Aims Internet-based therapy (IBT) is effective in reducing symptoms of gambling disorder (GD), yet limited acceptability may constrain treatment uptake and engagement. This study explored perspectives on the expected acceptability (defined as perceiving the intervention as appropriate) of IBT for GD. Methods Twenty-eight individuals with current or lifetime gambling problems responded to open-ended questions in a qualitative survey, including reflections on a vignette describing a hypothetical patient receiving IBT for GD. Results Data were analyzed using thematic analysis and we identified three themes. The theme “Urgent matters” reflected participants’ desire for more emphasis on crisis management and harm reduction early in IBT. “Keeping the same standard” indicated that participants’ content preferences match what is typically offered in cognitive behavioral therapy, but with concerns that online delivery might compromise treatment quality. “Risk of pseudotherapy” reflected perceptions that IBT is more susceptible to falsely appearing effective compared to face-to-face therapy. Participants conveyed an understanding that GD characteristics of avoidance and motivational ambivalence can undermine IBT engagement, particularly in the absence of social contact with a therapist or others with lived experience. Conclusions The findings suggest that assessments of IBT acceptability for GD and potential interventions aiming to increase acceptability should account for gambling-specific challenges.
Nordic countries have traditionally governed drug use and related policies either as criminal or health-related issues - an approach described as a dual-track model. Far less attention has been paid on human rights perspectives in the Nordic drug policy context. Internationally, human rights challenges in drug policies have been increasingly addressed by civil society organizations representing people who use drugs, as well as harm reduction actors. In 2026, the human rights perspective was brought on the Nordic political agenda more prominently than before as, for the first time, the Nordic civil society organizations representing people who use drugs held a joint international conference on the human rights theme. This report provides notes from the conference and discusses current international and Nordic debates on drug policy as a human rights issue.
Aim As part of the development of Barcelona's new Action Plan on Drugs, this study explored the perceptions and experiences of individuals receiving outpatient and residential addiction treatment services, integrating service users’ perspectives into service planning. Methods A qualitative descriptive design was employed, utilizing five focus groups (three with women, two with men) involving a total of 37 participants from outpatient and residential addiction treatment services. Data were analysed using thematic content analysis. Results Participants often initiated treatment during personal crises, primarily through self-referral. Women reported discomfort in mixed-gender treatment environments, highlighting feelings of unsafety and exposure to aggression. A pervasive sense of social and familial stigma was identified, with women disproportionately affected. Employment was viewed as critical to recovery, yet treatment programs often discouraged contact with prior environments, including those offering job opportunities. Conclusions Participants recommended service improvements, including increased availability of residential placements, especially for women; expanded emergency support; greater coordination across services; specialized training for general practitioners; and gender-sensitive approaches to care. These findings underscore the need for user-informed, evidence-based, and gender-responsive addiction services to enhance treatment effectiveness and long-term recovery outcomes.
Aims This study examines how national policies have framed substance use issues among older adults in Norway.Methods An analysis of 18 Norwegian white papers published between 2003 and 2024 by the Ministry of Health and Care Services, the Ministry of Social Affairs, and related ministries was conducted through "What Is the Problem Represented to Be?" poststructural analysis.Results White papers acknowledge increasing alcohol and substance use among older adults and depict these developments as significant challenges for health and social services both at present and in the future. In response, the following three strategies are proposed: promoting active aging to address inactivity, which can contribute to substance use; combating loneliness and isolation, which represent both the causes and consequences of substance use among elderly individuals; and implementing preventive home visits to help older individuals manage daily challenges and recognize early signs of harmful substance use.Conclusions Relevant policies primarily address alcohol and prescription drugs but largely ignore the so-called illicit substances. The strategies employed constitute a funnel, leading from broad and preventive strategies to narrow and curative strategies. Although this variation holds some promise, we argue that these policies inadvertently portray substance use in older adults as if all individuals with substance use problems share the same characteristics, experiences, and needs. This generalization risks exacerbating health inequalities among older adults who use substances.
