Previous studies have shown that substance misuse in adolescence is associated with increased risks of hospitalizations for mental and physical disorders, convictions for crimes, poverty, and premature death from age 21 to 50. The present study examined 180 adolescent boys and girls who sought treatment for substance misuse in Sweden. The adolescents and their parents were assessed independently when the adolescents first contacted the clinic to diagnose mental disorders and collect information on maltreatment and antisocial behavior. Official criminal files were obtained. Five years later, 147 of the ex-clients again completed similar assessments. The objectives were (1) to document the prevalence of alcohol use disorders (AUD) and drug use disorders (DUD) in early adulthood; and (2) to identify family and individual factors measured in adolescence that predicted these disorders, after taking account of AUD and DUD in adolescence and treatment. Results showed that AUD, DUD, and AUDÂ +Â DUD present in mid-adolescence were in most cases also present in early adulthood. Prediction models detected no positive effect of treatment in limiting persistence of these disorders. Thus, treatment-as-usual provided by the only psychiatric service for adolescents with substance misuse in a large urban center in Sweden failed to prevent the persistence of substance misuse. Despite extensive clinical assessments of the ex-clients and their parents, few factors assessed in mid-adolescence were associated with substance misuse disorders 5Â years later. It may be that family and individual factors in early life promote the mental disorders that precede adolescent substance misuse.
Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up.
To estimate, in a national cohort, the absolute risk of suicide within 36 years after the first psychiatric contact.
Prospective study of incident cases followed up for as long as 36 years. Median follow-up was 18 years.
Individual data drawn from Danish longitudinal registers.
A total of 176,347 persons born from January 1, 1955, through December 31, 1991, were followed up from their first contact with secondary mental health services after 15 years of age until death, emigration, disappearance, or the end of 2006. For each participant, 5 matched control individuals were included.
Absolute risk of suicide in percentage of individuals up to 36 years after the first contact.
Among men, the absolute risk of suicide (95% confidence interval [CI]) was highest for bipolar disorder, (7.77%; 6.01%-10.05%), followed by unipolar affective disorder (6.67%; 5.72%-7.78%) and schizophrenia (6.55%; 5.85%-7.34%). Among women, the highest risk was found among women with schizophrenia (4.91%; 95% CI, 4.03%-5.98%), followed by bipolar disorder (4.78%; 3.48%-6.56%). In the nonpsychiatric population, the risk was 0.72% (95% CI, 0.61%-0.86%) for men and 0.26% (0.20%-0.35%) for women. Comorbid substance abuse and comorbid unipolar affective disorder significantly increased the risk. The co-occurrence of deliberate self-harm increased the risk approximately 2-fold. Men with bipolar disorder and deliberate self-harm had the highest risk (17.08%; 95% CI, 11.19%-26.07%).
This is the first analysis of the absolute risk of suicide in a total national cohort of individuals followed up from the first psychiatric contact, and it represents, to our knowledge, the hitherto largest sample with the longest and most complete follow-up. Our estimates are lower than those most often cited, but they are still substantial and indicate the continuous need for prevention of suicide among people with mental disorders.
In a Russian Orthodox Church drug rehabilitation program in St. Petersburg, drug addiction was often described as a disease of frozen feelings. This image suggests that rehabilitation is a process of thawing emotional worlds and, thus, allows the emotions to flow once again. In this article I argue that "frozen feelings" is better understood as the unsocial emotional worlds many drug users experience, and that rehabilitation in this church-run program particularly focuses on the cultivation of an emotional world that supports sociality. This is done, I argue, by means of ethically training rehabilitants to learn how to control and manage their emotional worlds, and in so doing, rehabilitants become new moral persons better able to live in the social world.
BACKGROUND: Over the last decade adolescent males have been shown to use anabolic-androgenic steroids (AAS) in order to improve their sports performance and appearance, as well as in combination with alcohol and psychotropic drugs. However, the risk profile of AAS use is still not well understood. This study analysed the importance of social, personality and health factors for the use of AAS. METHODS: More than 2,700 senior high school students in Uppsala, Sweden, filled out an anonymous closed-response questionnaire. RESULTS: The findings from multiple logistic regression analyses of adolescent males (n = 1,353) showed that immigrant status, average/low self-esteem, average/low perceived school achievement and use of prescription tranquillisers/sedatives had independent significant associations with the use of AAS after controlling for age and previously known factors such as strength training, truancy and heavy alcohol consumption. CONCLUSION: The characteristics of AAS users extend beyond activities such as strength training and multiple drug use to include social, personality and health aspects.
The main aim of this study was to examine the role of illicit drug use before the age of 18 years in developing a criminal career. The study included 7577 18-year-old men conscripted for military service in Stockholm County in 1969/1970. At enrolment they answered questions regarding alcohol and illicit drug use, social background, behavioural factors and health. Data on adult and adolescent criminality were obtained from official registers from the age of 15 to the age of 43. Subjects with self-reported drug use were registered significantly more often (p
Substance use is among the key public health threats that find its genesis during adolescence. Timing of puberty has been lately researched as a potential predictor of subsequent substance abuse. The present study, therefore, aims to assess the effect of age at menarche on current practices of smoking, alcohol drinking and drug use among 14-15 year old Canadian girls.
