INTRODUCTION:Interest in managing alcohol-related risks through temporary abstinence challenges has grown significantly. Studies on abstinence challenges in the general population show improvements in for example mental health, blood pressure, insulin resistance and alcohol consumption, but studies in clinical samples are lacking, including qualitative research on patients' perspectives on such a clinical intervention. This study aimed to explore the patients' experiences of a sober month before initiating psychological treatment for controlled drinking. METHODS:A qualitative interview study (n = 14) was conducted at a specialised addiction clinic in Stockholm, Sweden. Participants were recruited within a randomised controlled trial examining a sober month as an adjunct to psychological treatment for controlled drinking. Data were analysed with applied thematic analysis. RESULTS:Four themes were identified: (i) Breaking the cycle of habitual drinking; (ii) Regaining control; (iii) A sober month made abstinence a more prominent part of goals; and (iv) A failed attempt at sobriety as a setback to change. A sober month was perceived as positive for most patients and became a challenge that increased the sense of control and perceived ability to abstain. The benefits of the sober month made participants consider more restrictive goals or abstinence over time. Not being able to abstain made participants less motivated and reconsidered controlled drinking as their goal. DISCUSSION AND CONCLUSIONS:Having a sober month can increase awareness of the ability to abstain and guide patients toward lower consumption goals. To reduce the risks of negative consequences, it is important to identify and support those who do not manage to abstain. TRIAL REGISTRATION:ClinicalTrials.gov identifier: 47033189.

This current two-year clinical study among adult patients with alcohol use disorder (AUD) examined drinking motives and their cross-sectional and longitudinal associations with alcohol consumption, severity of AUD, and other alcohol-related problems. Enhancement, coping, conformity, and social motives have been found to impact alcohol use, yet longitudinal studies on drinking motives in clinical populations are sparse. This observational study used data from a randomized controlled trial (RCT) conducted in Stockholm, Sweden, from 2017 to 2022, including 250 participants with AUD. Data from both treatment groups were included. Assessments of study outcomes were conducted at five time points: at baseline, and after 12, 26, 52, and 104 weeks. Self-report questionnaires and diagnostic interviews were used to assess drinking motives, alcohol consumption, alcohol-related problems, and mental health. Instruments used for self-reports included: The Drinking Motives Questionnaire-Revised Short Form (DMQ-R SF) and the Alcohol Use Disorders Identification Test (AUDIT). The DMQ-R SF assessed enhancement, coping, conformity, and social motives. The AUDIT assessed self-perceived alcohol problems. Interviews were conducted to assess alcohol consumption using the Timeline Follow-Back method (TLFB) and AUD using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Generalized linear models were used to examine associations between drinking motives (DMQ R-SF) and alcohol-related outcomes (TLFB/AUDIT/AUD by the DSM-5). Reductions in both drinking motives (enhancement 15.6

OBJECTIVE:Alcohol use disorders (AUDs) can lead to unemployment, yet they remain undertreated. Pharmacotherapies may strengthen labour market attachment but are underused. This study investigates the association between AUD pharmacotherapy use and the risk of becoming unemployed among individuals with an AUD diagnosis in Sweden. METHODS:A longitudinal register-based study was conducted, using the Swedish Work, Illness and labour market Participation (SWIP) cohort, restricted to gainfully employed individuals between 16 and 60 years with a first-time AUD diagnosis in Sweden between 2006 and 2019 (n=77 503). The exposure was AUD pharmacotherapy use. The outcome was the first unemployment spell (≥90 consecutive days) that occurred after the first-time AUD diagnosis (2006-2020). Covariates included sociodemographic characteristics, comorbidities and unemployment history. The association between pharmacotherapy use and unemployment was examined using Cox regression models. RESULTS:Of the cohort, 42.8% used AUD pharmacotherapy and 15 098 individuals became unemployed during the observation period (median 7.1 years, IQR 3.3-10.6 years). Relative to those with AUD who did not use any pharmacotherapy, an inverse association between the use of AUD pharmacotherapy and unemployment incidence was observed (adjusted HR (aHR): 0.86; 95% CIs 0.82 to 0.89). CONCLUSIONS:AUD pharmacotherapy may decrease the risk of long-term unemployment. The findings further underscore the importance of pharmacotherapy treatment to sustain work ability and promote a healthy workforce.

