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.
Longitudinal research investigating psychiatric trajectories among patients with poly-drug use patterns remains relatively scant, even though this specific population is at elevated risk for multiple negative outcomes. The present study examined temporal associations between poly-drug use (i.e. heroin, cannabis, tranquilizers, and amphetamines) and mental distress over a 10-year period.
A clinical cohort of 481 patients was recruited from substance use treatment facilities in Norway, and prospectively interviewed 1, 2, 7 and 10years after the initial data collection at treatment admission. At each assessment participants completed a questionnaire addressing their substance use and mental distress. Longitudinal growth models were used to examine whether, and if so, how, levels of drug use were associated with the level and rate of change in mental distress over time.
Results from the longitudinal growth models showed a co-occurrence between active poly-drug use and mental distress, such that there was a dose-response effect where mental distress increased both in magnitude and over time with the number of drugs used. Reduction in mental distress during the 10-year study period was evident only in the no-drug use condition. Use of multiple drugs and mental distress appear strongly co-related over time.
Pre-treatment assessment should carefully identify individuals manifesting poly-drug use and mental disorders. Treatment and follow-up services should be tailored to their specific needs.
Criminality among female (n=351) drug abusers is compared to that of men (n=798) as part of a longitudinal study of persons in treatment in Sweden (the SWEDATE project). The extent of criminality was much less among females than among males, and fewer women than men were criminal. The pattern of criminality varied between the sexes. Women's crime debuts occurred later, and they committed less violent crimes and more drug-related crimes. The majority of women supported themselves in other ways than with criminality. Also, women tended to have a more severe pattern of abuse, a more rapid drug career, and more complex psychological problems than men. A subgroup of prostitutes whose drug of choice was heroin often began drug use early with cannabis and went on to amphetamine for their first injection, which often took place in a junkie pad. There was also a criminal group (as there was among men) with a very early and intensive juvenile delinquency pattern, early drug debuts and a rapid transition to regular abuse and extensive adult criminality. Forty-two percent of the women had no criminal records; they had more extensive multiple drug abuse than the other women (this was also true for the noncriminal male addicts). The study shows that drug abuse and criminality are interrelated for certain individuals, but not for others.
The authors review the existing literature on inhalation of gasoline fumes, highlighting the acute and chronic physical and psychological effects. The clinical picture of gas sniffing includes visual hallucinations, changes in consciousness, euphoria, nystagmus, dizziness, weakness and tremors. There is the possibility of rapid recovery, sudden death or brain damage with chronic abuse. When leaded gasoline is abused then blood and urine lead levels and erythrocytic delta-aminolevulinic acid dehydrase (ALAD) levels may be helpful. Although the treatment of acute and chronic gas sniffing syndromes is often supportive and non-specific, when lead levels are high chelated therapy is indicated including British anti-lewisite, calcium disodium versenate or D-penicillamine. We also report our findings on an isolated native Indian population where intentional gas sniffing has reached epidemic proportions. Ten percent of the total population and 25% of the children between 5 and 15 years of age had been identified as gasoline inhalation abusers. In this population, the most important etiological factors included environmental, family and cultural components. The authors emphasize the need to correct the family and social deficiencies in such communities if the incidence of gas sniffing is to be decreased.
OBJECTIVES: Few epidemiological studies have compared less well-integrated urban areas with well-integrated rural areas with the same methods. The aim of this study was to explore the prevalence of mental disorder in a socially stable demographic western region of Norway and make comparison with previously observed prevalence figures of mental illness in Oslo, the capital of Norway. METHOD: A random sample of the 107,738 residents of Sogn and Fjordane, a western rural region of Norway, age 18-65 years, was drawn from the Norwegian Population Register. A total of 1,080 subjects, 63% of the original sample, were interviewed with the Composite International Diagnostic Interview. RESULTS: The mean age of the subjects was 39.2 years. The 12-month prevalence of mental illness was 16.5% and the lifetime prevalence was 30.9%. Simple phobia and social phobia had the highest 12-month prevalence whereas alcohol abuse and major depression had the highest lifetime prevalence. All mental disorders were more prevalent in women than in men, with the exception of alcohol and drug abuse. Severe psychopathology was found in 2.2% (12 month prevalence) and 5.1% (lifetime prevalence). These observations show that the 12-month and the lifetime prevalence of mental illness in this western area is approximately half the rate of figures observed for Oslo. CONCLUSION: Epidemiological figures for a western rural region of Norway showing 12-month and the lifetime prevalence of mental disorder are considerably lower than figures obtained in studies from the capital of Norway. However, the same basic pattern of mental illness can be observed in the rural as in the urban area of Oslo, with alcohol abuse/dependence and major depression being the most common disorders at both sites. The sex pattern is also the same with higher figures for women both in rural and urban areas with the exception of alcohol and drug abuse being higher in men.