Aims: Finnish gambling policy, long based on a state-controlled monopoly, is set to shift to a license-based regime in 2027. The study investigates the Corporate Political Activity (CPA) strategies and discursive frames used by gambling industry actors, comparing their application among actors and phases of the legislative process in the context of Finland's gambling policy reform. Methods: In total, 36 formal statements were analyzed, including submissions to the public consultation (n = 19) and parliamentary hearings (n = 17). A deductive content analysis was conducted, based on the previous CPA frameworks. Results: The results indicate that gambling industry actors proposed alternative policies and sought to prevent certain parts of the legislation from being enacted. Discursive framings shifted throughout the legislative process: legal rights dominated consultations, while unintended effects, especially increased unlicensed gambling, became more salient in parliamentary hearings. Clear differences emerged among actors. International actors prioritized policy substitution and framed the proposed legislation as excessive and harmful to their legal rights, whereas the state monopoly operator did not prevent enactment of regulations. A further difference concerned proposals to replace some harm-reduction measures with more restrictive alternatives. Conclusions: The growing influence of the gambling industry may risk deprioritizing the prevention and reduction of gambling harm in future gambling policy.
Aims: To examine the level of vendor compliance with age-verification legislation governing alcohol sales in Cyprus across two repeated cross-sectional mystery shopping studies conducted in 2015 and 2024, and to identify factors influencing the likelihood of selling alcoholic beverages to underage-appearing individuals. Methods: In 2015, 200 purchase attempts were conducted across six venue types using paired student mystery shoppers. In 2024, 200 visits were conducted by individual mystery shoppers in comparable venue types, excluding nightclubs. In both studies, vendor responses were coded as: no age verification, verbal confirmation, or ID request. Descriptive statistics were computed, and logistic regression assessed venue and seller characteristics associated with vendor compliance. Results: In 2015, 94.5% of vendors sold alcohol without any verification, verbal confirmation was requested in 4.0%, and only 1.5% requested ID. Logistic regression showed that age verification was more likely with male buyers. In 2024, non-compliance remained high (85.5%), with verbal confirmation requested in 13.5% of visits, and ID requests at just 1%. Regression analyses showed higher compliance in bars than in kiosks, and female mystery shoppers were more often asked for age confirmation. Few vendors reported receiving training or legislative updates, with 22% recalling any regulatory updates and just 15% stating they had ever been formally informed about alcohol sales regulations. Compliance rates remain well below those reported in Northern and Western Europe, where structured inspection and vendor training are routine. Conclusions; Vendor compliance with age-verification laws in Cyprus remains persistently low. The findings highlight the need for systematic compliance monitoring, vendor education, and stronger enforcement policies, contributing to the broader European discussion on effective alcohol-control implementation.
Aims The study examines how key stakeholders sought to influence the outcome of Finland's 2018 Alcohol Act reform in the formal consultation rounds.Methods Drawing on the Advocacy Coalition Framework, we analyzed 224 stakeholder statements to uncover competing belief systems and framing strategies regarding alcohol-related harm.Results We identified and named two main advocacy coalitions according to their standpoints on the reform's liberalization aspirations: the Public Health Coalition advocated for maintaining restrictive regulation based on population-level evidence and the Total Consumption Model, and the Alcohol Industry Coalition promoted deregulation through individual-level framings of responsibility and selective use of evidence. Both coalitions pursued epistemic dominance by reinforcing their own credibility and challenging that of their opponents. Although the Public Health Coalition relied on established scientific consensus, the Alcohol Industry Coalition appropriated the language of evidence-based policymaking to legitimize liberalization, aligning with broader neoliberal and populist discourses that question expert authority. Despite the scientific coherence of the public health side, the reform advanced in favour of deregulation, reflecting a broader shift toward a new public health and harm paradigm, in which individual responsibility is emphasized.Conclusions The analysis shows how competing belief systems and discursive strategies shape alcohol policy in contexts where scientific expertise is increasingly politicized. It highlights a need for public health advocates to adjust their strategies to this new reality.
