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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare two short-term treatments for alcohol-related problems. The study was performed at an outpatient clinic for substance misuse, and subjects (65 men and 28 women) were recruited through advertisements in the local newspaper. The subjects were randomized to either a four-session guided self-change group or a one-session advice group. Alcohol consumption, degree of alcohol dependence, negative consequences of drinking, and health-related quality of life were measured or assessed, respectively, by using the timeline follow-back technique, the Short Alcohol Dependence Data (SADD) questionnaire, The Drinker Inventory of Consequences questionnaire, and the Nottingham Health Profile questionnaire. Biological markers for high alcohol consumption [carbohydrate-deficient transferrin (CDT) and gamma-glutamyl transferase (γ-GT) levels] were analyzed. All assessments were made at baseline and at 9- and 23-month follow-up periods after treatment. Self-reported alcohol consumption was significantly reduced (P < .0001) in both treatment groups at the 23-month follow-up period, as were measures of alcohol dependence, negative consequences of drinking, and health-related quality of life, whereas no corresponding reduction was found in CDT or γ-GT values. No statistically significant differences in self-reported alcohol consumption were found between the two groups. Patient satisfaction was significantly higher with the four-session guided self-change treatment than with the one session of advice. This finding seems to indicate that individuals, although suffering from alcohol-related problems of relatively low severity, appreciate more time with a therapist. [Copyright &y& Elsevier]

Background: The aim was to study the prevalence of mental disorders among homeless men and women admitted for inpatient treatment in hospitals. Methods: Hospital care utilization of homeless people, 1364 men and 340 women, was compared with a control group consisting of 3750 men and 1250 women from the general population, 1996–2002. Results: Homeless women ran a higher risk for mental disorders than women in the population [risk ratio (RR) 20.88]; their risk was also higher than the risk for homeless men (RR 1.20). Younger homeless women had the highest risk (RR 2.17). Alcohol use disorders were equally common among homeless men and women, but women had more drug use disorders (RR 1.32). Women had higher risk of schizophrenia (RR 2.79), and personality disorders (RR 2.73). When adjustment was made for substance use disorders, no increased risk for mental disorder was found in the homeless group. Conclusion: The elevated risk for mental disorders among the homeless was mainly related to substance use problems. Younger homeless women had the highest risk of mental disorder. [ABSTRACT FROM AUTHOR]

Background: A number of factors have been identified that protect adolescents or, alternatively, put them at risk for drug use and other high-risk behaviours. These factors concern different personal and environmental factors, e.g. the community, the school setting, family, peer group and individual characteristics. The aim of the present study was to examine the associations between risk and protective factors and adolescents' use of alcohol and drugs. Methods: In both May 2003 and 2004, random samples of 4800 adolescents (a total of 9600) in Sweden were contacted and asked to fill out a questionnaire. It concerned use of alcohol and illicit drugs and a large number of adolescent risk and protective factors. A total of 5445 (57%) adolescents agreed to participate. Results: About 44% of the adolescents in grade 9 (15-16 years of age) had been drunk on at least one occasion and nearly 80% of those in grade 11 (17-18 years of age). Almost 15% in grade 9 and 40% in grade 11 had been drinking heavily during the previous month, and 4% in grade 9 and 12% in grade 11 had used cannabis. Strong associations Were found between elevated individual, family, school and community risk factors and use of alcohol and drugs. Conversely, protective factors were negatively related to the use of alcohol and drugs. Conclusions: This study confirms the importance of risk and protective factors within different domains in explaining alcohol and drug use among adolescents. The results support efforts targeting multiple risk and protective factors in alcohol and drug preventive interventions for adolescents. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate a research and development project to reduce alcohol and drug use-related problems, conducted during 2003-2005, in six urban and rural municipalities in Sweden, Umeå, Kramfors, Solna, Kalmar, Laholm, and Lund. The development of alcohol and drug use trends and patterns will be followed through 2008 in the six targeted intervention communities and in the six matched control communities. The evaluation includes archival data, survey data, observational data, as well as process measures. The six communities have gradually reoriented their thinking about prevention from a single focus on youth activities to a broader approach involving the whole population. The project's and the study's limitations are noted and future needed research is suggested. [ABSTRACT FROM AUTHOR]

