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Patrik KarlssonProfessor

Forskning

Alkohol- och narkotikaanvändning bland ungdomar och vuxna samt olika insatser inom dessa områden, evidensbaserad praktik.

Forskningsprojekt

FUSS

Framtidens sociala arbete med substansbruk (FUSS): klienter, vårdvägar, organisation och samverkan i ett föränderligt vårdsystem.

Publikationer

I urval från Stockholms universitets publikationsdatabas

  • Academic orientation and alcohol-related harm among adolescents

    2024. Siri Thor (et al.). BMC Public Health 24 (1)

    Artikel

    Background

    This study aimed to examine the social gradient in self-reported alcohol-related harm (ARH) among young alcohol consumers by including a largely overlooked group of adolescents. We also explored the extent to which such a gradient could be attributed to differential exposure or differential vulnerability to risk factors.

    Method

    Cross-sectional survey of upper-secondary students (n = 2996) in Sweden. Negative binomial regressions estimated the relationship between academic orientation (higher education preparatory; HEP, vocational; VP and introductory; IP) and ARH. To assess the contribution of explanatory factors, we estimated models that included risk factors such as heavy episodic drinking (HED).

    Results

    A graded association was observed between academic orientation and ARH, with more ARH among students in IP (IRR = 1.79) and VP (IRR = 1.43) than in HEP. Adjustments for risk factors attenuated the estimates by approximately half, but there was still 14% more ARH in VP and 50% more in IP than in HEP. The additive interaction test indicated a positive and significant interaction for students in VP who engaged in HED, versus students in HEP, who did not.

    Conclusion

    The findings suggest a negative gradient in the association between academic orientation and ARH, where the students in IP experienced the highest levels of ARH. While differential exposure and vulnerability to HED account for a significant proportion of the excess risk among VP students, HED seems to be less important relative to other risk factors among IP students. More research is needed to identify the mechanisms underlying the elevated levels of ARH among the most disadvantaged group—students enrolled in IP.

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  • Trajectories of NEET in individuals formerly placed in out‐of‐home care: A Swedish national cohort study

    2024. Lars Brännström (et al.). International Journal of Social Welfare

    Artikel

    It is widely acknowledged that individuals with out-of-home care (OHC) experiences, including foster-family care and residential care, face an increased risk of poor labour market attachment during emerging adulthood. However, limited understanding exists regarding how this attachment, conceptualized here as ‘not in employment, education, or training’ (NEET), evolves beyond young adulthood and the degree to which this development is marked by persistence or desistance. Using group-based trajectory modelling and multinomial regression on population-based register data for over 650,000 Swedish men and women (including approximately 14,000 with OHC experience), followed from birth to age 40, the results indicate that OHC-experienced individuals, especially those first placed as teenagers, exhibit a substantially higher risk of persistent NEET compared to peers without OHC experience. Nevertheless, the majority of OHC-experienced individuals followed pathways characterized by desistance. Implications for research, policy and practice are discussed.

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  • Age of Onset and DSM-5 Alcohol Use Disorder in Late Adolescence – A Cohort Study From Sweden

    2024. Jonas Raninen (et al.). Journal of Adolescent Health

    Artikel

    Purpose

    To examine if the prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alcohol use disorder (AUD) differs between two groups with different age of onset of alcohol use and if endorsement of different AUD criteria differs between the two groups.

    Methods

    A two-wave longitudinal prospective cohort survey conducted in Sweden (2017–2019) with a nationwide sample of 3,999 adolescents aged 15/16 years at baseline (T1), and 17/18 years at follow-up (T2); 2,778 current drinkers at T2 were analysed. Participants were categorized into early onset of drinking (drinking already at T1 54.3%) or late onset (not drinking at T1 but at T2, 45.8%). AUD was measured with questions corresponding to the 11 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for AUD. Potential confounding factors measured at T1 were sex, sensation-seeking, impulsivity, emotional symptoms, peer problems, conduct problems, and hyperactivity.

    Results

    The early onset group had a higher prevalence of AUD at T2 compared to the late onset group (36.3% vs. 23.1%, p < .001). The higher risk of AUD remained significant in a linear probability model with control for additional confounding factors (β = 0.080, p < .001). All individual criteria were reported more in the early onset group, and there was no evidence of differential item functioning.

    Discussion

    The age of onset of alcohol use was a significant predictor of AUD in late adolescence among Swedish adolescents. Those with an earlier onset of alcohol use had a higher prevalence of AUD and of all individual criteria. The items in the scale were similarly predictive of AUD in both groups.

