweden.,Riddargatan 1: clinic for Alcohol and Health, Stockholm, Sweden
| |
Collapse
|
21
|
Nilsson T, Allebeck P, Leifman H, Andréasson S, Norström T, Guldbrandsson K. Effects on Alcohol Consumption and Alcohol Related Harm of a Community-Based Prevention Intervention With National Support in Sweden. Subst Use Misuse 2018; 53:412-419. [PMID: 28816572 DOI: 10.1080/10826084.2017.1334063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In order to strengthen local alcohol prevention work in Sweden the Swedish government has for the past almost 15 years commissioned the Public Health Agency of Sweden to initiate a series of community-based alcohol prevention projects. The latest of these, labeled local development with ambitions (LUMA), included 25 municipalities in Sweden. OBJECTIVES Aim of this study is to examine if LUMA municipalities that received financial support, with requirements, increased local alcohol prevention and if alcohol consumption and harm declined. METHODS Twenty-five Swedish municipalities that received financial support aiming to strengthen local alcohol preventing activities (intervention group) were compared to municipalities that did not receive such support (control group, N = 224), before, during, and after the intervention period. Two composite measures of policy and activity were created and used. The composite activity measure includes seven activity indicators and the composite policy measure includes six policy indicators. Harm measures have been selected based on several recommended indicators for monitoring alcohol, tobacco, and other drugs in Sweden. A fixed effects model was used to analyze data. RESULTS The results reveal that prevention activities increased and several alcohol-related harm indicators were reduced in intervention municipalities (LUMA) compared with in control municipalities. CONCLUSIONS It seems as if financial support, combined with specific requirements and support from the regional and national level, can stimulate local alcohol prevention activities and have a significant effect on alcohol consumption and alcohol-related harm. Similar evaluations in other countries would be of great value for assessing the generalizability of findings.
Collapse
Affiliation(s)
- Tony Nilsson
- a Division of Social Medicine, Department of Public Health Sciences , Karolinska Institutet , Sweden.,b The Swedish Council for Information on Alcohol and Other Drugs (CAN)
| | - Peter Allebeck
- a Division of Social Medicine, Department of Public Health Sciences , Karolinska Institutet , Sweden
| | - Håkan Leifman
- b The Swedish Council for Information on Alcohol and Other Drugs (CAN).,c Department of Clinical Neuroscience , Centre for Psychiatric Research Karolinska Institutet , Sweden
| | - Sven Andréasson
- a Division of Social Medicine, Department of Public Health Sciences , Karolinska Institutet , Sweden
| | - Thor Norström
- c Department of Clinical Neuroscience , Centre for Psychiatric Research Karolinska Institutet , Sweden.,d Swedish Institute for Social Research, Stockholm University , Sweden
| | - Karin Guldbrandsson
- a Division of Social Medicine, Department of Public Health Sciences , Karolinska Institutet , Sweden.,e The Public Health Agency of Sweden
| |
Collapse
|
22
|
Hallgren M, Andersson V, Ekblom Ö, Andréasson S. Physical activity as treatment for alcohol use disorders (FitForChange): study protocol for a randomized controlled trial. Trials 2018; 19:106. [PMID: 29444712 PMCID: PMC5813364 DOI: 10.1186/s13063-017-2435-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/29/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Help-seeking for alcohol use disorders (AUDs) is low and traditional treatments are often perceived as stigmatizing. Physical activity has positive effects on mental and physical health which could benefit this population. We propose to compare the effects of aerobic training, yoga, and usual care for AUDs in physically inactive Swedish adults. METHODS This is a three-group, parallel, single-blind, randomized controlled trial (RCT). In total, 210 adults (aged 18-75 years) diagnosed with an AUD will be invited to participate in a 12-week intervention. The primary study outcome is alcohol consumption measure by the Timeline Follow-back method and the Alcohol Use Disorders Identification Test (AUDIT). Secondary outcomes include: depression, anxiety, perceived stress, sleep quality, physical activity levels, fitness, self-efficacy, health-related quality of life, and cognition. Blood samples will be taken to objectively assess heavy drinking, and saliva to measure cortisol. Acute effects of exercise on the urge to drink alcohol, mood, and anxiety will also be assessed. DISCUSSION The treatment potential for exercise in AUDs is substantial as many individuals with the disorder are physically inactive and have comorbid health problems. The study is the first to assess the effects of physical activity as a stand-alone treatment for AUDs. Considerable attention will be given to optimizing exercise adherence. Both the feasibility and treatment effects of exercise interventions in AUDs will be discussed. The Ethical Review Board (EPN) at Karolinska Institutet has approved the study (DNR: 2017/1380-3). TRIAL REGISTRATION German Clinical Trials Register, ID: DRKS00012311. Registered on 26 September 2017.