Background Executive functions (EF) encompass abilities such as planning, decision-making, and inhibitory control, critical for learning, establishing and maintaining behavioral change. The association between alcohol use disorder (AUD) and impairments in EF are well established. However, prior research is dominated by studies on convenience samples including individuals with severe AUD with high levels of psychiatric comorbidity, which limits generalizability. The present study therefore aimed to investigate the degree of impairment and predictive ability of EF, on alcohol consumption, among individuals with moderate AUD with low levels of psychiatric comorbidity. Methods Adults with moderate AUD ( n = 147) were recruited at three specialized addiction outpatient clinics in Stockholm, to a randomized controlled trial investigating the efficacy of two psychological treatments. Participants underwent neuropsychological testing before treatment. Eight tests from the CANTAB ® battery were administered at baseline, assessing mental flexibility, sustained attention, visuospatial working memory, response inhibition, and delay discounting. Assessments of alcohol use and related symptoms were conducted at baseline, the 12- and 26-weeks follow-up. A non-clinical reference sample ( n = 72) completed corresponding CANTAB ® tests. The two groups were compared regarding EF using descriptive statistics and t -tests, and the predictive value of EF for reduction in alcohol consumption, was investigated using multiple regression models. Results Individuals with AUD did not perform worse on any of the tests on executive function (CANTAB ® ) as compared to the non-clinical reference sample. Measures of EF were not significant predictors for reduction in alcohol use for the 12-week, or the 26-week follow-up. Conclusions EFs were not impaired and were not a clinically relevant predictor of treatment outcomes in this population with AUD. Future research on EF as a predictor in AUD treatment, needs to corroborate the present findings, and include other populations, e.g., with different socio-economic backgrounds and by including other methodologies for measuring EF.

Introduction Youth are increasingly exposed to gambling and gambling-like activities in digital environments, often before reaching the legal gambling age. This development challenges existing regulatory frameworks and may increase the risk of early gambling involvement and gambling-related harm. However, empirical evidence capturing the full range of contemporary gambling exposures among youth remains limited. Methods A cross-sectional survey was conducted among upper secondary school students (aged 16–19 years) in two schools in Sweden (N = 722). Gambling participation across traditional and emerging gambling formats, casino stream watching, and gambling-related harms were assessed. Gambling-related harm was defined as reporting at least one harm item (GHS-10 ≥ 1). Analyses were descriptive, with univariable estimates of associations between gambling formats and harm. Results Gambling participation was common, with a clear age-related pattern. Students under 18 years frequently engaged in emerging gambling-like activities, including gambling with non-monetary stakes, whereas turning 18 years was associated with a marked shift toward high-risk online gambling formats. Gambling-related harms were substantially more prevalent among students aged 18 years and older. Exposure to casino streaming content was associated with gambling-related harm, and a substantial proportion of students reported gambling after viewing such content. Gambling-related harm was more prevalent across most gambling formats, with particularly elevated levels among students engaging in fast-paced online gambling. Conclusions The findings indicate that current regulatory safeguards are insufficient to protect late adolescents from gambling-related harms within an increasingly digital gambling ecosystem. Preventive policies should address the broader risk environment currently shaping late adolescents’ gambling, where engagement across multiple gambling formats, gambling-related media exposure, and financial vulnerability, may interact to increase the risk of harm. Enhanced consumer protection measures for late adolescents entering the legal gambling market, alongside stronger regulation of gambling-like activities and gambling-related content accessible to minors, are essential to reduce gambling-related harm.

