Before 1970, special institutions, often prison-like, were built for the severely dependent. The effect of this type of treatment, often lasting for months or even years, was hard to document scientifically. During the 1970s several steps were taken towards a more preventive strategy that involved delivery of alcohol interventions in general health care settings, particularly within primary health care. The World Health Organization's (WHO) introduction of the concepts of hazardous and harmful drinking represented a shift from the traditional dichotomous view of individuals being alcoholic-or-not to a continuum where, in line with Rose's "prevention paradox", a large number of people with low risk may give rise to more cases of disease than the small number with high risk. The need for efficient methods to detect persons with various degrees of alcohol risk was evident, and a WHO multinational project that resulted in the publication of AUDIT (Alcohol Use Disorders identification Test) was carried out in the mid 1980s. The usefulness of this principle of case finding was then investigated in a subsequent multinational WHO project of brief intervention, as well as in several other similar projects. Many of these projects have proven quite efficient, but screening and brief intervention for alcohol problems is still not standard procedure in primary health care. The paper discusses some of the reasons why.

Aim: This study examines the discursive construction of medical cannabis in Swedish newspapers, with the aim of understanding how the news media recontextualise the medical potential of cannabis.

Design: The study is centred on the concept of recontextualisation, which focuses on how discourses are reinterpreted and reshaped when moving from one context to another, with a special focus on recontextualisation in relation to the media. Methodologically, the study uses critical discourse analysis to qualitatively analyse 134 articles of different subgenres, published in four Swedish newspapers between 2015 and 2020.

Results: The study shows that medical cannabis is constructed around myriad topics and contexts, ranging from news that focuses on the medical potential of cannabis to articles where medical cannabis is mentioned in passing and constructed in a more abstract form. The media have difficulties retaining a conceptual boundary between medical and recreational cannabis. Moreover, the study shows that the medical potential of cannabis is discursively constructed using three different discourses: patient discourse, strong science discourse, and weak science discourse.

Conclusions: The study suggests that there is a widening of the debate on cannabis in the Swedish public sphere, giving more recognition to the potential medical use of cannabis. The media, however, show difficulties in refining discourses on medical cannabis, which results in an altering between constructions that are strongly connected to science, and those that are not.

Artikeln bygger på intervjuer med 15 barn till föräldrar med  missbruksproblem.  Syfte: Att bidra till fördjupad förståelse av barns situation, när en förälders missbruk upphört. Metod: En explorativ intervjustudie med barndomssociologi och symbolisk interaktionism som teoriram. Resultat: Att missbruket upphört ger barn utrymme att känna efter hur de mår, att reflektera över missbrukets påverkan på deras hälsa och personlighet och att försöka förändra sig och sitt liv. Deras behov av bearbetning kan kvarstå lång tid. Det kan ta tid och vara svårt att bygga upp relationen till föräldern. Barn kan känna omsorgsansvar men också misstro och oro för återfall. Tonåringen kan dock se en möjlighet att gå vidare med sitt eget liv. Om missbruket bara upphör för en av två föräldrar med missbruksproblem  är barn fortfarande berörda av missbruk. Konklusion: Barns behov av bearbetning i relation till föräldrarna kan både ta och kvarstå lång tid oavsett om barnet bor med föräldern eller inte.  Barnen kan både behöva hjälp för egen del och i relation till föräldern. Det ska vara påbjudet att professionella arbetar med ett familjeperspektiv, oavsett organisatoriska uppdelningar och oavsett om förälder och barn bor ihop eller ej. Det kräver strukturer, rutiner och resurser för samverkan över organisatoriska gränser.

AIMS & DESIGN - In this study we follow a Stockholm birth cohort born in 1953 (n = 14 294) from youth to middle age. The cohort members were in their teenage years when drug abuse was established as a considerable threat to Swedish society and some of the cohort members themselves became drug abusers (n=431). RESULTS - As expected, life became dramatically worse for those with documented drug abuse when young, than for the rest of the cohort members. While 72 percent of those without documented drug abuse were socially included at the age of 56, the corresponding share among those with documented drug abuse was 18 per cent. And while 5 percent in the former group were diseased at 56, this was true for 38 percent in the latter group. Supplementary analyses showed that social inclusion was also less stable among those with documented drug abuse than among the rest of the cohort, and that the flow from exclusion to inclusion was virtually nonexistent, which was not the case for those without experience of drug abuse. CONCLUSIONS - Gender specific analyses showed that the situation, at least in absolute terms, tended to be even worse for male drug abusers than for women. Gender differences in alcohol abuse, criminality, and with respect to parenthood are suggested as possible explanations to be further studied in future research.