Secondary prevention of alcohol problems in health care has been proved efficacious in many studies, yet its implementation remains scarce, and its effectiveness in regular health care remains unknown. This article reports results from a feasibility study of dissemination of alcohol prevention methods in primary health care in Stockholm. Initial interviews with general practitioners (GPs) and district health nurses indicated that few raised the issue of alcohol with patients, made notes about alcohol in patient charts or found working with alcohol issues rewarding. The impact of a training session, where a project nurse visited all willing GPs and nurses, was limited. Although the uptake of the prevention package was high, follow-up at 3 months indicated that little use was made of the materials. Specifically, screening rates were low. In the future, secondary prevention of alcohol problems will require better adaptation to the realities of primary care. [ABSTRACT FROM PUBLISHER]

Objectives. The purpose of the study was to assess risk indicators for admission for alcoholism in young men. Methods. Level of alcohol consumption and background variables were analyzed in a survey of 49 464 Swedish conscripts. Admissions to psychiatric care were registered during a 15-year follow up. Results. A strong association was found between level of alcohol consumption at conscript and future admission for alcoholism. The strongest risk indicator for admission for alcoholism, however, was "Contacts with police or child care authorities," with an odds ratio of 4.9 Conclusions. For conscripts reporting moderate alcohol consumption there was a clear association between an increasing burden of risk indicators and future alcoholism. Among men who already had a high level of alcohol consumption at conscription, additional risk indicators, with the exception of psychological factors, had relatively little impact on future admission for alcoholism. Poor emotional control and early symptoms of mental disorder, however, were instrumental not only in enhancing the risk for high consumption at conscription, but also in enhancing the risk for high consumption at conscription, but also in enhancing the risk for high consumes to become abusers or addicted. [ABSTRACT FROM AUTHOR]

The article discusses several prevention programmes for alcoholism. A study from conducted by researchers from Sweden and Norway found no effects in trial communities compared to controls. It also argues that the government's alcohol and drug prevention field would result in increased drinking and increased problem levels. It also notes the effort of the Swedish parliament to adopt a comprehensive national alcohol action plan to promote the importance of national control policy. It emphasizes various studies on alcoholism have only smaller effects on the community.

Introduction: Alcohol consumption and drug use, as well as alcohol- and drug-related problems, vary considerably in different regions in Sweden, and between men and women of different ages. Aim: The aim of the present study was to examine the regional, gender and socioeconomic distribution of risk consumption of alcohol, alcohol dependency and drug use in a random sample in Sweden. Material and methods: In both May 2003 and 2004, 7200 gender-stratified adults (a total of 14,400), randomly selected from 12 regions in Sweden, were contacted by mail, and asked to fill out an enclosed questionnaire. The questionnaire concerned use of alcohol, alcohol-related problems, and use of illicit drugs. Results: Heavy alcohol consumption and cannabis use were more frequent in the south of Sweden than in the north, and the further north, the lower the frequency. Alcohol and drug use decreased with age, and was higher for men than for women. On average, 11.5% of all men and 5.0% of all women consumed alcohol intensively at least weekly, 8.6% of men and 4.5% of women had a generally high alcohol consumption, 4.1% of men and 2.5% of women were alcohol addicted, and 2.9% of men and 1.3% of women had used cannabis during the last 12 months. Conclusions: High alcohol consumption and use of illegal drugs seem to be more prevalent in those parts of Sweden that are closer to the European continent. In our opinion, this might be an effect of the closeness to other European countries with lower prices for alcohol, less strict alcohol control policies, and higher availability of drugs. Consideration of regional, gender and age differences in problems related to alcohol and drugs seem to be important in the planning and development of preventive activities. [ABSTRACT FROM AUTHOR]