Abstract Background and aims Little is known regarding predictors of outcome in treatment of alcohol dependence via the internet and in primary care. The aim of the present study was to investigate the role of socio-demographic and clinical factors for outcomes in internet-based cognitive behavioral treatment (ICBT) added to treatment as usual (TAU) for alcohol dependence in primary care. Design Secondary analyses based on data from a randomized controlled trial in which participants were randomized to ICBT + TAU or to TAU only. Setting The study was conducted in collaboration with 14 primary care centers in Stockholm, Sweden. Participants The randomized trial included 264 adult primary care patients with alcohol dependence enrolled between September 2017 and November 2019. Interventions Patients in the parent trial were randomized to ICBT that was added to TAU (n = 132) or to TAU only (n = 132). ICBT was a 12-week intervention based on motivational interviewing, relapse prevention and behavioral self-control training. Measures Primary outcome was number of standard drinks last 30 days. Sociodemographic and clinical predictors were tested in separate models using linear mixed effects models. Findings Severity of dependence, assessed by ICD-10 criteria for alcohol dependence, was the only predictor for changes in alcohol consumption and the only moderator of the effect of treatment. Participants with severe dependence showed a larger reduction in alcohol consumption between baseline and 3-months follow-up compared to participants with moderate dependence. The patients with moderate dependence continued to reduce their alcohol consumption between 3- and 12-months follow-up, while patients with severe dependence did not. Conclusions Dependence severity predicted changes in alcohol consumption following treatment of alcohol dependence in primary care, with or without added ICBT. Dependence severity was also found to moderate the effect of treatment. The results suggest that treatment for both moderate and severe alcohol dependence is viable in primary care. Clinical trial registration: The study was approved by the Regional Ethics Board in Stockholm, no. 2016/1367–31/2. The study protocol was published in Trials 30 December 2019. The trial identifier is ISRCTN69957414, available at http://www.isrctn.com , assigned 7 June 2018, retrospectively registered.

BACKGROUND:Sweden faces high rates of overdose mortality, but supervised consumption sites (SCSs), where people can use drugs under healthcare supervision, have not been adopted. No studies have assessed the willingness of Swedish people who inject drugs to use a future SCS or their views on potential rules. METHODS:This mixed-methods study applied a risk-environment approach and collected data from people who inject drugs in Stockholm using a 28-item survey and qualitative interviews. RESULTS:Most of the 219 survey respondents reported significant risk factors, including unstable housing, previous opioid overdose, and public drug use. Among participants, 158 (72.1 %) were willing to use an SCS, while 61 (27.9 %) were unsure or unwilling. In multivariate analysis, opioid use (AOR 3.24; CI 1.31-8.02), public injection (AOR 5.22; CI 2.35-11.56), and overdose within the past year (AOR 6.89; CI 1.66-28.56) predicted willingness to use an SCS. The most common reason was "I want to avoid stress" (82.2 %). For the 61 participants unwilling or unsure, the main reason was "already having a safe place for drug use" (78.75 %). Certain rules, like bans on groin/neck injection and assisted injection, were less accepted among both survey and interview respondents. Qualitative data revealed reluctance to inject in front of SCS staff due to privacy concerns. CONCLUSION:Our results suggest high SCS acceptability among a marginalised cohort of people who inject drugs in Stockholm. Results confirm and extend prior research by illuminating their perceptions, including important preferences to consider when designing a future SCS in Sweden.

AIM:To examine the socioeconomic differences in the effectiveness of alcohol use disorders (AUD) pharmacotherapy and risk of AUD hospitalisation. DESIGN:A prospective register-based cohort study. SETTING:Sweden. PARTICIPANTS:Individuals who were registered as living in Sweden in 2005 (16-64 years) with a first-time AUD diagnosis and complete information on their socioeconomic position (SEP) between 2005 and 2019 (n = 148 626). MEASUREMENT:The outcome was AUD hospitalisation. The use of AUD pharmacotherapy was treated as a time-varying exposure. SEP was the moderator. The association between the joint-exposure (pharmacotherapy use and SEP) and AUD hospitalisation was assessed using a competing-risk regression model, adjusted for sociodemographic factors, previous mental health diagnoses and use of other psychiatric medications. FINDINGS:Pharmacotherapy use was associated with a lower risk of AUD hospitalisation among high SEP individuals [subdistribution hazard ratio (SHR) = 0.83, 95% confidence interval (CI) = 0.77-0.90], but not among those with low SEP (SHR = 1.02, 95% CI = 0.94-1.10) and middle SEP (SHR = 1.01, 95% CI = 0.94-1.09), compared with low SEP individuals when not using pharmacotherapy. CONCLUSIONS:In Sweden, alcohol use disorder (AUD) pharmacotherapy appears to be effective to reduce the risk of AUD hospitalisation only among individuals of high socioeconomic position.