AIM – The study explores arenas of adolescent binge drinking in small Swedish towns and the meanings these have for young persons. The focus is thus on space and place, and on the geography of underage drinking.

DESIGN – An ethnographic approach was used, including direct observations, document studies and contacts with youth workers on local and national levels, and interviews with 28 underage binge-drinking adolescents chosen as informants.

FINDINGS – Adolescent binge drinkers seem to have moved away from street and other outdoor drinking arenas to home environments, where they feel they have more control over their party location and participants.

CONCLUSIONS – One consequence of outdoor drinking moving indoors is that professional youth workers and police cannot enter party arenas and the only adults who can do so are the parents. This has implications for preventive alcohol strategies and outreach social work. Measures should be directed to parents to make them fully aware of the importance of the party location in their homes.

Aim: The article describes similarities and differences regarding various risk factors between girls and boys with substance abuse problems who begin outpatient treatment at the Maria clinics in Sweden. Potential hypotheses and some implications are also discussed. Methods: This cross-sectional study was based on interview data from 2169 adolescents obtained over three years from outpatient clinics in 11 Swedish cities. Results: Girls appear to consistently have more difficult family and childhood environments than boys, and are more likely to have problems related to school, more serious substance abuse problems, and more severe mental health problems. Criminal activity is significantly higher among boys. Conclusions: The study shows that girls entering treatment generally have significantly more risk factors than boys and thus more extensive problems in several aspects of life, which in turn increases the risk of developing serious drug and alcohol problems in adulthood. The study supports the gender-paradoxical relationship in which a smaller proportion of girls than boys enter treatment for substance abuse, even though girls tend to have more problematic life situations.

Inter-rater reliability studies are unusual as regards the standardised interview instruments used in the Swedish treatment care system for substance abusers. This article presents the results of a study intended to establish the inter-rater reliability of DOK interviews, through identification of question areas and items with high or low correspondence, and through analysis of how ratings differ between different interviewers.

In total 41 practitioners participated in this study, with various experiences and from six different treatment units of the Swedish treatment care system for substance abusers. Participants gave their ratings and completed the DOK questionnaire based on a video-taped interview. Calculation and analysis of the correspondences were carried out for each individual question area and also each individual item by using appropriate statistical methods. Differences between the various assessors are presented.

The results of the study show that the percentage agreement for the question areas and the items is generally high, with the exception of a few isolated questions.

Among the many possible different explanations for a lack of correspondence is that the questions could be ambiguously constructed and defined or the interview guidelines do not offer satisfactory guidance, or some questions could be too detailed. In addition, a few of the raters may lack sufficient training or experience when it comes to conducting interviews based on DOK. The combined results of the study show that there is a high level of inter-rater reliability, which indicates that in practice it is possible to utilise structured interviews such as DOK.

Aim: There is a lack of knowledge about how adolescents with substance abuse problems manage after taking part in treatment. It is also difficult to perform traditional follow-up studies with this group. This article presents the outcome of a prospective study of 455 adolescents who underwent outpatient treatment, based on data taken from official registers. It aims to describe and analyse indications of continued use of substance (CUS) and how various risk and protective factors predict outcomes after initiated treatment at a Maria clinic in Sweden.

Design: The study is based on structured interviews at intake, and the data that indicated CUS were taken from several different national registers. The analyses included descriptive data and bivariate associations, logistic regressions and a CHAID analysis.

Results: Almost two thirds of the adolescents have no indication of CUS at one-year follow-up. The ten studied risk factors independently were weak predictors of CUS and it was instead the accumulation of risk factors that were linked to a negative outcome.

