Nordic Studies on Alcohol and Drugs最新文献

Background: Denmark and Sweden have similar welfare systems, but different drug policies. Denmark has historically a more liberal and more harm reduction-oriented drug policy than Sweden. On this background, we present a study of risks and use of formal and informal resources among structurally vulnerable people who use drugs in Copenhagen in Denmark and Malmö in Sweden.

Methods: The study reports from research projects in each city that investigated the everyday lives and risks- and enabling environments of structurally vulnerable people who use drugs. Both projects involved the same survey. Participants were recruited at treatment and low-threshold services in Copenhagen (n = 243) and Malmö (n = 231).

Results: The participants in the two cities used many different resources provided by the welfare system, but participants from Copenhagen made more use of available harm reduction services. The participants from Malmö used drugs in more risky settings and relied more on other people who use drugs for resources and had more concerns regarding overdoses and other drug-related harms and about being arrested by the police.

Conclusions: In both cities, the Nordic welfare state plays a large role in providing resources, but drug policy can influence access to harm reduction resources and the experience of criminalization. These differences can play a role in shaping the local risk environments, although the patterns identified should be interpreted with caution given the exploratory nature of the study. More comparative research is needed to explore how drug policy shape risk environments.

Aims: Social, structural and systemic factors are critical to understanding drug-related deaths among adults. The relevance of these factors to young people is not known. This study explores the life experience, drug using histories and the interactions of a group of young people with agencies and services prior to their death. Our approach seeks to look beyond the immediate cause of death and identify broader contextual factors that may have contributed to a death through a "whole-life view".

Methods: The study developed a socio-ecological autopsy approach informed by social autopsy methods and social ecology and risk environment frameworks. Health, social work, police and post-mortem records of the young people were collated and analysed. Summary narratives, chronologies and descriptive statistics were produced using Excel and NVivo.

Findings: Twenty-one deaths were identified; almost all were due to multi-drug toxicity, mainly heroin mixed with other substances. Almost all the young people had reported mental health issues such as anxiety, depression and self-harm, and had experinced at least one recorded overdose before they died. Most grew up in precarity and poverty in deprived areas. In their short lives, most of this cohort of young people experienced multiple adversities in childhood and as young adults, particularly in the year preceding their death.

Conclusions: Complex and fragmented services struggled to respond holistically to early signs of difficulties and to the young people's cumulative experience of trauma and adversity, mental ill-health and drug-related harms in the context of prohibition. There is a need for a radical rethink of systems to enable integrated youth-centred approaches that meet the needs of those at risk of drug-related deaths and to address the broader social and structural contexts of drug deaths.

Aim: To explore the influence of gender and time in addiction recovery on engagement in meaningful activities and the reduction of harmful behaviours among the recovery population in Sweden. Methods: Participants were recruited through social media, recovery and treatment services, and snowballing, resulting in a sample of 110 individuals who consider themselves in addiction recovery for more than 3 months. Bivariate analyses were used to explore gender differences in relation to personal characteristics and current utilization of recovery support. The relationship with time in recovery was examined for three recovery stages (early (5 years)) in relation to meaningful engagement and detrimental activities. The Strengths and Barriers Recovery Scale (SABRS) was used to calculate changes in recovery-related well being. Specifically, we assessed the overall difference between reported strengths and barriers - referred to as the "SABRS change score" - and compared these by gender and stage of recovery. Results: The data indicate variations in recovery experiences across genders and stages of recovery, with women reporting more strengths in recovery and a greater change in recovery strengths from active addiction to recovery. The findings affirm the progressive character of recovery, illustrating how prolonged periods in recovery correlate with decreased negative activities (barriers) and increased meaningful activities (recovery strengths). Conclusions: These findings provide significant insights into recovery pathways in Sweden. As well as providing empirical support for defining addiction recovery as a process over time that is associated with enhanced well being and increased (community) engagement and citizenship, recovery support services that sustain recovery in the long-term will result in reduced harmful behaviours and increases in meaningful activities.