OBJECTIVE:Research on long-term outcomes in individuals with alcohol use disorders receiving treatment for controlled drinking is limited. This study investigated 2-year outcomes in adults with alcohol use disorder who received behavioral treatment aimed at controlled drinking. METHOD:A randomized controlled trial including 250 participants (52% male) with assessments at baseline and 12, 26, 52, and 104 weeks at three specialized addiction clinics in Stockholm, Sweden, was conducted. Participants received either behavioral self-control training (five sessions) or motivational enhancement therapy (four sessions), both delivered over 12 weeks. Mixed linear regression models analyzed 2-year outcomes. RESULTS:No differences were detected between behavioral self-control training and motivational enhancement therapy in the primary outcome of mean weekly alcohol consumption or secondary outcomes at the 2-year, that is, the 104-week, follow-up. A total of 44.1% in behavioral self-control training, and 39.3% in motivational enhancement therapy reported less than 10 weekly standard drinks in both women and men, which is defined as low-risk drinking according to Swedish national guidelines. CONCLUSIONS:Clinically meaningful reductions in alcohol consumption were maintained across the sample at 104 weeks, irrespective of treatment condition. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

BACKGROUND:Opioid overdose incidence in Myanmar has not been systematically measured. We quantified individual risk factors of overdose, overdose incidence and mortality, and examined predictors of pre‑overdose engagement with harm reduction services. METHODS:Electronic registers from 21 Asian Harm Reduction Network-Best Shelter (AHRN-BS) sites in Sagaing, Kachin, and northern Shan (2014-2025) were linked. Incidence and mortality were calculated with the exact Poisson method. A retrospective cohort of 155,875 clients-65,089 people who inject drugs-was analyzed with modified Poisson regression to estimate adjusted prevalence ratios (aPR) for overdose; cases occurring in 2022-2025 were further analyzed for predictors of past‑year service engagement. RESULTS:Registers captured 3472 verified opioid overdoses in 2913 persons. Among people who inject drugs, pooled incidence was 16.8/1000 person‑years (95 % CI 16.2-17.5) and overdose mortality 0.5/1000 person‑years (0.4-0.7). Current injecting without opioid‑agonist therapy (OAT) carried an aPR 8.1 (95 % CI 6.1-10.6) relative to recent non‑injecting use, rising to aPR 10.7 (95 % CI 7.8-14.8) among those who also received OAT. Three‑quarters of overdoses (2598) occurred in persons not enrolled in harm reduction programs; incidence among enrolled clients was 5.7/1000 person-years (95 % CI 5.2-6.2). Migrants were less likely to have accessed services in the year preceding overdose (aPR 0.82, 95 % CI 0.68-0.98). Alcohol was reported in 70.5 % of events and stimulants in 7.2 %. DISCUSSION:Opioid overdose is common and disproportionately affects people outside existing programs. Expanding peer‑led and mobile outreach, tailoring referral pathways for migrants, broadening community naloxone distribution, and securing sustained domestic financing are urgent priorities.