Collapse
Affiliation(s)
- Mats Hallgren
- Department of Public Health Sciences, Karolinska Institutet, Solna, 171 77 Sweden
| | | | - Örjan Ekblom
- Swedish School for Sport and Health Sciences, Stockholm, Sweden
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Solna, 171 77 Sweden
- Center for Psychiatric Research, Stockholm, Sweden
| |
Collapse
|
23
|
Andréasson S, McCambridge J. Alcohol Researchers Should Not Accept Funding From the Alcohol Industry: Perspectives From Brief Interventions Research. J Stud Alcohol Drugs 2018; 77:537-40. [PMID: 27340951 DOI: 10.15288/jsad.2016.77.537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sven Andréasson
- President, INEBRIA (the International Network on Brief Interventions for Alcohol & Other Drugs).,Professor, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jim McCambridge
- INEBRIA President, 2012-2015, Professor, Department of Health Sciences, University of York, York, England
| |
Collapse
|
24
|
Sherk A, Stockwell T, Chikritzhs T, Andréasson S, Angus C, Gripenberg J, Holder H, Holmes J, Mäkelä P, Mills M, Norström T, Ramstedt M, Woods J. Alcohol Consumption and the Physical Availability of Take-Away Alcohol: Systematic Reviews and Meta-Analyses of the Days and Hours of Sale and Outlet Density. J Stud Alcohol Drugs 2018; 79:58-67. [PMID: 29227232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE Systematic reviews and meta-analyses were completed studying the effect of changes in the physical availability of take-away alcohol on per capita alcohol consumption. Previous reviews examining this topic have not focused on off-premise outlets where take-away alcohol is sold and have not completed meta-analyses. METHOD Systematic reviews were conducted separately for policies affecting the temporal availability (days and hours of sale) and spatial availability (outlet density) of take-away alcohol. Studies were included up to December 2015. Quality criteria were used to select articles that studied the effect of changes in these policies on alcohol consumption with a focus on natural experiments. Random-effects meta-analyses were applied to produce the estimated effect of an additional day of sale on total and beverage-specific consumption. RESULTS Separate systematic reviews identified seven studies regarding days and hours of sale and four studies regarding density. The majority of articles included in these systematic reviews, for days/hours of sale (7/7) and outlet density (3/4), concluded that restricting the physical availability of take-away alcohol reduces per capita alcohol consumption. Meta-analyses studying the effect of adding one additional day of sale found that this was associated with per capita consumption increases of 3.4% (95% CI [2.7, 4.1]) for total alcohol, 5.3% (95% CI [3.2, 7.4]) for beer, 2.6% (95% CI [1.8, 3.5]) for wine, and 2.6% (95% CI [2.1, 3.2]) for spirits. The small number of included studies regarding hours of sale and density precluded meta-analysis. CONCLUSIONS The results of this study suggest that decreasing the physical availability of take-away alcohol will decrease per capita consumption. As decreasing per capita consumption has been shown to reduce alcohol-related harm, restricting the physical availability of take-away alcohol would be expected to result in improvements to public health.
Collapse
Affiliation(s)
- Adam Sherk
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Tim Stockwell
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Tanya Chikritzhs
- National Drug Research Institute, Health Sciences, Curtin University, Perth, Western Australia
| | | | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Johanna Gripenberg
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Harold Holder
- University of California-Berkeley, Berkeley, California
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Pia Mäkelä
- National Institute for Health and Welfare, Helsinki, Finland
| | - Megan Mills
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Thor Norström
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Mats Ramstedt
- Swedish Council for Information on Alcohol and Other Drugs, Stockholm, Sweden
| | - Jonathan Woods
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
25
|
Sherk A, Stockwell T, Chikritzhs T, Andréasson S, Angus C, Gripenberg J, Holder H, Holmes J, Mäkelä P, Mills M, Norström T, Ramstedt M, Woods J. Alcohol Consumption and the Physical Availability of Take-Away Alcohol: Systematic Reviews and Meta-Analyses of the Days and Hours of Sale and Outlet Density. J Stud Alcohol Drugs 2018. [DOI: 10.15288/jsad.2018.79.58] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Adam Sherk
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Tim Stockwell
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Tanya Chikritzhs
- National Drug Research Institute, Health Sciences, Curtin University, Perth, Western Australia
| | | | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Johanna Gripenberg
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Harold Holder
- University of California–Berkeley, Berkeley, California
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Pia Mäkelä
- National Institute for Health and Welfare, Helsinki, Finland
| | - Megan Mills
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| | - Thor Norström
- Swedish Institute for Social Research, Stockholm University, Stockholm, Sweden
| | - Mats Ramstedt
- Swedish Council for Information on Alcohol and Other Drugs, Stockholm, Sweden
| | - Jonathan Woods
- Centre for Addictions Research of British Columbia, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
26
|