Conclusion: The majority of adolescents who start outpatient treatment for substance abuse problems return to a lesser extent in registers that may indicate a continued problem with alcohol and drugs one year later. A concentration of more than five risk factors appears to be associated with a registration. The study also provides an example of an alternative method for following up adolescents with alcohol and drug abuse problems.

Aim: There is a lack of knowledge about how adolescents with substance abuse problems manage after taking part in treatment. It is also difficult to perform traditional follow-up studies with this group. This article presents the outcome of a prospective study of 455 adolescents who underwent outpatient treatment, based on data taken from official registers. It aims to describe and analyse indications of continued use of substance (CUS) and how various risk and protective factors predict outcomes after initiated treatment at a Maria clinic in Sweden. Design: The study is based on structured interviews at intake, and the data that indicated CUS were taken from several different national registers. The analyses included descriptive data and bivariate associations, logistic regressions and a CHAID analysis. Results: Almost two thirds of the adolescents have no indication of CUS at one-year follow-up. The ten studied risk factors independently were weak predictors of CUS and it was instead the accumulation of risk factors that were linked to a negative outcome. Conclusion: The majority of adolescents who start outpatient treatment for substance abuse problems return to a lesser extent in registers that may indicate a continued problem with alcohol and drugs one year later. A concentration of more than five risk factors appears to be associated with a registration. The study also provides an example of an alternative method for following up adolescents with alcohol and drug abuse problems.

Objectives: Opioid substitution treatment (OST) is often described as a strict and highly regulated treatment method, in which patients have limited influence over their treatment. In 2014, a reform was introduced by the regional council of Skåne in southern Sweden, which allowed OST patients to choose their treatment provider, thus transferring power from care providers to patients. The aim of this study was to examine what this increase in patient influence has meant for the clinics that provide OST in Skåne, and how these clinics have dealt with the new competitive situation that has arisen following the introduction of the reform. Methods: The study is based on two waves of semi-structured interviews with clinic managers at all OST clinics in Skåne. Results: The clinic managers described the increase in patient influence as a positive change, which had led to the patients being treated with more respect. The competition among clinics was expressed, among other things, in the form of differing views on the prescription of benzodiazepines, which initially gave rise to dissatisfaction among clinics with a more restrictive approach to such prescriptions. The reform did not lead to any clear diversity between clinics, apart from different approaches to the prescription of benzodiazepines. The incentive for competition-based diversity is, however, limited by the strict national regulatory system and by the reimbursement system, which restricts the ways in which clinics can conduct treatment activities. Conclusion: OST-clinic managers were largely positive about the increased patient empowerment and the shift in power balance associated with the patient choice reform. The introduction of the reform did not lead to any clear diversity between treatment providers, apart from differing views on the prescription of benzodiazepines, which by some managers was regarded as unfair competition. 

Aim: The purpose of this qualitative study was to investigate the effects experienced by users of a novel psychoactive substance, the benzodiazepine flubromazolam, by analysing users' own accounts on the Swedish forum Flashback.org. Method: A thematic analysis of anonymous self-reports published on the forum was performed and generated five general themes describing effects and experiences by flubromazolam users. Results: The themes which emerged were: Onset and duration, Desired effects, Adverse effects and addiction, Loss of control, General estimations and evaluations. The main reported characteristics of flubromazolam were heavy hypnotic and sedative effects, long-lasting amnesiac effects and the rapid development of tolerance. Flubromazolam was also anxiolytic and acted as a muscle relaxant for many users. Some users experienced euphoria or intense wellbeing. Other prominent characteristics were loss of control (leading to poor choices and actions, with unpleasant consequences) and long-lasting, often severe withdrawals. There were also serious incidents where users had been admitted to hospital, acute psychiatric treatment or taken into custody by the police. Conclusion: Flubromazolam appears to be a highly addictive and precarious benzodiazepine with many, possibly severe, side effects. The substance is generally described as very potent and with long-lasting effects. Memory loss and loss of control are common adverse effects, and withdrawals appear to be severe for many users

The aim of the article is to understand the meaning of subversive situations and collective storytelling in a Swedish male second division handball team. By subversive we mean situations and stories which exceed the limit of what is seen as legitimate outside the secret alliance of the group. The article examines how alcohol functions to transform the scene in which a situation or a collective story becomes subversive.