AimsAdolescent substance use presents significant public health concerns, leading to risk of developing substance use disorders later in life. Early identification through reliable screening tools is essential. This study evaluated the psychometric properties and diagnostic screening accuracy, for identifying cannabis use, of two widely used tools: the DUDIT and the ASSIST-Y cannabis use subscale, in a Swedish adolescent population.MethodsData were collected from 1450 randomly selected adolescents and a sample of 60 treatment-seeking adolescents, all 15 to 18 years old. Internal consistency was measured using Cronbach's alpha, and test-retest reliability assessed with intraclass correlation coefficients (ICC). Construct validity was investigated through exploratory factor analysis, and diagnostic screening accuracy determined via receiver operating characteristic (ROC) analysis.ResultThe DUDIT and ASSIST-Y demonstrated good (alpha = 0.89) and moderate (alpha = 0.55) internal consistency, respectively. Test-retest reliability was good for the DUDIT (ICC = 0.88) and moderate for the ASSIST-Y (ICC = 0.68). Factor analysis indicated an ambiguous structure for both instruments, where the two instruments measure different aspects of substance use-related problems. Both instruments showed moderate to good diagnostic screening accuracy. The optimal cut-off scores for boys and girls on the DUDIT are 4 and 1, respectively, and for the ASSIST-Y, 3 for boys and 2/3 for girls.ConclusionsBoth scales demonstrated ambiguous construct validity and results suggest that the ASSIST-Y cannabis use subscale requires refinement, particularly concerning its internal reliability. In sum, the DUDIT performed better than the ASSIST-Y, indicating that the DUDIT is a reliable screening tool for substance use among an adolescent general population.

BACKGROUND AND AIMS: In Sweden, up to 7% of people exhibit harmful alcohol use or dependency, but only a small fraction (10–20%) pursue treatment. While Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) are effective for alcohol use disorders (AUD), their cost-effectiveness has not been studied. This research evaluates the cost-effectiveness of BSCT and MET in treating AUD, focusing on achieving controlled drinking from both a healthcare and limited societal perspective. DESIGN, SETTING, AND PARTICIPANTS: A Markov model was created to compare the cost-effectiveness of BSCT and MET for treatment-seeking individuals with AUD. This model simulated a sample of patients with AUD over five years, calculating the costs and outcomes for both treatments. It used a cost-utility analysis to determine the cost per quality-adjusted life year (QALY). The model accounted for varying levels of alcohol intake and related health complications. Efficacy data came from a randomized trial, with complication risks, costs, utilities, and mortality rates drawn from existing literature. INTERVENTION AND COMPARATOR: BSCT, consisting of five sessions, was compared to MET, constituted by four sessions. MEASUREMENTS: The primary outcome was cost per QALY. Probabilistic and univariate sensitivity analyses were performed to estimate how parameter uncertainty affected model outputs. FINDINGS: BSCT proved less costly than MET, yielding savings in healthcare costs by $50.52 and societal costs by $118.12 on average per person. Additionally, BSCT demonstrated an advantage in QALYs, with a gain of 0.060 QALYs per patient over MET. Sensitivity analyses confirmed the robustness of these results, indicating that BSCT is the cost-effective treatment option. CONCLUSIONS: In comparison to MET, BSCT is less costly and more beneficial for health, indicating its potential as a valuable treatment option for individuals with AUD targeting controlled drinking. The model can be applied to assess the cost-effectiveness of various other AUD treatment interventions.

BACKGROUND AND AIMS:Alcohol is a well-established risk factor for numerous health conditions, making screening for hazardous alcohol use in healthcare a critical task. While self-reported data suggest that alcohol consumption varies across seasons, this seasonal fluctuation has not yet been confirmed using objective biological markers. This study aimed to measure whether phosphatidylethanol (PEth) captures variations in hazardous alcohol use across two temporal resolutions: month of the year and day of the week. DESIGN:Observational cross-sectional study based on data from medical records. SETTING:Healthcare services, Region Dalarna, Sweden, between 2017 and 2023. PARTICIPANTS/CASES:Adult patients (n = 62 431, 50% females) screened for hazardous alcohol use with PEth within primary care. MEASUREMENTS:This study utilizes test results from PEth, with results >0.30 μmol/l defined as hazardous alcohol use. We compared the prevalence of hazardous alcohol use across months and weekdays using logistic regression while adjusting for sex, age, smoking status, the Charlson Comorbidity Index and psychiatric diagnoses. FINDINGS:The prevalence of hazardous alcohol use increased between May and August, ranging from 13.2% to 15.9%, compared with 10.7% in November. This corresponds to a 48% relative increase in the peak month of July [prevalence ratio (PR) = 1.48, 95% confidence interval (CI) = 1.33-1.64]. Hazardous alcohol use was also more prevalent among patients tested on Mondays (13.0%) compared with Thursdays, with the lowest prevalence (12.0%). The difference was particularly pronounced among female patients, with a 14.0% higher relative prevalence on Mondays (PR = 1.14, 95% CI = 1.02-1.27). CONCLUSIONS:In Sweden, the prevalence of hazardous alcohol use appears to fluctuate seasonally and, to a lesser extent, across weekdays, as measured by blood tests for phosphatidylethanol, a biomarker for hazardous alcohol use. November showed the lowest prevalence and July the highest, consistent across age, sex and the year of the observational period. Hazardous alcohol use showed a slight elevation of prevalence during Mondays compared with Tuesday to Friday.