Holloway AS, Ferguson J, Landale S, Cariola L, Newbury-Birch D, Flynn A, Knight JR, Sherritt L, Harris SK, O’Donnell AJ, Kaner E, Hanratty B, Loree AM, Yonkers KA, Ondersma SJ, Gilstead-Hayden K, Martino S, Adam A, Schwartz RP, Wu LT, Subramaniam G, Sharma G, McNeely J, Berman AH, Kolaas K, Petersén E, Bendtsen P, Hedman E, Linderoth C, Müssener U, Sinadinovic K, Spak F, Gremyr I, Thurang A, Mitchell AM, Finnell D, Savage CL, Mahmoud KF, Riordan BC, Conner TS, Flett JAM, Scarf D, McRee B, Vendetti J, Gallucci KS, Robaina K, Clark BJ, Jones J, Reed KD, Hodapp RM, Douglas I, Burnham EL, Aagaard L, Cook PF, Harris BR, Yu J, Wolff M, Rogers M, Barbosa C, Wedehase BJ, Dunlap LJ, Mitchell SG, Dusek KA, Gryczynski J, Kirk AS, Oros MT, Hosler C, O’Grady KE, Brown BS, Angus C, Sherborne S, Gillespie D, Meier P, Brennan A, de Vargas D, Soares J, Castelblanco D, Doran KM, Wittman I, Shelley D, Rotrosen J, Gelberg L, Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Deng Y, Dziura J, Fiellin LE, O’Connor PG, Bedimo R, Gibert C, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Justice AC, Bryant KJ, Fiellin DA, Giles EL, Coulton S, Deluca P, Drummond C, Howel D, McColl E, McGovern R, Scott S, Stamp E, Sumnall H, Vale L, Alabani V, Atkinson A, Boniface S, Frankham J, Gilvarry E, Hendrie N, Howe N, McGeechan GJ, Ramsey A, Stanley G, Clephane J, Gardiner D, Holmes J, Martin N, Shevills C, Soutar M, Chi FW, Weisner C, Ross TB, Mertens J, Sterling SA, Shorter GW, Heather N, Bray J, Cohen HA, McPherson TL, Adam C, López-Pelayo H, Gual A, Segura-Garcia L, Colom J, Ornelas IJ, Doyle S, Donovan D, Duran B, Torres V, Gaume J, Grazioli V, Fortini C, Paroz S, Bertholet N, Daeppen JB, Satterfield JM, Gregorich S, Alvarado NJ, Muñoz R, Kulieva G, Vijayaraghavan M, Adam A, Cunningham JA, Díaz E, Palacio-Vieira J, Godinho A, Kushir V, O’Brien KHM, Aguinaldo LD, Sellers CM, Spirito A, Chang G, Blake-Lamb T, LaFave LRA, Thies KM, Pepin AL, Sprangers KE, Bradley M, Jorgensen S, Catano NA, Murray AR, Schachter D, Andersen RM, Rey GN, Vahidi M, Rico MW, Baumeister SE, Johansson M, Sinadinovic C, Hermansson U, Andreasson S, O’Grady MA, Kapoor S, Akkari C, Bernal C, Pappacena K, Morley J, Auerbach M, Neighbors CJ, Kwon N, Conigliaro J, Morgenstern J, Magill M, Apodaca TR, Borsari B, Hoadley A, Scott Tonigan J, Moyers T, Fitzgerald NM, Schölin L, Barticevic N, Zuzulich S, Poblete F, Norambuena P, Sacco P, Ting L, Beaulieu M, Wallace PG, Andrews M, Daley K, Shenker D, Gallagher L, Watson R, Weaver T, Bruguera P, Oliveras C, Gavotti C, Barrio P, Braddick F, Miquel L, Suárez M, Bruguera C, Brown RL, Capell JW, Paul Moberg D, Maslowsky J, Saunders LA, McCormack RP, Scheidell J, Gonzalez M, Bauroth S, Liu W, Lindsay DL, Lincoln P, Hagle H, Wallhed Finn S, Hammarberg A, Andréasson S, King SE, Vargo R, Kameg BN, Acquavita SP, Van Loon RA, Smith R, Brehm BJ, Diers T, Kim K, Barker A, Jones AL, Skinner AC, Hinman A, Svikis DS, Thacker CL, Resnicow K, Beatty JR, Janisse J, Puder K, Bakshi AS, Milward JM, Kimergard A, Garnett CV, Crane D, Brown J, West R, Michie S, Rosendahl I, Andersson C, Gajecki M, Blankers M, Donoghue K, Lynch E, Maconochie I, Phillips C, Pockett R, Phillips T, Patton R, Russell I, Strang J, Stewart MT, Quinn AE, Brolin M, Evans B, Horgan CM, Liu J, McCree F, Kanovsky D, Oberlander T, Zhang H, Hamlin B, Saunders R, Barton MB, Scholle SH, Santora P, Bhatt C, Ahmed K, Hodgkin D, Gao W, Merrick EL, Drebing CE, Larson MJ, Sharma M, Petry NM, Saitz R, Weisner CM, Young-Wolff KC, Lu WY, Blosnich JR, Lehavot K, Glass JE, Williams EC, Bensley KM, Chan G, Dombrowski J, Fortney J, Rubinsky AD, Lapham GT, Forray A, Olmstead TA, Gilstad-Hayden K, Kershaw T, Dillon P, Weaver MF, Grekin ER, Ellis JD, McGoron L, McGoron L. Proceedings of the 14th annual conference of INEBRIA. Addict Sci Clin Pract 2017. [PMCID: PMC5606215 DOI: 10.1186/s13722-017-0087-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
27
|
Glass JE, Andréasson S, Bradley KA, Finn SW, Williams EC, Bakshi AS, Gual A, Heather N, Sainz MT, Benegal V, Saitz R. Rethinking alcohol interventions in health care: a thematic meeting of the International Network on Brief Interventions for Alcohol & Other Drugs (INEBRIA). Addict Sci Clin Pract 2017; 12:14. [PMID: 28490342 PMCID: PMC5425968 DOI: 10.1186/s13722-017-0079-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/14/2017] [Indexed: 11/29/2022] Open
Abstract
In 2016, the International Network on Brief Interventions for Alcohol & Other Drugs convened a meeting titled “Rethinking alcohol interventions in health care”. The aims of the meeting were to synthesize recent evidence about screening and brief intervention and to set directions for research, practice, and policy in light of this evidence. Screening and brief intervention is efficacious in reducing self-reported alcohol consumption for some with unhealthy alcohol use, but there are gaps in evidence for its effectiveness. Because screening and brief intervention is not known to be efficacious for individuals with more severe unhealthy alcohol use, recent data showing the lack of evidence for referral to treatment as part of screening and brief intervention are alarming. While screening and brief intervention was designed to be a population-based approach, its reach is limited. Implementation in real world care also remains a challenge. This report summarizes practice, research, and policy recommendations and key research developments from our meeting. In order to move the field forward, a research agenda was proposed to (1) address evidence gaps in screening, brief intervention, and referral to treatment, (2) develop innovations to address severe unhealthy alcohol use within primary care, (3) describe the stigma of unhealthy alcohol use, which obstructs progress in prevention and treatment, (4) reconsider existing conceptualizations of unhealthy alcohol use that may influence health care, and (5) identify efforts needed to improve the capacity for addressing unhealthy alcohol consumption in all world regions.