One of the authors spent several years as an active member in the handball team, collecting ethnographical data both from sports settings and related situations involving storytelling, for example, at parties, in dressing rooms, and during team trips to other Nordic countries. In addition interviews were conducted with 17 members of the team. 

The storytelling and the subversive situations make it possible to create an alternative world, in which the members of the team can overstep different types of rules of conduct and civilized behaviour. This is made possible in part because of the meaning attached to alcohol as a transformer of social reality and also because of the character of the social group as homosocial and secret.

Although the scientific community, particularly academic publishing, claims to be gender-neutral and based on meritocracy, it mirrors other parts of modern society, wherein residual gender imbalances and implicit and explicit gender biases are reproduced. In this report, we address gender imbalances (in particular, the overrepresentation of men) in the editorial workforce of academic journals as barriers to women's promotion and career progression in addiction science. We also consider potential gender-related elements and biases in the peer-review and editorial decision-making processes, which may result in women's lower publication rates, thereby creating another gender-related barrier to women's promotion, career progression and academic recognition. Establishing a more balanced gender representation in addiction publishing will require the adoption of the SAGER guidelines and the development of Gender Equality Plans for addiction specialty journals. Finally, although our focus concerns gender, the organisational mechanisms identified here also affect other types of heterogeneity and intersectional thinking.

Aims

In this article we scrutinise three prominent guidelines on psychosocial interventions for alcohol problems. We pay special attention to how congruent the guidelines are in terms of the interventions recommended, and the processes used in order to identify and rank the “evidence” underpinning these recommendations.

Data

The analysed guidelines are: 1) Practice Guideline for the Treatment of Patients with Substance Use Disorders, American Psychiatric Association (2006); 2) Alcohol-Use Disorders. The NICE Guideline on Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence (2011), National Collaborating Centre for Mental Health, UK; 3) Guidelines for the Treatment of Alcohol Problems, Australian Government, Department of Health and Ageing (2009). The purpose is not to review the three guidelines as such, but to study them as an example of the production of evidence. All report to be based on “best available evidence”, so the guidelines were compared both regarding the actual recommendations and the guideline production procedures and differences in these procedures with related consequences.

Results & CONCLUSIONS

Prestigious organisations in different national contexts have reached divergent conclusions about evidence-based practice and the quality of the scientific studies underpinning these conclusions. Differences in the guidelines regarding interpretations, limitations and grading illustrate the difficulties with the dilemmas of sensitivity (to include factors that are significant for how a psychological intervention is to be judged) and specificity (that irrelevant studies are cleared off) in the recommendations presented.

Aim: This study accounts for how people aged 55-69 with ongoing long-term alcohol problems conceptualize past, present and future.

Methods: A total of 19 interviews were performed, from which reflective life reviews were obtained and analyzed as narrative life accounts. Three structuring thematic traits were identified: resentment of life, acceptance of life and gratitude towards life.

Results: The study shows how past, present and future intertwine into meaningful entities incorporating certain governing master narratives about recovery, familiar for example from expert discourse and the AA movement. When it comes to the theme of resentment, the participants articulated disappointment over what life had become and emphasized especially the missed work-related opportunities that the drinking had caused. In the theme of acceptance letting go of the past was viewed as important for creating a sober future. Within the dimension of gratitude the past was seen as a resource for self-development and future recovery.

Conclusions: How long-term alcohol problems are conceptualized in the long view of a life narrative may have great implications for outlooks of a sober future. A closer look at the social and cultural material incorporated in the stories of this age group is an important task for future research.

In this commentary we discuss the translation into Swedish of the term Gambling Disorder (GD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2015). An earlier commentary in this journal described and discussed the translation into Finnish (Castrén, Salonen, Alho, & Lahti, 2014).

AimsTo investigate potentially crucial aspects of Swedes' perceptions of nine different addictions

Data and methodsPopulation survey, sent out to 2,000 adult Swedes (18-74 years), focusing on the perceived severity of, responsibility for, options to recover from, and character of addiction to cigarettes, snuff, alcohol, cannabis, amphetamine, cocaine, heroin, medical drugs, and gambling.