The analysis of the study was based on all female respondents aged 14 to 15 years during Cycle 4 (2000/2001) of the National Longitudinal Survey of Children & Youth (NLSCY). The main independent variable was age at menarche assessed as the month and year of the occurrence of the first menstrual cycle. The dependent variables were current smoking, heavy alcohol drinking in the past 12 months and drug use in the past 12 months. Three logistic regression models were performed to investigate the association between age at menarche and each of the substance use outcomes, adjusting for possible confounders. Bootstrapping was performed to account for the complex sampling design.
The total weighted sample included in the analysis represented 295,042 Canadian girls. The prevalence of current smokers, heavy drinkers (drunk in the past 12 months) and drug users in the past 12 months was approximately 22%, 38% and 26%, respectively. After adjusting of all potential confounders, no association was found between age at menarche and any of the substance use outcomes. School performance and relationship with the father, however, stood out as the main variables to be associated with smoking, heavy drinking and drug use.
Qualitative studies understanding the social and psychological changes experienced by early maturing Canadian adolescents are warranted to identify other correlates or pathways to substance use in this higher risk population.
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The nexus between substance use and aggressive crime involves a complex interrelationship among mediating individual and community-level variables. Using multilevel logistic regression models, we investigate how community-level concentration of poverty variables mediate the predictive relationships among individual level social attachment variables and substance use on aggressive crime in a large national sample of male arrestees (N = 20,602) drawn from 24 U.S. urban areas. The findings support our hypothesis that individual social attachments to marriage and the labor force (education and employment) are the principal individual-level pathway mediating the substance abuse/aggression nexus. In the random intercept model, 3.17% of the variation not explained by the individual-level predictor variables is attributable to community-level variation in urban area female-headed households and households receiving welfare. This confirms our hypothesis that social structural conditions of an urban environment differentially expose persons to conditions that predict being arrested for an aggressive crime. Our findings tend to counter the cultural theorists who argue for an indigenous culture of violence in inner-city ghettos and barrios.
Some 211 male alcoholic in-patients were compared with a simple random sample of 200 men from Greater Stockholm. The group of male alcoholic in-patients and the random sample were subdivided with respect to alcohol consumption and use of hepatotoxic drugs: (IA) men from the random sample with low or moderate alcohol consumption and no use of drugs (n = 169); (IB) men from the random sample with low or moderate alcohol consumption with use of drugs (n = 31); (IIA) alcoholic in-patients with use of alcohol but no drugs (n = 171); (IIB) alcoholic in-patients with use of alcohol and drugs (n = 40). Earlier and more severe alcohol-related and anti-social problems were found among subjects with an alcoholic parent than among subjects without an alcoholic parent. The highest level of problems was noted for subjects with alcoholism in both parents and among the alcoholic in-patients. Groups which resembled each other were the drug users in the alcoholic group and in the general sample. Both inherited and environmental factors are important determinants and many of these individuals have psycho-social problems as children and adults. The children of those adults who used alcohol in combination with drugs (IIB) had most problems and the most severe problems. In the general population sample, those who used alcohol in combination with drugs (IB) had so many problems in the family and psycho-social problems themselves that they resembled the alcoholic in-patients and especially the group with high alcohol consumption in combination with drugs (IIB). A new finding is that the high-risk groups IB and IIB, who used both alcohol and drugs, had experienced a more disturbed school career and were more aggressive, had more nervous problems, and were more emotionally disturbed than the other groups. It is concluded that alcohol and drug use by parents may be predictive of future alcoholism in their children.
This paper reviews the state of alcohol treatment services in Russia. There have been some recent improvements, for example the introduction of confidentiality in treatment, the closure of correctional centres, and the payment of state benefits to in-patients. However, there remains a considerable stigma attached to a diagnosis of alcoholism. Although new approaches to treatment have been promulgated, in practice Russian treatment methods remain idiosyncratic with little in the way of psychotherapy. Many techniques utilise placebos and persuasion, with the patient as a passive recipient. Services are generally of a poor quality, and underfunded and medical specialists are poorly trained. To improve matters it is suggested that there will need to be: (1) changes in knowledge and attitude among the general population and within the specialist services; and (2) a continuing exchange of ideas and specialists between Russia and the West.
Alcohol use is a public health problem in the Russian Federation. This study explored relationships between alcohol use and behavioral risks for HIV transmission among men who have sex with men (MSM) in Moscow, Russia. Alcohol use disorder identification test (AUDIT) scores for 1367 MSM participating in a cross-sectional survey and HIV testing were categorized to: "abstinence/low use", "hazardous use", "harmful use/dependency". Multiple logistic regression models compared dependent variables for sexual and drug use behaviors across alcohol use strata. Hazardous and harmful/dependent alcohol use were significantly associated with high-risk sexual behaviors and drug use. Harmful use/dependency was associated with an increased odds of having more than five male sex partners (last 12 months; adjusted odds ratios-AOR 1.69; 95 % CI 1.25-2.27), inconsistent condom use during anal intercourse (AOR 2.19; 95 % CI 1.61-2.96) and, among those using recreational drugs, injection drug use (last month; AOR 4.38: 95 % CI 1.13-17.07) compared to abstinent/low-level users. Harmful/dependent use was marginally associated with HIV infection (AOR 1.48; 95 % CI 0.97-2.25). HIV prevention efforts for MSM in Moscow may benefit from addressing problem alcohol use to mitigate high-risk behaviors.