Collapse
Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Sara Wallhed Finn
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ann-Sofie Bakshi
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, ICN, Hospital Clínic, IDIBAPS, RTA, Barcelona, Spain
| | - Nick Heather
- Department of Psychology, Faculty of Health & Social Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Marcela Tiburcio Sainz
- Department of Social Sciences in Health, Ramón de la Fuente Muñiz, National Institute of Psychiatry, Mexico City, Mexico
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
28
|
Affiliation(s)
- Sven Andréasson
- Stockholm Center for Addiction and Center for Psychiatric Research, Riddargatan 1 - mottagningen för alkohol och hälsa, Karolinska Institutet, Department of Public Health Sciences, 11435 Stockholm, Sweden
| | - Jim McCambridge
- Department of Health Sciences, Faculty of Science, University of York, Heslington, YO10 5DD, UK
| |
Collapse
|
29
|
Nilsson T, Leifman H, Andréasson S. Monitoring local alcohol prevention in Sweden: Application of Alcohol Prevention Magnitude Measure (APMM). Nordic Studies on Alcohol and Drugs 2017. [DOI: 10.1515/nsad-2015-0047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims National alcohol policy in Sweden has to a certain extent grown weaker, and there has instead been an increased focus on strengthening local alcohol prevention. Swedish municipalities carry out a variety of alcohol prevention activities, but there is little knowledge of how the magnitude of all these activities has developed over time. One reason for this lack of information is the limitation of tools for monitoring prevention activities locally. The aim of this study is 1) to develop an Alcohol Prevention Magnitude Measure (APMM) based on local data and 2) to analyse the development of local alcohol prevention by using APMM. Data The APMM is based on 37 different indicators of local prevention. Data derives from web-based surveys comprising all Swedish municipalities and from information on licensed premises at the local level. Results The results reveal that local alcohol prevention in Sweden, as measured by the APMM, has increased generally between 2006 and 2010. The increase is the result of more local policies and activities. Conclusion The results indicate that the APMM captures real changes at the local level, as the APMM increased significantly in community intervention municipalities compared to others.
Collapse
Affiliation(s)
- Tony Nilsson
- Department of Public Health Sciences Division of Social Medicine Karolinska Institutet
| | - Håkan Leifman
- Department of Clinical Neuroscience Centre for Psychiatric Research Karolinska Institutet
| | - Sven Andréasson
- Department of Public Health Sciences Division of Social Medicine Karolinska Institutet
| |
Collapse
|
30
|
Andréasson S. [Good prognosis for alcohol addiction, but few seek treatment. Today's dependence policies are stereotypical and outdated - primary health care could give good treatment]. Lakartidningen 2016; 113:D7FZ. [PMID: 27701673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Sven Andréasson
- Beroendecentrum Stockholm - Riddargatan 1 Stockholm, Sweden - , Sweden
| |
Collapse
|
31
|
Abstract
OBJECTIVE The authors assessed 1) the overall risk of death among cannabis users compared with nonusers and the extent to which psychosis affects excess mortality; 2) mortality among persons with psychotic disorders and the extent to which cannabis use affects excess mortality; and 3) the interaction effect of cannabis use and diagnosis of psychotic disorders on mortality. METHOD This was a longitudinal study of 50,373 Swedish male military conscripts (ages 18-19) who were followed in the National Cause of Death Register up to around age 60. Cox proportional hazard modeling was used to assess risk of death in relation to baseline cannabis use and diagnosis of psychotic disorders. RESULTS Subjects with a baseline history of heavy cannabis use had a significantly higher risk of death (hazard ratio=1.4, 95% CI=1.1, 1.8) than those without such a history. The authors found an excess mortality among subjects with psychotic disorders, but the level did not differ between those with a history of cannabis use (ever users: hazard ratio=3.8, 95% CI=2.8, 5.0; heavy users: hazard ratio=3.8, 95% CI=2.6, 6.2) and those without such a history (hazard ratio=3.7, 95% CI=3.1, 44). No interaction was observed between cannabis use and diagnosis of psychotic disorders with regard to mortality. CONCLUSIONS The results suggest that individuals with an early history of heavy use of cannabis are at a higher risk of death than those with a history of no use of cannabis. Although the authors adjusted for several confounders at baseline, the results should be interpreted with caution because of a lack of information on confounders in the period after conscription.