ResultsThere are large differences in the ways in which various addiction problems are perceived. Whereas tobacco use, and to some extent gambling, are seen as relatively harmless "habits", not particularly easy to get hooked on but easy to quit, the use of drugs such as heroin, amphetamine, and cocaine is seen as a major societal problem, and users are seen both as "sinners" who need to mend their ways and as powerless "victims". In between comes the use and misuse of alcohol, cannabis and medical drugs, about which perceptions are more divided.

ConclusionsRespondents tend to downplay the risks and dangers with addictive habits that are common and familiar in mainstream culture, and to dramatise the risks and dangers with such habits that are uncommon or "strange". This may have unfortunate consequences for addicts' options to find a path out of their predicaments.

Aim:

A drinking pattern is not only a major drinking variable, but is also one indicator of a country's drinking culture. In the present study, we examine drinking patterns within and across the neighbouring countries of Denmark and Germany. The aim of the research is to determine to what extent drinking patterns differ or are shared at the sub-national level in the two countries.

Method:

Data came from the German 2012 Epidemiological Survey of Substance Use (n = 9084) 18-64 years (response rate 54%), and the Centre for Alcohol and Drug Research's 2011 Danish national survey (n = 5133) 15-79 years (response rate 64%), which was reduced to a common age range, producing a final n = 4016. The drinking pattern variable included abstention, moderate drinking, heavy drinking, risky single occasion drinking (RSOD), and was investigated with bivariate statistics and gender-specific hierarchical cluster analysis.

Results:

For men three clusters emerged: one highlighting abstention and RSOD, moderate/heavy drinking, RSOD and RSOD + heavy drinking. For women, two clusters appeared: one highlighting abstention and moderate/heavy drinking and the other highlighting RSOD and RSDO + heavy drinking. The clusters revealed different geographical patterning: for men, a west vs. east divide; for women, a north-south gradient.

Conclusions:

The analysis could identify for each gender clusters representing both separate and shared drinking patterns as well as distinctive geographical placements. This new knowledge can contribute to a new understanding of the dynamics of drinking cultures and could indicate new approaches to prevention efforts and policy initiatives.

Aims:

The principle aim of this study was to investigate changes in alcohol consumption among adolescents in Stockholm from 2010 to 2016. A further aim was to investigate whether there are divergent or similar trends in alcohol consumption among elementary schools in Stockholm from 2010 to 2016 and, if there are diverging trends, to examine how the differences might be explained.

Methods:

Data were analysed using multilevel mixed effects linear regression, in which individual students represented one level and schools the second level.

Data:

Student-level data were derived from the Stockholm School Survey for the years 2010, 2012, 2014 and 2016 (n = 15481). School-level data (n = 132) were derived from registries of the Swedish National Agency for Education.

Results:

The results showed that there was an almost 45% decline in total alcohol consumption among ninth-grade students in Stockholm between 2010 and 2016. The decline was similar among all analysed consumption groups. Two factors were found to statistically explain some of the general decline: more restrictive parental attitudes towards alcohol and, more importantly, decreasing alcohol consumption among the students’ peers. The downward trends among schools between 2010 and 2016 were universal but not identical, but when parental attitudes towards alcohol and peers’ alcohol behaviour were controlled for, the diverging school trends in alcohol consumption were considerably more equal.

Conclusions:

School constitutes a social context for the student of which both parents and peers are important parts, and the diverging changes may be due to the norms and behaviours, influenced by parents and peers, characterising these schools.

Background and aims: Problematic internet use (PIU), and kindred concepts such as internet addiction (IA), make up a growing research field, partly due to the suggested inclusion of internet gaming disorder in a future DSM-6 as well as the fact that gaming disorder is on its way to being included in the ICD-11. Conclusions from research are far from unified. This study aims to synthesise the research field of problematic internet use/internet addiction/gaming disorder, with a focus on the reporting of prevalence and change.