BackgroundThere is a limited population-based data on hazardous alcohol use and associated social determinants in many African countries.ObjectivesTo examine patterns of hazardous alcohol use across a range of social determinants of health in Uganda, with a particular focus on gender differences.MethodsThis cross-sectional study used data collected in 2021-2022 from an open population cohort spanning urban, semi-urban, and rural communities. Alcohol use was assessed with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Covariates were selected according to the WHO's Social Determinants of Health framework. Poisson regression with robust variance was used for data analysis.ResultsOf the 3459 participants, 2085 (60%) were women. Overall, the prevalence of hazardous alcohol use was 5% among women and 18% among men. Strong positive associations with hazardous use were found for individuals residing in semi-urban areas (female aPR 2.1 [95% CI 1.3-3.3], male aPR 1.8 [95% CI 1.4-2.5]), past-year perpetration of intimate partner violence (female aPR 2.2 [95% CI 0.8-5.6], male aPR 1.4 [95% CI 0.9-2.2]), smoking, middle age for men (aPR 1.6 [95% CI 1.2-2.2]), and employment as a vendor in a restaurant or bar for women (aPR 1.5 [95% CI 1.0-2.2]). Strong negative associations were found for high educational attainment, Muslim or Pentecostal religion, and living in a marriage or union for women (aPR 0.7 [95% CI 0.5-1.0]).ConclusionsHazardous alcohol use was prevalent, especially among men, in a representative Ugandan population sample. Specific target groups for public health and clinical interventions were identified, such as women working in the hospitality sector. Residents of semi-urban communities may encounter unique risks for hazardous alcohol use, compared with rural and highly urban populations.

OBJECTIVE:To investigate oral status in relation to demographic, socioeconomic, medical and psychosocial risk factors among outpatients receiving treatment for Substance Use Disorder (SUD). METHODS:This cross-sectional study included 91 outpatients from Stockholm, Sweden. Oral status was assessed using the Decayed, Missing, Filled Teeth (DMFT) index and Probing Pocket Depth (PPD). Psychosocial and functional factors were evaluated using the Addiction Severity Index (ASI), which measures problem severity in areas such as medical and social functioning, and the Global Assessment of Functioning Scale (GAF), which assesses overall social and occupational functioning. Data were analysed using non-parametric correlations and logistic regression. RESULTS:The mean DMFT was 12.4 (±8.1), with missing teeth (MT) as the dominant component. The median PPD was 28. The logistic regression analysis showed significant associations between risk factors and oral status variables. Age ≥ 40 years was associated with fewer teeth (OR: 3.52, 95% CI: 1.30-9.54), higher DMFT (OR: 8.88, 95% CI: 3.43-23.01) and more severe PPD (OR: 5.64, 95% CI: 1.95-16.32). Low education (< 9 years) was associated with fewer decayed teeth (DT) (OR: 0.23, 95% CI: 0.09-0.59) and lower PPD values (OR: 0.29, 95% CI: 0.10-0.86). These results highlight the significant influence of age and education on oral status among patients with SUD. CONCLUSION:This study identified relationships between oral status and several demographics, socioeconomic, medical and psychosocial risk factors among patients with SUD. Age was the strongest predictor of oral status, with low education being the only significant socioeconomic risk factor.