Collapse
Affiliation(s)
- Edison Manrique-Garcia
- From the Department of Public Health Sciences, Karolinska Institutet, Stockholm; the Institute of Social Medicine, University of Rio de Janeiro State, Rio de Janeiro; and the Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm
| | - Antonio Ponce de Leon
- From the Department of Public Health Sciences, Karolinska Institutet, Stockholm; the Institute of Social Medicine, University of Rio de Janeiro State, Rio de Janeiro; and the Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm
| | - Christina Dalman
- From the Department of Public Health Sciences, Karolinska Institutet, Stockholm; the Institute of Social Medicine, University of Rio de Janeiro State, Rio de Janeiro; and the Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm
| | - Sven Andréasson
- From the Department of Public Health Sciences, Karolinska Institutet, Stockholm; the Institute of Social Medicine, University of Rio de Janeiro State, Rio de Janeiro; and the Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm
| | - Peter Allebeck
- From the Department of Public Health Sciences, Karolinska Institutet, Stockholm; the Institute of Social Medicine, University of Rio de Janeiro State, Rio de Janeiro; and the Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm
| |
Collapse
|
32
|
Affiliation(s)
- Sven Andréasson
- President, INEBRIA (the International Network on Brief Intervention for Alcohol and Other Drugs).,Professor, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jim McCambridge
- INEBRIA President, 2012-2015, Professor, Department of Health Sciences, University of York, York, England
| |
Collapse
|
33
|
Pedersen KB, Sjølie AK, Vestergaard AH, Andréasson S, Møller F. Fixation stability and implication for multifocal electroretinography in patients with neovascular age-related macular degeneration after anti-VEGF treatment. Graefes Arch Clin Exp Ophthalmol 2016; 254:1897-1908. [PMID: 27080862 DOI: 10.1007/s00417-016-3323-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To quantify fixation stability in patients with neovascular age-related macular degeneration (nAMD) at baseline, 3 and 6 months after anti-vascular endothelial growth factor (anti-VEGF) treatment and furthermore asses the implications of an unsteady fixation for multifocal electroretinography (mfERG) measurements. METHODS Fifty eyes of 50 nAMD patients receiving intravitreal anti-VEGF treatment with either bevacizumab or ranibizumab and eight eyes of eight control subjects were included. Fixation stability measurements were performed with the Eye-Link eyetracking system and the retinal area in degrees2 (deg2) containing the 68 % most frequently used fixation points (RAF68) was calculated. MfERG P1 amplitude and implicit time were analyzed in six concentric rings and as a summed response. Patients were examined at baseline, 3 and 6 months. Four different mfERG recordings were performed for the control subjects to mimic an involuntary unstable fixation: normal central fixation, 2.4°, 4.8°, and 7.1° fixation instability. RESULTS For control subjects, a fixation instability of 2.4° (corresponding to the central hexagon) did not reduce mfERG ring amplitudes significantly, whereas 4.8° and 7.1° fixation instability reduced the amplitudes significantly in rings 1 and 2 (p < 0.001) as well as in the peripheral rings in the 7.1° instability condition (p < 0.001). Fixation stability improved non-significantly for patients at 3 and 6 months. The size of the retinal area of fixation was at baseline, 3 and 6 months negatively correlated to visual acuity (VA) (rbaseline = -0.65, r3 months = -0.60, and r6 months = -0.66 respectively, p < 0.001) and mfERG amplitudes of the three innermost rings (rbaseline = -0.29, p = 0.042, r3 months = -0.43, p = 0.003 and r6 months = -0.31, p = 0.042). The VA cutoff for a fixation area less than 5 deg2 (approximately the central hexagon) was 65, 77, and 68 ETDRS letters (corresponding a maximal Snellen equivalent of 0.31) at baseline, 3 and 6 months, respectively. CONCLUSIONS MfERG amplitudes in recordings of nAMD patients are at substantial risk of being reduced due to poor fixation as a large number of patients may use a fixation area of more than 5 deg2. Fixation monitoring during recording as well as interpretation of results should be performed with care, especially in patients with poor visual acuity.
Collapse
Affiliation(s)
- K B Pedersen
- Department of Ophthalmology, Rigshospitalet-Glostrup, Nordre Ringvej 57, 2600, Glostrup, Denmark.
| | - A K Sjølie
- Department of Ophthalmology, Odense University Hospital, 5000, Odense, Denmark
| | - A H Vestergaard
- Department of Ophthalmology, Odense University Hospital, 5000, Odense, Denmark
| | - S Andréasson
- Department of Ophthalmology, Lund University, 221 00, Lund, Sweden
| | - F Møller
- Department of Ophthalmology, Vejle Hospital, 7100, Vejle, Denmark
| |
Collapse
|
34
|
Wåhlin S, Finn SW, Andréasson S. [Stop stigmatizing alcohol problems]. Lakartidningen 2016; 113:DWHL. [PMID: 26906045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Sven Wåhlin
- Beroendecentrum Stockholm - Riddargatan 1 Stockholm, Sweden - Stockholm, Sweden
| | | | | |
Collapse
|
35
|
Andréasson S, Chikritzhs T, Dangardt F, Holder H, Naimi T, Stockwell T. [Moderate alcohol consumption brings no positive effect on health. A critical research analysis]. Lakartidningen 2016; 113:DUWS. [PMID: 26881794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The evidence for the beneficial health effects of moderate drinking is weaker than commonly perceived. No randomised controlled trials have been done. Observational studies suffer from unavoidable methodological limitations, chiefly from confounding and misclassification. Clinical advice to patients as well as public health recommendations should discourage initiation of alcohol consumption, as well as recommend the reduction of excessive drinking. The absence of health benefits strengthens the the arguments for effective population-level policies, e.g. raising alcohol prices and restricting the physical availability of alcohol.