In recent decades, the landscape of pain management has shifted dramatically, particularly in the USA, where the increased prescription of opioid medications has contributed to a national public health crisis. As a reflection of cultural and societal dynamics, fiction literature provides a valuable lens for examining evolving perceptions of pain and its treatment. This study explores the depiction of analgesic use in Stephen King's novels, focusing on the period from 1977 to 2019. By analyzing references to specific medications, including over-the-counter pain relievers and prescription opioids such as oxycodone and hydrocodone, the paper traces a chronological pattern that mirrors real-world changes in medical practice. The analysis highlights a growing presence of more potent medications in King's later works, often presented without moral framing or medical explanation. This neutral portrayal of analgesics, including opioids, may reflect a broader cultural acceptance of pharmacologic solutions to pain. The study also considers how King's personal experience with injury and recovery may have influenced these depictions. By examining the intersection of fiction, health, and culture, this paper contributes to a deeper understanding of how literature reflects and informs public discourse on medical issues.
Background:Patient self-determination and integrity are central to quality health care. In addiction treatment, patients encounter choices related to treatment options, yet little is known about how such choices are expressed in practice. The present study aimed to explore how treatment-related choices are expressed and in what situations they occur, from the perspectives of patients and healthcare staff. Methods:A qualitative exploratory design was applied. Observations and interviews were conducted at a Swedish addiction day care unit over seven weeks. Data were analyzed using content analysis. Results:Choices emerged throughout the treatment process across different treatment arenas, from initial assessment to discharge. The analysis identified seven subthemes of choice, organized into two themes: (1) unconditional choices reflecting active involvement in treatment (considered choices, spontaneous choices, and delegated choices) and (2) conditional choices, reflecting more passive involvement (negotiated choices, menu choices, either-or choices and hindered choices). Conclusions:Patients' choices were shaped by their life circumstances and constrained by staff routines, organizational procedures and treatment policies. Emphasizing patient choice and health literacy during treatment may support informed decision-making and strengthen self-efficacy in maintaining a drug-free life. Future research is recommended to examine the gap between opportunities for choice and treatment routines and policies.
Aim The present study discusses the addictive potential from vaping heuristically in view of existing research literature. We also paying attention to aayouth perspective in a Norwegian context.Methods The study compiled paradigmatic explanations of addiction and then conducted a narrative review of the sparse literature on vape addiction. We draw som conclusions based on the results from a number of review-based viewpoints.Findings Addiction to e-cigarettes or vapes is typically characterized by daily use, the first inhalation of the day occurring shortly after waking up, use of nicotine-containing e-liquid, continued use despite an expressed desire to abstain, acknowledgment that persistent use may lead to health harm and the experience of withdrawal symptoms following abrupt cessation. Higher frequency of use, longer duration of use, elevated nicotine concentration in the e-liquid, prior cigarette smoking and the use of pod-based e-cigarettes containing nicotine salts appear to be associated with a greater degree of dependence. Nicotine addiction among vapers may originate from previous smoking, although individuals without any smoking history also exhibit withdrawal symptoms. Overall, the level of addiction among vapers appears to be lower than that observed among smokers.Conclusions Among Norwegian youth, e-cigarette use is generally experimental, transient and infrequent, and the use of nicotine-free products is common. It is therefore likely that a small segment of young vapers meets established criteria for addiction. Nevertheless, irregular use in the early stages may evolve into more dependency-driven patterns of use over time.
Aims:Alcohol, drugs and gambling are subject to governmental control policies and regulation. We have investigated how supporters of regulation/criminality of drug use and liberals advocating more lenient control provide arguments on the governmental control policies and regulation on addiction policies. Methods:We organized three experiments in Helsinki, Finland, in 2023 on the argumentation on alcohol, drug and gambling policies. Altogether, 98 lay persons, mainly students at the University of Helsinki, participated in the experiments. As a method, we employed the imitation game, which can be used to measure how knowledgeable members of a social group are regarding the knowledge of another group. The method produces both quantitative and qualitative data. Results:On drug policy, supporters and opponents of criminality of drug use were asymmetrically segregated. The opponents of criminality were in a minority and were more knowledgeable of the knowledge and beliefs of the majority supporting criminality. When it came to the alcohol and gambling policy fields, both supporters and opponents of regulation had more symmetrical relations. Conclusions:The results can be used for addiction policies and anticipating emerging new lines of argumentation.