Comorbidity between psychiatric disorders and alcohol use disorders (AUD) is common. Swedish national guidelines recommend integrated treatment for both disorders, however, compliance to the guidelines is low. To facilitate uptake, health care staff at psychiatric units in Region Stockholm, Sweden, have participated in training and implementation of the 15-method for screening and treatment of AUD. Few studies focus on the patient perspective of interventions for AUD in psychiatric care. The aim of this study was to investigate how patients in psychiatric outpatient care perceived receiving interventions according to the 15-method, within the context of a large-scale implementation project. Qualitative study with data collected through individual interviews involving 15 adults who had Alcohol Use Disorder Identification Test (AUDIT) score >6 for women/ >8 for men and contact with a psychiatric unit whose staff had taken part in the implementation project of the 15-method. The interviews were analyzed with reflexive thematic analysis using the four constructs of the Normalization Process Theory; coherence, cognitive participation, collective action and reflexive monitoring, as a framework. All participants had received alcohol screening, four had received the assessment in the second step in the 15-method, three received pharmacotherapy, however, none reported receiving the psychological treatment. A majority found it natural to discuss alcohol within the psychiatric care setting and described that these conversations led to increased awareness about their hazardous alcohol consumption (coherence). Alcohol use was perceived as a sensitive topic and staff attitude was important to create a working alliance (cognitive participation). Conversation about alcohol could evoke behavior change but few participants had been offered alcohol interventions beyond screening (collective action) and expressed a wish to receive more support (reflexive monitoring). Treatment for psychiatric symptoms was described as conditioned to non-hazardous level of alcohol consumption (coherence), leading to active actions to become eligible for treatment (cognitive participation). Moreover, conditioning of care mainly led to short-term behavior changes (reflexive monitoring). Patients in psychiatric care are positive to receiving alcohol-interventions within this context, indicating that psychiatric care offers a window of opportunity to address comorbidity. However, future staff training and implementation initiatives should be tailored to the specific challenges in psychiatric care, such as conditioning of care. Not applicable.

There is a lack of research on which specific factors that predict positive outcomes in support programs for concerned significant others (CSOs) to individuals with substance use disorders (SUDs). The aim of the study was to investigate predictors of positive outcomes among young adults in the areas of: treatment seeking, decreased substance use, and improved parent-young adult relationships. Outcomes were assessed at 24-weeks following a randomized controlled trial (RCT) comparing Community Reinforcement and Family Training (CRAFT) and manualized counselling for parents of young adults (18-24 years) with hazardous substance use. A secondary analysis from an RCT including 113 parents (92% female) of young adults (87% male) recruited from two outpatient clinics for young adults in Stockholm, Sweden, subsequently nationwide. Clinical and sociodemographic predictors of treatment entry, substance use, and relationship happiness at 24 weeks follow-up were assessed using linear and logistic mixed-effects models. Previous young adult treatment engagement and higher parental self-efficacy were significant predictors of treatment entry, explaining 16% of the variance. Baseline alcohol and substance use consistently predicted higher use over time across measures. Parental stress showed complex associations: higher stress predicted reduced substance use in some models but increased use in others. For the measure of relationship happiness, baseline scores were the strongest predictor. Taken together, the findings suggest promising targets for tailored support programs for parents of young adults with SUD, such as components designed to enhance parental self-efficacy. ISRCTN12212515 https://www.isrctn.com/ISRCTN12212515 . Submitted November 7th, 2018, registered March 4th, 2019.