Collapse
Affiliation(s)
- Sven Andréasson
- Beroendecentrum Stockholm - Riddargatan 1 Stockholm, Sweden - , Sweden
| | - Tanya Chikritzhs
- Curtin University, Perth - National Drug Research Institute, Perth Perth, Australia Curtin University, Perth - National Drug Research Institute, Perth Perth, Australia
| | - Frida Dangardt
- University College - London, United Kingdom of Great Britain and Northern Ireland University College - London, United Kingdom of Great Britain and Northern Ireland
| | - Harold Holder
- Pacific Institute for Research and Evaluation - Prevention Research Center Oakland, United States Pacific Institute for Research and Evaluation - Prevention Research Center Oakland, United States
| | - Timothy Naimi
- Boston Medical Center, Section on General Internal Medicine; Boston University Schools of Medicine and Public Health, USA
| | - Tim Stockwell
- University of Victoria, BC - Centre for Addictions Research of BC Victoria, Canada University of Victoria, BC - Centre for Addictions Research of BC Victoria, Canada
| |
Collapse
|
36
|
Wåhlin S, Andréasson S. [Treatment of alcohol dependence in primary health care can provide good results. The 15-method--a structured care model matched to patient needs]. Lakartidningen 2015; 112:DIIY. [PMID: 26371479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The main obstacle for people with an alcohol problem to seek help is the stigma attached to alcohol problems and alcohol treatment. Seeking help in primary health care is less stigmatised. Alcohol dependence is mostly of mild or moderate severity and can consequently be managed by non-specialists to a large extent. The 15-method is a structured stepped care model with evidence-based components, where interventions are matched to patient need. The first step, to recognise the impact of alcohol on health, should be mastered by all health professionals.
Collapse
Affiliation(s)
- Sven Wåhlin
- Beroendecentrum Stockholm - Riddargatan 1 Stockholm, Sweden - Stockholm, Sweden
| | - Sven Andréasson
- Beroendecentrum Stockholm - Riddargatan 1 Stockholm, Sweden - , Sweden
| |
Collapse
|
37
|
Wåhlin S, Andréasson S, Roos K. [Alcohol addiction in itself is not a reason to suspend the driving license]. Lakartidningen 2014; 111:952-954. [PMID: 24946502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
38
|
Wallhed Finn S, Bakshi AS, Andréasson S. Alcohol consumption, dependence, and treatment barriers: perceptions among nontreatment seekers with alcohol dependence. Subst Use Misuse 2014; 49:762-9. [PMID: 24601784 DOI: 10.3109/10826084.2014.891616] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Alcohol use disorders are highly prevalent worldwide. However, only a minority with alcohol dependence seek and undergo treatment. From a public health perspective, it is important to understand why people do not seek treatment. OBJECTIVES This study aims to describe how people with alcohol dependence perceive and discuss treatment for alcohol use disorders and their reasons for seeking and not seeking treatment. METHODS 32 alcohol dependent adults from the general population participated in focus groups and individual interviews in Stockholm during 2011-2012. Data were analyzed with thematic content analysis. RESULTS Suffering from alcohol dependence, as well as realizing the need for, and entering treatment, were associated with shame and stigma, and were strong barriers to treatment. Other barriers included the desire to deal with alcohol problems on one's own and the view that seeking treatment required total abstinence. Negative health-effects were mainly a nonissue. The participants' knowledge about treatment options was limited to lifelong abstinence, medication with Disulfiram and residential treatment. These were seen as unappealing and contrasted sharply with preferred treatment. CONCLUSIONS/IMPORTANCE: Public health literacy regarding alcohol use, dependence, and treatment ought to be improved in order to lower barriers to treatment. Treatment services need to better match the needs and wishes of potential service users, as well as taking stigmatization into account. In order to develop suitable treatments, and to reach the majority who do not seek treatment, the clinical understanding of alcohol dependence needs to be expanded to include mild to moderate dependence.
Collapse
Affiliation(s)
- Sara Wallhed Finn
- Department of Public Health Sciences, Karolinska Institutet , Stockholm , Sweden
| | | | | |
Collapse
|
39
|
Hallgren M, Romberg K, Bakshi AS, Andréasson S. Yoga as an adjunct treatment for alcohol dependence: a pilot study. Complement Ther Med 2014; 22:441-5. [PMID: 24906582 DOI: 10.1016/j.ctim.2014.03.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 02/27/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This pilot study explores the feasibility of yoga as part of a treatment program for alcohol dependence. DESIGN Eighteen alcohol dependent patients were randomized to receive either treatment as usual or treatment as usual plus yoga. Assessments were taken at baseline and six month follow-up. SETTING 'Riddargatan 1': an outpatient alcohol treatment clinic located in Stockholm, Sweden. INTERVENTIONS Treatment as usual consisted of psychological and pharmacological interventions for alcohol dependence. The 10-week yoga intervention included a weekly group yoga session. Participants were encouraged to practice the yoga movements at home once per day. MAIN OUTCOME MEASURES Alcohol consumption (timeline follow-back method, DSM-IV criteria for alcohol dependence, and the Short Alcohol Dependence Data questionnaire), affective symptoms (the Hospital Anxiety and Depression Scale), quality of life (Sheehan Disability Scale) and stress (the Perceived Stress Scale and saliva cortisol). RESULTS Yoga was found to be a feasible and well accepted adjunct treatment for alcohol dependence. Alcohol consumption reduced more in the treatment as usual plus yoga group (from 6.32 to 3.36 drinks per day) compared to the treatment as usual only group (from 3.42 to 3.08 drinks per day). The difference was, however, not statistically significant (p = 0.17). CONCLUSIONS Larger studies are needed to adequately assess the efficacy and long-term effectiveness of yoga as an adjunct treatment for alcohol dependence.