Aims:This study aims to enhance understanding of child maltreatment (CM) in connection with problematic parental substance use (PPSU) and to identify related individual and familial support needs. Methods:Using inductive qualitative content analysis, we examined the life stories of trained experts-by-experience (N = 11) who had experienced PPSU and various forms of CM, including physical and emotional violence and neglect in their family during childhood and adolescence. Results:Several family-related and parental risk factors for CM emerged, such as intergenerational transmission of substance use, socioeconomic disadvantage, unemployment or excessive work, parental physical and mental health issues, social wellbeing challenges such as social isolation, violent behaviour, and inadequate parenting practices. Participants also described mitigating factors that partly buffered adverse effects. Conclusions:The findings highlight diverse and persistent support needs. PPSU can expose children to a wide range of harmful CM experiences. Effective early identification of both PPSU and related CM requires close collaboration between social and health services, as well as inclusive and active client engagement. A holistic understanding of individual and family circumstances affected by PPSU is essential for preventing CM and its intergenerational transmission.
Aims:This study describes the substance use of gerontological social work clients and the ways it affects their use and needs for social and healthcare services, as featured in client documents written in the context of assessment of the need for services. Methods:The data consist of gerontological social work client documents of 55 clients from one municipality in Finland. The data were analyzed using reflexive thematic analysis in two stages. The first stage addressed the question of documenting substance use and the second stage included clients with ongoing substance abuse (N = 15). Results:Substance use was common among the sampled gerontological social work clients. Only a small number of clients were identified as having harmful substance use, and these clients had complex needs for services and multiple uses of services. However, their service use and needs were rarely documented from the point of substance use, even though problematic substance use had been included in legislation as one criterion for having complex needs. Thus, some of the service professionals seemed to have ignored substance use when assessing the needs of older clients. Conclusions:There is need to develop social work training to increase the professional knowledge base and identify or bring up matters of substance use when encountering older clients with substance abuse.
Aims In recent years, a grey market has emerged in Sweden where teenagers use social media to obtain alcohol. This market has not yet been explored qualitatively. The present study addresses this gap by examining how social media is used to illicitly trade alcohol.Methods First, a netnographic approach involved systematically searching for and documenting social media accounts offering alcohol. Second, 33 in-depth, app-based textual interviews were conducted with 16 sellers and 17 buyers who had engaged in illicit alcohol transactions. Responses were thematically analysed within a critical realist framework, capturing experiential (explicit), inferential (inductive) and dispositional (retroductive) themes.Results Snapchat is the preferred platform due to its popularity among youths, ephemeral messaging features and recommendation algorithms. Sellers typically source smuggled alcohol in bulk to maintain competitive prices. Underage buyers cite ease of access, speed and convenience as main motivations. Risk perceptions differ as sellers worry primarily about arrest offline and platform bans online, whereas buyers fear personal victimisation during face-to-face exchanges.Conclusions Restriction-generated markets and platformisation sustain illicit alcohol markets. Strict regulations inadvertently shape the market's demand by denying legal access to underage individuals' desire for alcohol. Simultaneously, the design of Snapchat facilitates rapid, anonymous connections and exchanges. The findings underscore a need for policymakers and practitioners to consider how social media amplifies underage alcohol consumption risks.
Aim:To investigate the informal caregiving experiences of adult offspring of patients recently hospitalized with alcohol-related liver disease (ALD). Methods:A narrative analysis was conducted building on 13 semi-structured qualitative interviews with adult offspring of patients who were recently hospitalized with ALD at a department of medicine. Analytical frameworks were the rites of passage framework and its concept of liminality, combined with Taylor's social imaginaries and Järvinen and Bloch's complementary role requirements. Results:Adult offspring of patients with ALD described longstanding mental health issues that had worsened in response to their parent's repeated hospitalizations. They described how internalized and institutionalized ideas about family shaped a strong sense of moral obligation to care for their parent, which was often intensified when hospital staff implicitly positioned them as caregivers. The offspring described a prolonged liminal phase marked by recurring crises that prevented them from regaining a stable and ordinary everyday life. Conclusions:The study demonstrates the emotional and moral dilemmas of informal caregiving in adult offspring of a parent hospitalized with ALD. This is a psychosocially vulnerable group whose wellbeing may be further compromised when they are drawn into caregiving roles. Healthcare professionals should avoid reinforcing such roles and rather engage in open dialogue, acknowledge their position and needs.