Methods: Longitudinal studies of PIU/IA formed the basis for a scoping review. Systematic searches of Web of Science, Scopus and Proquest, for peer-reviewed and published articles based on empirical data collected at a minimum of two time points for studies, and with an end point set at 2017, led to the inclusion of 97 studies. Endnote X7 was used to organise the results and NVivo 11 was used for synthesising the results.

Results: Analyses focused on prevalence and change. Findings show variation among measures and prevalence as well as in reported outcomes relating to social life and other problems. Most studies reported relations between PIU/IA and other problems in life, but no specific time order could be established. Furthermore, many studies did not present data on prevalence or change even though using a longitudinal survey design.

Discussion and conclusions: In summary, the research field is plagued by a lack of consensus and common understanding, regarding both measures, perceptions of the problem, and findings.

AIM - This article analyses and discusses the estimation of serious or problematic drug use through an empirical example based on a local Swedish study in Gothenburg. METHODS AND DATA - This was a case-finding study with questionnaires directed at organisations which have contact with the target group. The material was supplemented with information from the two documentation systems DOK and ASI. A total of 2,148 reports were collected. Health care data of 1,096 individuals was also collected for analysis with the truncated Poisson method. Analyses with capture-recapture or truncated Poisson were conducted to calculate the size of the hidden population. RESULTS - The statistical analyses resulted in variable numbers for the hidden population, and the total prevalence of serious drug abuse in Gothenburg is estimated to be between 2,200 and 4,400 people. CONCLUSION - The study shows that estimation of the presence and prevalence of problematic drug abuse involves many methodological difficulties and challenges. The significant variation of the size of the hidden population presented in the study raises doubts about the reliability and validity of the different methods. The methods are clearly sensitive to the importance of fulfilling the different basic assumptions

Aim: This article describes and discusses the Swedish UngDOK interview and its psychometric properties. Method: The study is based on empirical data from 1633 intake interviews collected by 15 units in ten cities and focused primarily on the two central sections of intake form: alcohol and drug use and mental health. The statistical analyses concern internal consistency, test–retest reliability, discriminant validity and internal non-response. Results: The reliability of AUDIT-C and the mental health domain was good with regard to both internal consistency and test–retest. The test–retest values were generally satisfactory, except for frequency of drug use and association with peers who use drugs. The discriminant validity shows that the interview clearly distinguishes adolescents with more profound problems from a group with milder problems and that a minor degree of inconsistency and non-response bias may occur in empirical material based upon self-reported information. Conclusion: The study showed that the psychometric properties of the UngDOK interview are generally satisfactory and may be regarded as a valuable option for practices engaged in treating adolescents with substance-use problems.

Aims: To follow up on exchange students' alcohol use, drug use, mental health, self-rated health, and risky sexual behaviour after a semester abroad and to compare them with students who remained on campus. Methods: The study design was a follow-up study based on a previous baseline survey of 114 prospective exchange students and 451 campus students. Of the original 565 students, 48 (42.1%) prospective exchange students and 209 (43.3%) campus students responded to the follow-up. Both the baseline survey and the follow-up survey included the General Health Questionnaire 12, one single item from Self-Rated Health, and nine items from Knowledge, Attitudes and Sexual Behaviour in Young People in Sweden. Results: We found a statistically significant increase in the weekly consumption of alcohol among exchange students after their semester abroad. A larger proportion of exchange students had sex with a new partner and sex with more than three partners during their semester abroad compared to follow-up campus students. Conclusions: Our findings indicate that exchange students consume alcohol more frequently during their semester abroad and indulge in sexually risky behaviour. Exchange students' use of alcohol and sexually risky behaviour could be associated with even greater risks due to them being in an unknown environment, unfamiliar culture, and with limited support from family and friends. This highlights the need for further research on exchange students' experiences, especially concerning alcohol use and sex while abroad.

