Youth's personal relationships, psychological symptoms, and the use of different substances: A population-based study

Background: Externalising symptoms and peer influence are well-established predictors of youth's substance use in general. However, there is little integrative research that compares the relative contribution of psychological and social relationship characteristics as predictors of the use of specific substances among youth in different developmental stages. Methods: A representative sample of Danish adolescents ( n = 1,168) and emerging adults (EA; n = 1,878) reported last-month prevalence use of cigarettes, cannabis, and other illicit drugs (OID), and four indices of alcohol use. Predictor variables included internalising and externalising symptoms, and major characteristics of the youth's relationships (e.g., parental drug use, number of close friends). Results: Having a close friend who used illicit drugs, and high externalising symptoms, predicted the risk for using all substances across both age groups. Alcohol use was more consistently related to peer-related variables than to symptoms. Smoking cigarettes, cannabis use, and OIDs use were related to peer and symptom variables. Age group moderated some associations. Parental separation was related more strongly to alcohol use among adolescents than among EA, and higher internalising symptoms were more strongly related to smoking and using OIDs among adolescents than among EA. Male EAs had higher risk for using alcohol than female EAs. Conclusion: Beyond having a close friend who used illicit drugs, and externalising problems, the use of each substance was better explained by a different group of variables. There were few but important moderations by age group. The findings highlight the need for research on risk factors for substance use that is developmentally sensitive, particularly for adolescents, and for specific substances. Thus, interventions and policies should address social, developmental, and psychological factors.

Kettil Bruun is more relevant than ever

Kettil Bruun is best known for the total consumption model introduced in 1975 in the collective work “Alcohol control policy in public health perspective”. There were three tracks in particular that led Bruun's research towards the total consumption model: research on the distribution of power, research on international drug policies, and his contributions to criminology and social policy. Kettil Bruun’s lifework shows that the innovation, intersectionality, and synergy which are now rehearsed in pompous research strategies were a non-question 40 years ago. These aspects were a natural part of the scientific pursuit of answers. Maybe in a much more modest and homemade form, but all the more import in terms of applicability at the general level of principle.

Former inpatients’ narratives of substance use four years after substance use disorder treatment: A qualitative follow-up study

Aim: The aim of this study was to explore the narratives of former substance use disorder (SUD) inpatients about substance use after their discharge from long-term SUD treatment in 2017. Method: We conducted semi-structured in-depth interviews with 11 former inpatients of SUD treatment. The data were analysed using a qualitative, thematic analysis model. Findings: During the analysis, two main themes emerged pertaining to participant reflections on substance use – their experience of non-problematic substance use (that is, substance use without declining into pre-treatment levels of misuse behaviours) and problematic substance use (that is, substance use associated with destructive patterns). All participants except one had engaged in substance use after their discharge three to four years ago. The commonly used substance was alcohol, which also appeared to be the most common substance for which there was consensus among the informants regarding non-problematic use. Conclusions: Most of the participants continued to use substances in some way, and some reported that such use did not affect them negatively. Healthcare providers and therapists in SUD treatment should avoid defining a relapse or failed treatment outcome in concrete terms. What is perceived as an actual relapse or a failed treatment outcome is highly subjective. Furthermore, complete sobriety might not necessarily be the best or the only way to measure the SUD treatment stay. An improvement in the quality of life and well-being, even when core symptoms are still present, may be considered a successful treatment outcome.

Childhood with a relative's excessive alcohol use, and own drinking in adult years

Objective: The aim of this study was to investigate if individuals who had been brought up by relatives (e.g. parents, siblings and grandparents) who consumed excessive alcohol effected these individuals' own alcohol use in their adult years. The participants in the study were also asked about their alcohol consumption in the past 12 months, and abstainers were asked about their reasons for choosing to live their lives without consuming alcohol. Method: A quantitative approach was used. Data collected from the Icelandic RARHA SEAS were used in this study. A panel of 2500 respondents in the age range of 18-65 years was randomly sampled and was intended to be adequately representative of the Icelandic population. There was a 34.9% response rate ( n=873). Results: Of the 873 source of this study, 26.6% (n=211) categorised as Group A had lived with relatives who excessively consumed alcohol, and this had negatively affected them in their childhood. In their adult years, Group A seemed to be more frequently intoxicated than the control group, Group B (n=659). They also experienced more negative consequences from their alcohol consumption. Group A was likely to consume alcohol to deal with difficult feelings such as depression, and they were also more likely to abstain than Group B. Conclusions: The childhood experience of living with relatives who excessively use alcohol does not impact everyone in the same way in their adult years. Some of them are more likely to use excessive alcohol as adults without relating it to their childhood experience of relatives excessively using alcohol.