Background: Treatment satisfaction is an important indicator of patients' perceptions of opioid agonist treatment (OAT) for opioid dependence. In addition, treatment satisfaction may have implications for treatment outcomes. The present study aimed to explore treatment satisfaction among OAT patients one year after enrollment, as well as the role of different psychosocial and treatment characteristics in treatment satisfaction. Methods: The study was based on data from the NorComt project (2012-2016), which used a multicenter cohort design with structured questionnaire-based interviews. The sample consisted of 175 OAT patients in Norway who rated their treatment satisfaction (high, mixed, low) one year after enrollment in a new treatment episode in OAT. Treatment satisfaction (high versus mixed or low) was used as a dependent variable in logistic regression models, with demographic characteristics, well-being, substance use, and treatment characteristics as independent variables. Results: Overall, 54.9% of the participants reported high satisfaction with OAT one year after enrollment, while 25.7% reported mixed satisfaction and 19.4% low satisfaction. Of the 175 participants who reported on treatment satisfaction, 161 remained in treatment at follow-up. Reporting an active occupational status and an individual treatment plan in OAT was associated with increased odds for reporting treatment satisfaction, while reporting ongoing substance use was associated with decreased odds for reporting treatment satisfaction. Conclusions: Psychosocial, situational factors, as well as coordinated, integrated support, may play a role in OAT patients' treatment satisfaction. To identify facilitators and barriers in OAT, it is vital to address relevant needs and goals for treatment from the perspectives of patients.

Aim: Control policies in the fields of alcohol and gambling show similarities across Nordic countries. The so-called Nordic model has consisted of strong state intervention and, in many cases, monopolistic provision. However, internal and external pressures pose challenges to the model. This article provides a comparative review of current policies on alcohol and gambling in the Nordic region. Methods: We analyse framings, implementation and outcomes of current alcohol and gambling policies in Denmark, Finland, Iceland, Norway and Sweden. We produce a review of legal documents and grey literature. We also analyse on-going and recent policy changes (2021-2024). Our focus is on policies related to World Health Organisation's evidence-based "best buys": physical availability, taxation and marketing. While these best buys are designed for alcohol, we also apply these to gambling. Results: Control policies in the region take place on a spectrum from more restrictive to more market-oriented. Overall, alcohol policy is more restrictive than gambling policy. In comparison with gambling policy, alcohol policy was characterised by a stricter public health framing and consistent implementation based on the best buys. In terms of policy outcomes, more stringent alcohol regulations translated, to some extent, to lower consumption and prevalence, but not systematically. Recent policy developments suggest that alcohol policy may be heading towards increased de-regulation, whereas gambling policies are becoming stricter. Conclusions: The Nordic model continues to be visible particularly in alcohol control. However, the model is challenged by politics. To persist, the Nordic model needs political will and increased cross-country and cross-sectoral collaboration.

Aim: The study aimed to describe the workplace interventions for registered nurses (RNs) with substance use disorder (SUD) related violations leading to disciplinary actions. Methods: A retrospective document analysis of disciplinary decisions related to RNs with SUD (N = 171) from a Finnish regulatory authority. The data were analyzed using descriptive statistics and qualitative methods. Results: Substance abuse at the workplace involved intervention actions by a nurse leader and employer with work ability assessment and measures, legislation-based measures for hearing the worker, investigation and handling. Substance abuse services and occupational health services were involved in more than half of incidents. In most of the cases, the RN's contract terminated. Conclusions: Further research about the interventions and supervision of healthcare workers with SUD could help clarify protocols and develop measures for the early detection at work places.

Aim: This paper explores how gender, risk, responsibility and shame feature in young people's (aged 18-20 years) stories about alcohol consumption with peers in Iceland. Methods: The data consist of 73 stories generated through the story completion method. The participants were presented with a story stem and invited to complete it. The stories were analysed using reflexive thematic analysis. The stories were selected to provide insights into the affect underpinning gendered bodies and certain cultural scenarios. Results: Alcohol consumption was presented not only as fun, but also as a way to calm nerves around expressing sexuality. Anxieties and regrets about alcohol consumption were gendered. Young female characters were shamed for drinking too much and portrayed as more at risk of coming to harm because of sexual violence. However, there were no signs of slut-shaming. To deal with the risks, they took measures such as being accompanied by a responsible sober friend. Parents were conspicuous by their absence, and adults rarely featured in the stories. Conclusions: The research provides insights into how young people's relations with alcohol are mediated by gender. The risks the participants identified in their fictional accounts should be considered in policies and pedagogical attempts to reduce harmful alcohol consumption practices. Schools should play a greater role in increasing young people's knowledge and understanding of alcohol and drug use and the social, behavioural, emotional and moral aspects associated with it.