Aims: To follow up on exchange students' alcohol use, drug use, mental health, self-rated health, and risky sexual behaviour after a semester abroad and to compare them with students who remained on campus. Methods: The study design was a follow-up study based on a previous baseline survey of 114 prospective exchange students and 451 campus students. Of the original 565 students, 48 (42.1%) prospective exchange students and 209 (43.3%) campus students responded to the follow-up. Both the baseline survey and the follow-up survey included the General Health Questionnaire 12, one single item from Self-Rated Health, and nine items from Knowledge, Attitudes and Sexual Behaviour in Young People in Sweden. Results: We found a statistically significant increase in the weekly consumption of alcohol among exchange students after their semester abroad. A larger proportion of exchange students had sex with a new partner and sex with more than three partners during their semester abroad compared to follow-up campus students. Conclusions: Our findings indicate that exchange students consume alcohol more frequently during their semester abroad and indulge in sexually risky behaviour. Exchange students' use of alcohol and sexually risky behaviour could be associated with even greater risks due to them being in an unknown environment, unfamiliar culture, and with limited support from family and friends. This highlights the need for further research on exchange students' experiences, especially concerning alcohol use and sex while abroad.

Aim: The public health model for prevention of disease and disorder has been influential in informing interventions regarding substance use. While a number of risk factors within this model have been found to predict substance use, few studies have explored the associations across substances, at different time points and in the same individuals. The aim of this study was to test this model across legal and illegal substance use among adolescents, and to identify potential changes in associations over time. Methods: Data from two waves of a nationally representative cohort study among Swedish adolescents were used. Baseline data were collected in 2017 (9th grade) with a follow-up in 2019 (11th grade). Using modified Poisson regression analyses, we explored cross-sectional associations between factors from different domains and prevalence of cigarette use, binge-drinking and illegal drug use at both baseline and follow-up. Results: The results in part supported the public health model. Substance use was predicted by factors within the family, school and the individual/peer domain, but several associations were not statistically significant. The only consistent risk factors across substances and time points were lack of parental monitoring, truancy and minor criminal activities. Conclusion: Despite widely different prevalence rates across substances, some risk factors were consistently associated with adolescent substance use. Nonetheless, the findings challenge the assumption that risk factors are stable over adolescence. They suggest a need for flexible prevention interventions spanning across substances and legal boundaries of substances, but also over domains to reflect the heterogenous needs of adolescents.

AIMS - The aim of this study is to investigate the medicalising of gambling problems by comparing the political discussions on gambling in the Swedish Parliament in the early 1970s and the early 2010s. DESIGN - Against a theoretical background on medicalising processes in general, and medicalisation of gambling problems in particular, we have analysed discussion protocols and parliamentary bills in the Swedish Parliament from the years 1970-1975 and 2012-2013. RESULTS - The problem descriptions of the 1970s and 2010s are, in certain respects, strikingly similar, identifying proactive operators such as the gambling companies and highlighting an inadequate legal framework. But where the MPs of the 1970s put some effort into describing the drab society which fed the need for gambling, the elected representatives of the 2010s shortcut to individual dependence. CONCLUSIONS - EU membership and the development of the Internet have made effective control and regulation impossible in the early 2010s and the political handling of the Swedish gambling problem is therefore a clear example of how market liberalisation can pave the way for individualisation, medicalisation and depoliticisation of social problems.

AIM – To analyse the Swedish drug question by examining dominant concepts used to portray theproblem in the years 1839–2011. Theoretically, we understand these concepts as ideological toolsthat shape the political initiatives and administrative efforts to deal with the problem. The studyis based on two kinds of source material: articles in medical journals from the years 1839–1964and public reports on vagrancy, the alcohol problem, mental health and the drug problem fromthe years 1882–2011.

FINDINGS – During the nineteenth century and the first part of the twentieth century the drugproblem remained an individual problem handled by doctors. When the Swedish drug problemwas established as a political question from the 1960s on, it also came to disengage itself from themedical frame of understanding. Medically oriented descriptions of “dependence” and “addiction”have appeared adequate or attractive when, for example, the socially motivated coercive treatmentsolution has been discredited (as in the 1970s), when there has been a desire to connect with aninternationally accepted terminology (as in the 1990s) or when a new organisational model with astronger professional support has been on the agenda (as in the 2010s). But otherwise the socialproblem description has called for concepts that have more or less explicitly dissociated themselvesfrom speculations in physiological or psychological predispositions for substance abuse.

Social service and addiction treatment: rehabilitation or harm reduction?