Collapse
Affiliation(s)
- Mats Hallgren
- Department of Public Health Sciences, Section of Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institute, Stockholm, Sweden.
| | - Karin Romberg
- Riddargatan 1: Alcohol Treatment Clinic, Stockholm, Sweden.
| | - Ann-Sofie Bakshi
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden.
| | - Sven Andréasson
- Riddargatan 1: Alcohol Treatment Clinic, Stockholm, Sweden; Department of Public Health Sciences, Division of Social Medicine, Karolinska Institute, Stockholm, Sweden.
| |
Collapse
|
40
|
Affiliation(s)
- Sven Andréasson
- Department of Public Health Sciences, Karolinska institutet, Stockholm, 17177, Sweden.
| |
Collapse
|
41
|
Abstract
BACKGROUND Adolescents' alcohol consumption is a public health concern in Sweden as well as in many other countries. Underage drinking is associated with increased risks of alcohol-related injuries, risky sexual behaviours and dependence later in life. Different strategies have been used in the effort to prevent this behaviour, and to postpone the onset of alcohol. The Strengthening Families Programme 10-14 (SFP 10-14) from the USA has been highlighted as one of the more effective prevention programmes. The aim of the present article was to evaluate the effectiveness of a culturally adapted Swedish version of the SFP 10-14. METHODS This was a cluster randomized controlled trial including 587 sixth-grade students (age 12) and their parents in 19 elementary schools in Stockholm. Schools were randomly assigned to either control (9 schools, 216 students) or to the family skills training intervention (10 schools, 371 students). The SFP Swedish version consisted of two parts with seven and five sessions, respectively, held separately for youths and parents except two joint family sessions. Measures of students' self-reported episodes of drunkenness, smoking, illicit drug use and other norm-breaking behaviours were collected at baseline (March 2003) and at three subsequent yearly surveys. Data were analysed using multilevel models with an intention-to-treat approach. RESULTS No preventive effects were found for smoking, alcohol and illicit drug use and other norm-breaking behaviours, nor did moderators affect the outcome. CONCLUSION The Swedish version of the SFP 10-14 was not effective in preventing youths' substance use in a Swedish context.
Collapse
Affiliation(s)
- Eva Skärstrand
- 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden2 Department of Clinical Neuroscience, STAD, Stockholm Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Knut Sundell
- 3 Department of Knowledge Based Policy and Guidance, National Board of Health and Welfare, Stockholm, Sweden
| | - Sven Andréasson
- 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
42
|
|
43
|
|
44
|
Abstract
AIMS The aim of the study was to investigate preferences in the general population regarding type of treatment for alcohol problems and the preferred setting for delivery of treatment and reasons for not seeking treatment for alcohol problems. METHOD Data were from a random, cross-sectional, interview survey of 9005 of the Swedish general population. Proportions of respondents preferring a certain treatment and source of treatment, and reasons suggested for why people do not seek treatment, were analysed in relation to number of standard drinks, employment status, education and income. RESULTS Most frequently endorsed forms of treatment were alcoholics anonymous or similar support groups and psychotherapy. More than 50% preferred psychiatric or addiction specialist treatment. Around 10% preferred primary health care and around 20% the occupational health services. About 5% preferred the social services. Respondents rated 'feeling ashamed' as the most important reason why people would not seek help for alcohol problems. CONCLUSION Large majorities of the respondents preferred treatment in the health care services and few in the social services. Internet-based treatment and pharmacological treatment attracted few respondents, the majority preferring more traditional forms of treatment. Alcohol treatment remains a stigmatized field, evidenced by shame being the most commonly reported reason for not seeking treatment.
Collapse
Affiliation(s)
- Sven Andréasson
- Corresponding author: Department of Public Health Sciences, Karolinska Institutet, 17176 Stockholm, Sweden.
| | | | | |
Collapse
|
45
|
Hallgren M, Andréasson S. The Swedish six-community alcohol and drug prevention trial: effects on youth drinking. Drug Alcohol Rev 2013; 32:504-11. [PMID: 23751136 DOI: 10.1111/dar.12057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 05/13/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Local communities are increasingly targeted for alcohol and drug prevention campaigns. This study describes some of the key findings from the Swedish six-community alcohol and drug prevention trial (2003-2007) and lessons learned following an evaluation of the trial's effectiveness. The paper focuses mainly on changes in youth drinking and related harms. DESIGN AND METHODS This was a pre- to post-intervention effect study comparing six trial communities that received added training and technical support with six control communities where regular prevention efforts were supported by national alcohol and drug action plans. A repeated, cross-sectional survey of 8092 youths aged 15-19 years assessed changes in alcohol consumption, binge drinking, perceived alcohol availability, access to alcohol via parents and adult attitudes towards the supply of alcohol to youths. National registry data were used to assess changes in hospital admissions due to alcohol intoxication. RESULTS Overall, there were few significant improvements in the six trial communities compared with the control communities. DISCUSSION AND CONCLUSIONS The absence of program effects was largely attributable to the selection of strategies (in particular, school and parental programs) lacking evidence of effectiveness in reducing alcohol consumption at the aggregate level. Prevention programs based on efficacy studies need to be tested in community-based effectiveness trials before being disseminated.