The present study aimed to investigate the extent to which two new implementation strategies—a new policy mandating alcohol interventions in primary care and access to online training, impacted alcohol-related clinical activities in primary care in Stockholm. This was a prospective longitudinal register-based study. One hundred twenty-nine primary care clinics in Region Stockholm agreed to provide data. The new healthcare policy was introduced in February 2021. A brief digital training for primary care professionals on managing harmful alcohol use and dependence was launched 10 months later. Seven indicators that reflect alcohol-related clinical activities were obtained from electronic case files: structured documentation on alcohol habits, the AUDIT instrument, ordering of blood tests for biomarkers of heavy drinking, prescription of medicines for alcohol dependence, registered alcohol-related diagnoses, completed advice regarding alcohol use disorder (AUD), and referrals to specialized care. Data from registers were collected before and after the policy and training was available. At baseline low levels of alcohol-related clinical activities were found in primary care. A modest, clinically non-significant increase was seen for all indicators except for frequency of prescription of medicines for alcohol dependence, over the whole follow-up. The digital training was not associated with an increase in alcohol-related clinical activities. While a policy making alcohol interventions mandatory, combined with a training program, has strong support from implementation science, only a modest, clinically non-significant increase in alcohol-related clinical activities was found. Stronger implementation strategies seem necessary to improve management of alcohol dependence in primary care.

BACKGROUND:Phosphatidylethanol (PEth) is a specific marker of alcohol intake, used both as a screening method for hazardous use and as an outcome measure in the treatment of alcohol use disorder (AUD). However, what cut-off values to apply for hazardous use in a treatment setting is still unclear. We aimed to investigate the correlation between PEth and self-reported drinking and identify the optimal cut-off for hazardous use, for patients with AUD and a stated goal of controlled drinking. METHODS:We used data from a randomized controlled trial of two different psychological treatments aiming for controlled drinking, conducted within specialized addiction care in Stockholm, Sweden. A total of 181 patients left samples that could be included in the current analysis. Outcomes were measured at five different time points over 2 years of follow-up. PEth 16:0/18:1 values were correlated with subjective reports of recent drinking based on the Timeline Follow-Back Method. RESULTS:The correlation between PEth and self-reported alcohol intake increased significantly over time, with the weakest correlation found at baseline (Spearman's ρ = 0.42) and the strongest at the 104-week follow-up (ρ = 0.69). When used to indicate hazardous drinking according to Swedish guidelines (≥10 units per week), receiver operating characteristic analysis revealed PEth ≥ 0.22 μmol/l to be the optimal cut-off. CONCLUSIONS:PEth is a useful outcome measure that can be used to validate subjective reports of current drinking. In a treatment setting aimed at controlled drinking, the accuracy of patients' self-report measures seems to improve over time. In this context, a PEth value of ≥0.22 μmol/l is a sensitive and specific indicator of hazardous drinking.

Abstract Background The prevalence of hazardous substance use is highest in the age between 18 and 25, but few young adults enter treatment. Community Reinforcement and Family Training (CRAFT) is a support program for concerned significant others (CSOs) of individuals with diverse substance use disorders and is proven efficacious in promoting treatment entry. The aim of the current study was to investigate the experiences of CRAFT among parents of substance using young adults. Methods We used a qualitative design conducting semi-structured interviews with 10 parents of young adults (18–24 years) with hazardous substance use. The participants were recruited from a randomized controlled trial of the CRAFT program. The transcribed interviews were analyzed using thematic analysis. Results We divided the results into three overall domains—Reasons for entering the CRAFT program, Strengths of the CRAFT program and Limitations of the CRAFT program – with three to four themes under each domain. The parents appreciated the accessible support at a time when they needed it due to feelings of shock and powerlessness, and they described communication strategies together with positive reinforcement as the two most helpful CRAFT-sessions. Regarding limitations of CRAFT in the current population, the parents wanted more accessible support for the young adults when they were ready to enter treatment, and described difficulties to practice CRAFT-components due to changing life-circumstances and fear of aggravated health for their young adults. Conclusion The results provide arguments for the health care system to implement support programs to parents of young adults with hazardous substance use. The results show that CRAFT is suitable for the current population, but with some possible additions due to changing circumstances that are common in the young adult developmental phase emerging adulthood. Trial registration The trial was pre-registered at isrctn.com, reference number ISRCTN12212515 date: November 7, 2018.