AIM –This paper aims to depict and analyze how professionals in Swedish social services legitimize two ideologically controversial help interventions, methadone maintenance and coercive treatment. Should addiction treatment primarily rehabilitate clients, or should it be a short-term measure for harm reduction? This question has been less and less discussed inSwedenduring the past few years, as it has been accepted that all help should be based on science, not ideology – irrespective of it being aimed at harm reduction or rehabilitation. However, there is a lack of research regarding how crucial players in addiction treatment relate to this development, especially when applied on socially vulnerable clients. MATERIAL & METHOD – The empirical material consists of 33 qualitative interviews with social workers from Stockholm and its surrounding area. The interviews are analyzed through discourse analysis. RESULT – When describing their work, the respondents' discourse assumed and advocated progress in client case management. CONCLUSION – By emphasizing concepts such as lifestyle change, client motivation, psychosocial support and aftercare the social workers could construct the two forms of treatment as less ideologically extreme, but also as undoubtedly aligned with the political goal of rehabilitation. 

Background and aims: Increasingly, efforts to counteract perceived problems in drug treatment at residential rehabilitation centres have come to rely on measures drawing on evidence-based practice (EBP). However, the Swedish media, government inquiries, and international research have identified a number of problems regarding both residential rehabilitation and EBP. This suggests that caution should be exercised when placing expectations on EBP. The aim of this study is to investigate how the responsible authorities have handled increasing demands for EBP with administrative control while facing critical evaluations of their steering and implementation efforts. The study examines the maturation of a widespread treatment ideology, which aims to be based on evidence, in a country known for its restrictive drug policy and its goal of becoming a drug-free society. Methods: Through a qualitative textual analysis of 17 years (2000-2016) of inquiries, directives, and authority archives we have traced the interplay between problem descriptions, intended goals, and implemented solutions. Findings: The analysis shows that the ambition to provide care and welfare based on EBP is still an ambition. Also, the authorities' control over the care actually provided still leaves room for improvement. Recurring criticism and the empirical material indicate that the expectations have not been met. Conclusions: We would like to suggest that continued frustration can be traced to the misconception that EBP is the opposite of values and ideology, and hence preferable. As drug treatment strives for scientific credibility to give it legitimacy, some types of evidence are preferred above others. We would like to suggest that we need to bring ideology to the fore, and openly discuss our restrictive policy goals and choices of evidence.

The Swedish gambling market faces a major change in legislation that will allow foreign-based companies to apply for a gambling licence in Sweden. A key element in the new legislation are consumer protection measures. The Swedish gambling market is currently divided between licensed companies and non-Swedish-based companies providing online gambling services without a licence in Sweden. How these companies view their responsibility for preventing gambling-related harm and how prepared they are for the new regulations are important questions regarding the new Swedish gambling market. Aims: To compare and analyse the views and practices on problem gambling and responsible gambling (RG) measures among licensed and unlicensed gambling companies on the Swedish market. Design/Methods/Data: Eleven semi-structured interviews were carried out with responsible gambling managers who are members of either of the two Swedish industry associations. Content analysis was used to analyse the interviews. Results: Non-licensed companies have implemented behaviour tracking and monitoring of gamblers in a more extensive way than licensed companies. Both the licensed and the unlicensed companies conceptualise problem gambling in a similar manner and rely on informed choice in preventing gamblers from developing problems, seemingly arguing that offering responsible gambling measures on their website is enough. Conclusions: There are several similarities in how the two types of companies define problem gambling and responsible gambling. Both groups lack a critical perspective when discussing RG. There is a need for companies not only to provide RG measures, but to take an active role in preventing harm among gamblers. Future research should focus on exploring how companies work with RG after the legislative change.

The composition, use, policies, and the societal position of cannabis are changing and diversifying internationally. Cannabis has emerged as an object of much controversy and is subject to varying forms of regulation. Its role and regulation are also debated in the Nordic countries. To shed light on such developments, this special issue sets out to explore how the phenomenon of cannabis, and related policies and subjectivities, are currently made, unmade, and transformed in multiple ways through discourses, practices, and materiality, and with different consequences.