Collapse
Affiliation(s)
- Mats Hallgren
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden
| | | |
Collapse
|
46
|
Andréasson S, Danielsson AK, Hallgren M. Severity of alcohol dependence in the Swedish adult population: association with consumption and social factors. Alcohol 2013; 47:21-5. [PMID: 23084032 DOI: 10.1016/j.alcohol.2012.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 09/25/2012] [Accepted: 10/07/2012] [Indexed: 11/25/2022]
Abstract
The severity of alcohol dependence can be estimated by the number of DSM-IV criteria that are fulfilled for this disorder. This paper describes the proportions in a general population sample that meet different numbers of diagnostic criteria for alcohol dependence and their association with drinking and social background factors. Data came from a random, cross-sectional, self-report survey of adults from 12 Swedish communities. 28,800 persons, age 19-70, were surveyed through postal questionnaires. 14,706 questionnaires (51%) could be used for analysis. Alcohol dependence was assessed by questions relating to the seven DSM-IV criteria for alcohol dependence. Alcohol consumption and social background factors were examined in relation to alcohol dependence. A total of 73.8% of the general population fulfilled no criteria for alcohol dependence; 4.0% reported 3 or more criteria and qualified for the diagnosis of alcohol dependence. There were trends toward an increasing number of dependence criteria with increasing consumption levels and negative social background factors. The majority of people with alcohol dependence however did not drink at the highest consumption levels, did not live alone, and were not unemployed. Given the current definition of alcohol dependence the majority of people have few criteria fulfilled (3 or 4) and few social problems. This has important implications for treatment as dependence with low severity may require less treatment and less specialist involvement.
Collapse
|
47
|
Romelsjö A, Allebeck P, Andréasson S, Leifman A. Alcohol, Mortality and Cardiovascular Events in a 35 Year Follow-up of a Nationwide Representative Cohort of 50,000 Swedish Conscripts up to Age 55. Alcohol Alcohol 2012; 47:322-7. [DOI: 10.1093/alcalc/ags021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
|
48
|
Gripenberg-Abdon J, Elgán TH, Wallin E, Shaafati M, Beck O, Andréasson S. Measuring substance use in the club setting: a feasibility study using biochemical markers. Subst Abuse Treat Prev Policy 2012; 7:7. [PMID: 22321198 PMCID: PMC3295681 DOI: 10.1186/1747-597x-7-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 02/09/2012] [Indexed: 11/17/2022]
Abstract
Background During the last few decades the use of club drugs (e.g., cocaine, amphetamines) has been of increased concern in nightlife settings. Traditionally, surveys have been used to estimate the use of club drugs, however, they mostly rely on self-reports which may not be accurate. Recent advances have allowed for readily accessible drug testing methods such as oral fluid drug testing. Nevertheless, research using oral fluid sampling to measure the frequency of drug use in the club environment is scarce. The objective of this study is to evaluate the feasibility of measuring the frequency of alcohol and drug use among Swedish clubbers using breath alcohol and oral fluid drug testing. Method The setting was a 40 hour electronic music dance event (EMDE) on a cruise ship on the Baltic Sea, departing from Sweden, with 875 passengers. Groups of participants at the EMDE were randomly invited to participate. Data were collected with face-to-face and self-administered questionnaires. Further, oral fluid samples were collected to determine illicit drug use, and blood alcohol concentration (BAC) levels were measured using a breath analyzer. Results A total of 422 passengers were asked to participate in the study whereof 21 declined (5.0% refusal rate). Of the 401 study participants (accounting for 45.8% of all attendees), 5 declined oral fluid drug testing. Results show that there was a discrepancy between self-reported and actual drug use as 10.1% of the participants were positive on illicit drug use (amphetamines, ecstasy/MDMA, cannabis, cocaine), while only 3.7% of the participants reported drug use during the last 48 hours. The average BAC level was 0.10% and 23.7% had BAC levels ≥ 0.15%, while 5.9% had levels below the detection limit. The mean BAC levels for the illicit drug users were significantly higher (p = 0.004) than for non-drug users (0.13% vs. 0.10%). Self-reported AUDIT-C scores (using a threshold of ≥ 5 for men and ≥ 4 for women) revealed that 76.0% of the men and 80.7% of the women had risky alcohol consumption patterns. Conclusion This study indicates that it is feasible to conduct breath alcohol and oral fluid drug testing in a Swedish club setting.
Collapse
|
49
|
Affiliation(s)
- Sven Andréasson
- Swedish National Institute of Public Health, 831 40 Östersund, Sweden.
| |
Collapse
|
50
|
Abstract
AIMS To evaluate long-term effects of a multi-component community-based club drug prevention programme. DESIGN A pre- (2003) and post-intervention study (2004 and 2008) design. SETTING High-risk licensed premises in central Stockholm, Sweden. PARTICIPANTS The intervention programme, 'Clubs against Drugs', included community mobilization, drug-training for doormen and other staff, policy work, increased enforcement, environmental changes and media advocacy and public relations work. MEASUREMENT The indicator chosen for this study was the frequency of doormen intervention towards obviously drug-intoxicated guests at licensed premises. Professional male actors (i.e. pseudopatrons) were trained to act impaired by cocaine/amphetamines while trying to enter licensed premises with doormen. An expert panel standardized the scene of drug intoxication. Each attempt was monitored by two male observers. FINDINGS At the follow-up study in 2008 the doormen intervened in 65.5% of the attempts (n=55), a significant improvement compared to 27.0% (n=48) at the first follow-up in 2004 and to 7.5% (n=40) at baseline in 2003. CONCLUSION The 'Clubs against Drugs' community-based intervention programme, a systems approach to prevention, appears to increase the frequency and effectiveness of club doormen's interventions regarding obviously drug-intoxicated guests.
Collapse
|