“He is lovely and awful”: The challenges of being close to an individual with alcohol problems

Introduction: In the last 20 years, there has been growing evidence that heavy drinking causes serious harm not only to the person who drinks but also to the person's relations and concerned significant others (CSOs). A relationship with a heavy drinker is often full of conflicts, and CSOs are frequently exposed to aggression, psychological, and sometimes physical violence from the heavy drinker. Despite their struggles, CSOs often feel it is difficult to seek professional help for these problems. The aim of this study was to investigate what problems CSOs of people with alcohol problems experience prior to seeking professional help to handle these issues. Moreover, to investigate what led to seeking professional help at all. Methods: This is a qualitative study with 12 female help-seeking CSOs of persons with alcohol problems. The participants were recruited from a randomised controlled trial (RCT) on Community Reinforcement and Family Training (CRAFT). Semi-structured interviews were conducted, audio-recorded, and transcribed. The analysis was based on interpretative phenomenological analysis. Results: Three overall themes and one sub-theme emerged from the analysis: (1) The CSO’s feelings and experiences of the situation prior to help-seeking, (2) The relationship with the drinker, (3) Reasons for help-seeking and its trajectory; and the sub-theme, What the CSOs hoped to gain from help-seeking. Conclusion: The present study showed that female CSOs of people with alcohol problems had suffered for a long time before seeking professional help. They felt their daily lives were unpredictable and stressful. They were often exposed to verbal and mental abuse and their relationships with the drinking relative were often characterised by frequent rowing. The CSOs had tried to cope for a long time using a number of different strategies; seeking help seemed to be the last option considered. Despite all the struggles and pain, the CSOs also felt a lot of love for their drinking relative and hoped for the return of their once sober relative. Our findings can be viewed as a support to the stress-strain-coping-support (SSCS) model proposed by Orford and colleagues.

Advice to policy-makers for improving services to the drug-death bereaved

Aims: The objective of this study is to contribute to an improvement of bereavement services and experiences for the bereaved after drug-related deaths (DRDs) by investigating their expressed opinions on what would constitute improvements. Methods: As part of a larger survey questionnaire, we asked people bereaved by DRDs what advice they would give to politicians to improve bereavement services. Out of 255 respondents, we received 196 written statements of advice, 83 focusing on the time after death. Two-thirds of these respondents were either parents or siblings, the other third were other family members or close friends. A thematic analysis was conducted to examine the written statements. Results: We found four central themes: broad-spectrum help, routinised help, respectful help and competent help. The advice represents a long list of psychosocial support to ideally be offered on a regular and long-term basis. Furthermore, the bereaved also discussed the cognitive and normative side of the services by including considerations about stigma and respect, and the need for more research- and experience-based knowledge about their experiences both before and after DRDs. Conclusions: Many of the services sought by the bereaved are already in place and described in national guidelines for follow-up strategies after sudden unexpected deaths. DRDs, however, has not been included as a task for the services and are not explicitly mentioned in these guidelines. The scope of research and policymaking on drug problems and DRDs should be broadened to include families and social networks in order to make the group more visible and strengthen their influence on policy.

Gambling harms caused by electronic gambling machines should be prevented with state control

Unlike in other Nordic countries, most of the electronic gambling machines (EGMs) are placed outside the Casino Helsinki and the gambling arcades in Finland. The placement of EGMs in non-casino locations, such as supermarkets, kiosks, and petrol stations, is matter of serious concern. We argue that availability and accessibility of EGMs has led to normalisation and banalisation of gambling in Finland. Exposure to EGMs also put at risk vulnerable populations and problem gamblers, who already suffer from the negative consequences of gambling harms. Gambling companies’ self-regulation initiatives and corporate social responsibility programmes are not enough to prevent and limit EGM related gambling harms. We suggest that Finland should follow Norway’s example and limit the availability of EGMs and transfer them from non-casino locations to gambling arcades. Finnish EGM policy should be a question of public policy guided by public health concerns.

Who are the young users of tobacco products? Prevalence and characteristics of Danish adolescents who have either smoked cigarettes, used alternative tobacco products, or used both

Aims: We examined characteristics (smoking in social relations, binge drinking, and well-being measures) of Danish 13-year-olds in relation to their tobacco use patterns. Ever use of cigarettes exclusively, ever use of alternative tobacco products (ATPs; e-cigarettes, snus, or waterpipe) exclusively, and use of both cigarettes and ATPs were studied. Methods: We used self-reported data from students at 46 Danish schools in 2017 comprising 2,307 students (response rate = 86%). Multi-level logistic regression analyses were used to examine the associations between student characteristics and the odds for having ever used any tobacco products, smoked cigarettes exclusively, used ATPs exclusively, or used both cigarettes and ATPs compared with never use of any tobacco products. Unadjusted estimates and estimates adjusted for gender were reported. Results: A significant minority of youth (13.2%) had used one or more tobacco products. Of these, 2.0% had exclusively smoked cigarettes, 7.2% had exclusively used ATPs, and 4.0% had used both. Findings showed that all included characteristics (families’ and friends’ smoking, binge drinking, and well-being characteristics) were associated with using any tobacco product; however, students with friends who smoked, had been binge drinking, and had low well-being at home had notably higher odds for having both smoked cigarettes and used ATPs compared to the other tobacco use patterns. Conclusion: ATPs were popular among Danish adolescents compared with conventional cigarettes. Thus, prevention efforts among adolescents should not merely focus on the health risks of conventional cigarette smoking but also on ATPs. Students with diverse tobacco use patterns were similar on various characteristics. However, findings indicate that adolescents who had used both conventional cigarettes and ATPs constitute a more risk-averse group in special need of prevention efforts. Gender did not markedly influence the results. These findings may help future strategies aiming at the youngest adolescents at risk of using tobacco products.