OBJECTIVE: To compare outcomes over 30 years experienced by individuals who as adolescents entered substance misuse treatment and a general population sample. METHOD: All 1992 individuals seen at the only clinic for substance misusing adolescents in Stockholm from 1968 to 1971 were compared to 1992 individuals randomly selected from the Swedish population, matched for sex, age and birthplace. Death, hospitalization for physical illness related to substance misuse, hospitalization for mental illness, substance misuse, criminal convictions and poverty were documented from national registers. RESULTS: Relative risks of death, physical illness, mental illness, substance misuse, criminal convictions and poverty were significantly elevated in the clinic compared to the general population sample. After adjustment for substance misuse in adulthood, the risks of death, physical and mental illness, criminality and poverty remained elevated. CONCLUSION: Adolescents who consult for substance misuse problems are at high risk for multiple adverse outcomes over the subsequent 30 years.
This study has 2 aims. Firstly, we explore and analyze the associations between physicians' unhealthy substance use and various work-cultural and social aspects; secondly, we describe how substance use disorder (SUD defined as by Alcohol Use Disorders Identification Test [AUDIT] and Drug Use Disorders Identification Test [DUDIT]) among colleagues is managed and how physicians seek help.
During the spring of 2014, a nationwide cross-sectional study was conducted as an anonymous electronic survey among a randomly weighted sample of medical specialists, junior hospital doctors, and general practitioners in Denmark. A total of 4000 physicians (approximately 1333 from each group) were sampled, and 1943 responded (49%). The survey included the AUDIT, the DUDIT, and questions on health and psychological issues.
Among the physicians in our study, 18.3% had an AUDIT exceeding 8 (hazardous or harmful alcohol use) and 3.2% had a DUDIT exceeding 1. Of these, 12.9% reported that their substance use had negative consequences for their social networks, and 34% to 42% reported no openness about substance use at their workplace. In total, 4 physicians (1%) of the 383 physicians with risky substance use reported to have been in regular treatment for SUDs. Most of the physicians with an unhealthy consumption of substances (78%) reported that it was irrelevant for them to seek help. Half of them reported that they had limited or insufficient knowledge of SUD. Around 55% of the physicians would encourage colleagues with SUDs to seek treatment.
Around 50% of physicians reported that their "SUD knowledge" was relevant, but limited or not satisfactory. One-third never experienced openness about SUD at work. More than half wished to encourage a colleague with SUD to seek treatment. Three quarters of the physicians with unhealthy substance use reported that they found it irrelevant to seek help.
Background: As a result of deinstitutionalization of psychiatric treatment and care, many people with severe mental illness have been offered supported accommodation. However, research on this costly intervention in Norway has been scarce. Aims: The aim of this study was to prospectively investigate the clinical and demographic factors associated with allocation to supported accommodation for people with schizophrenia. Methods: The study was a prospective cohort study of 334 people with schizophrenia acutely admitted to Haukeland University Hospital between 2005 and 2010. Information concerning allocation to supported accommodation in their residential municipalities was collected retrospectively. Univariate and multivariate statistical methods were used to assess the association of clinical and demographical variables with allocation to supported accommodation. Results: Supported accommodation was allocated to 29.6% of the participants during the study period. Age, gender, implementation of compulsory mental health care, substance abuse, symptom burden and suicidality were not associated with allocation to supported accommodation. Functional impairment, especially difficulties with activities of daily living, experiencing exacerbation in the course of chronic disease, being medicated and of Norwegian origin, favoured supported accommodation. Conclusions: Our results supported the hypothesis that people with severe mental illness presenting the greatest need for supported accommodation, based on functional difficulties and exacerbation of chronic disease were allocated supported accommodation. Symptom burden was not associated with allocation. Clinical implications: Further research is needed to examine the impact of supported accommodation on the outcomes for people with schizophrenia.