Background: There is little systematic research on what adolescents are provided within specialised substance use treatment. This study explored trends in treatment received (number of outpatient treatment visits and inpatient treatment episodes) according to year and age at first contact among adolescents who were enrolled at Sweden’s largest treatment provider, the Maria Ungdom Clinic in Stockholm, between 2011 and 2021. Methods: The data were derived from electronic health records for all patients (n = 29 967) who were in contact with Maria Ungdom Stockholm between 2011 and 2021. Negative binomial regressions estimated the association between year cohort and age at first contact and number of outpatient visits respective number of inpatient episodes. We also tested whether trends according to year cohort and age at first contact were moderated by sex and treatment type. Results: Patients in earlier cohorts and those who were younger at first contact had more outpatient visits. A similar association with age at first contact was observed for inpatient treatment, but was less evident for year cohort. Differences in outpatient visits according to year cohort and age at first contact were mainly observed in patients enrolled in both outpatient and inpatient treatment, and the same held true for differences in number of inpatient episodes according to age at first contact. Regression models that adjusted for potential different exposure time found a higher treatment rate among later cohorts and patients who were older at first contact. Conclusion: Patients in the earlier year cohorts and who were at younger age at first contact with Maria Ungdom received most treatment. However, later cohorts and patients who were at an older age at first contact with Maria Ungdom had a higher treatment rate, suggesting that these groups were provided with a more intensive treatment.

Swedish youth substance use problems are mainly treated at so-called Maria clinics, multidisciplinary units employing both medical and psychosocial staff. Interventions include assessments of substance use and health, urine testing, counselling and education about drug harms. The study analyzes how treatment staff represent youth problems in interviews so that they align with such interventions. We draw on Carol Bacchi’s (2009) post-structuralist “What’s the problem represented to be” (WPR) approach to policy analysis. It assumes that “problems” should be approached analytically as posterior rather than anterior to solutions; that they are calibrated in discourse and practice to fit with certain interventions. This is important since problematizations can ultimately authorize policy targets, determine resource allocation and steer who gets what help. We thus assert that staff discussions about patient groups and working methods include legitimization of why some, but not other, youth substance use problems are considered apt for Maria clinic treatment. Twenty interviews with professionals who work with youth substance use treatment in the Stockholm region were conducted. The results show that the participants primarily evoked patients with demarcated drug problems, who became motivated to treatment, submitted to adult monitoring and learned to care for their health and everyday routines. Three examples of other youth problems that were represented as less aligned with this treatment are also illustrated; adolescents with severe comorbidity, criminal identities and irrelevant support needs. The analysis highlights how the Maria clinic treatment appeared to be geared towards adolescents who can be effectively treated, responsibilized and deterred from substance use. We discuss whether adolescents who were considered less relevant for this treatment, namely those described as particularly unhealthy, rebellious or chaotic, are more adequate targets of intervention than the occasional cannabis users who receive a lot of attention in Swedish policy and practice.

Background  The evidence is mixed regarding how socioeconomic status (SES) it is related to cannabis use among adolescents. This study assessed the association between parental SES, measured as the highest level of completed education, and past 12 month cannabis use in older adolescents.Method  Self-reported survey data from the first and second wave of a nationwide cohort study (Futura01) were used (n = 3328). Register information on parental education was linked to the survey data. Two measures of cannabis use were considered: any use during the past 12 months, and use 10 + times during the past 12 months. Control variables included demographics, family and school variables, conduct and emotional problems, and cannabis use at baseline. Multilevel Poisson regression was used to assess the associations.Results  Adolescents having parents with low SES had a lower risk for any cannabis use during the past 12 months, ranging from RR = 0.71 (95% CI = 0.49–1.01) in the unadjusted model to RR = 0.61 (95% CI = 0.42–0.87) in the most adjusted model compared to adolescents with parents having high SES. Compared to those with parents with high SES, those with parents with intermediate SES had lower risk for any cannabis use past 12 months, with RRs ranging from 0.79 (95% CI = 0.59–1.07) in the unadjusted model to RR = 0.71 (95% CI = 0.53–0.95) in the fully adjusted model. For use 10 + times, non-significant associations were observed.Conclusion  Adolescents with parents with lower SES had a lower risk of any past 12 months cannabis use. For more frequent use, no statistically significant associations were observed.

Aims: Craving is commonly described as an ‘intense desire’ to use drugs. Due to its relevance for addiction theories and treatment, much effort has been put into understanding how and when craving occurs. An undisputed definition of craving is however still lacking. The aim of this article is to explore how craving is experienced and resisted after cessation of substance use.Methods: This article analyses interviews with former addiction treatment clients. By analyzing the described event of craving, the study shows the complexities in such narratives.Findings: We found that the interaction between temporal, relational and material forces move people toward or away from craving. Craving thus seemed to be both relational and located in-between forces.Conclusions: We conclude that craving appeared in the studied narratives to emanate from different atmospheres, with a concurrent focus on settings rather than on substances. A relational understanding of craving can add to the typical, but limited, account of craving as an individual issue. It also avoids stigmatizing ideas that people who do not resist cravings simply fail to say no. We end by asking if craving is a relevant concept within the addiction field at all.

IntroductionConduct problems (CP) predict cannabis use prospectively but the research is mixed as to whether this association is stronger among girls. A stronger association among girls would suggest a ‘gender paradox’ as both CP and cannabis use is less common in this group. This study aimed to assess whether the longitudinal association between CP and cannabis use in Swedish adolescents is stronger among girls.MethodsData from two waves of a nationally representative cohort study of Swedish adolescents born in 2001 were used. Baseline measurements were collected in 9th grade (at age 15–16) and follow-up measures at 11th grade (at age 17–18).ResultsCP at baseline were significantly associated with cannabis use at follow-up adjusted for hyperactivity problems, emotional problems, socio-demographics, parental monitoring, school grades and truancy at baseline (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06–1.24) but not when also adjusting for substance use at baseline. Boys were more likely to have used cannabis during the past year, even when controlling for prior substance use (OR 2.29, 95% CI 1.76–2.98). The association between CP and cannabis use was significantly weaker for boys (OR 0.83, 95% CI 0.72–0.95 in the fully adjusted model). The predicted probability of cannabis use was stable at 0.13 for boys across levels of CP, but ranged from 0.05 to 0.16 for girls.Discussion and ConclusionThe longitudinal association between CP and cannabis use was stronger among girls. The findings are indicative of a ‘gender paradox’ in the association between CP and cannabis use.