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  • Academic orientation and cannabis use—findings from a population-based study of Swedish adolescents in upper secondary school

    2024. Isabella Gripe (et al.). European Journal of Public Health

    Artikel

    Aim

    To examine the association between academic orientation and frequent cannabis use among Swedish adolescents in upper secondary school and include pupils from introductory programs (IPs), a large group of adolescents previously overlooked in research on adolescent cannabis use.

    Methods

    We used cross-sectional data from two anonymous school surveys carried out in upper secondary school in 2021. The samples consisted of pupils from all academic orientations, and the analysis included 3151 pupils in higher education preparatory programs (HEPs), 1010 pupils in vocational programs (VPs), and 819 pupils in IPs. The association between the exposure academic orientation and the outcome frequent (21+ times) cannabis was analyzed using multi-level mixed-effects Poisson regression.

    Results

    Estimates from the first model showed a significant (P < 0.05) 2.45 times higher risk of frequent cannabis use among pupils in IPs compared with in HEPs [incidence rate ratio (IRR) 2.45, 95% confidence interval (CI) 1.28–4.66] and 82% higher in VPs (IRR 1.82, 95% CI 1.09–3.04) compared with in HEPs. However, the associations between academic orientation and frequent (21+ times) cannabis use were attenuated and no longer significant when socioeconomic status, truancy, school dissatisfaction, and early onset of substance use were adjusted for.

    Conclusions

    There was a higher risk of frequent (21+ times) cannabis use among pupils in IPs, and this differential was explained by higher exposure to risk factors in this group. This result is important from a policy perspective as it provides knowledge of a previously neglected risk group for frequent cannabis use.

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  • Urine Samples and Drug-Body-Treatment Assemblages: Youth Enactments of Drug Testing in Sweden

    2024. Mats Ekendahl, Petra Kvarmans, Patrik Karlsson. Contemporary Drug Problems

    Artikel

    Drug testing plays a key role in youth substance use treatment in Sweden. Young people treated for substance use problems are routinely required to leave urine samples, and there is often controversy between patients and staff around its relevance. Still, there is a lack of research on how young people make sense of this practice. This article contributes to this knowledge through an ANT-inspired (Actor Network Theory) analysis of how youth enact urine testing in their treatment experiences. We attempt to tease out what kind of sociomaterial object urine testing is according to youth, and how it affects their lives. The study is based on interviews with 25 previous patients (mean age 17). The analysis shows that the participants enacted urine testing as both a stable object that creates binaries in knowledge networks (use or nonuse), and as a flickering object that appears in and affects diverse drug-body-treatment assemblages (even outside the clinic). The participants had internalized the importance of leaving negative samples to get discharged and avoid adult surveillance. They described a practice that made substance use a demarcated, individual and treatable problem, and also, often contrary to their own self-understandings, devalued their ability to be honest about and regulate their conduct. Through establishing substance use as a simplified either/or phenomenon and through attributing patients with the agency to become nonusers only, urine testing appears counter-productive if treatment is to strengthen informed decision making and responsibility among soon to be adults.

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  • Polyphonic narratives: The mixing of Alcoholics Anonymous and relapse prevention in stories about recovery and relapse

    2024. Karin Heimdahl Vepsä (et al.). Nordic Studies on Alcohol and Drugs

    Artikel

    Aim:  This exploratory study analyses the interplay between the treatment philosophies of Alcoholics Anonymous (AA) and Relapse Prevention (RP) in personal stories of addiction. While the basic ideas of AA and RP are compatible in many ways, they also carry some fundamental differences.

    Methods: The data consisted of interviews with 12 individuals recovering from substance use problems, who had experience of both AA and RP. The analysis drew on a dialogical narrative perspective, and the concept polyphony was used to shed light on the interplay between different treatment philosophies in personal stories of relapse.

    Findings: Although sometimes resulting in incoherence, the treatment philosophies were combined idiosyncratically, in ways that appeared productive for the participants’ self-images and recovery journeys.

    Conclusion: The combination of AA and RP philosophies in narratives of relapse and recovery may reflect a new treatment discourse where individualisation and responsibilisation stand in a complicated relationship with collectivism and surrendering to so-called addicting processes.

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  • Different measures of alcohol use as predictors of DSM-5 alcohol use disorder among adolescents – A cohort study from Sweden

    2024. Jonas Raninen (et al.). Drug And Alcohol Dependence, 111265-111265

    Artikel

    Background and aims

    This study addresses a significant gap in existing research by investigating the longitudinal relationship between various measures of alcohol use and the development of alcohol use disorders (AUDs) in a cohort of Swedish adolescents.

    Methods

    A prospective longitudinal survey was conducted on 3,999 adolescents in Sweden who were in 9th grade in 2017 and were followed up in 2019. Baseline assessments included lifetime alcohol use, recent use (past 30 days), risky drinking (AUDIT-C), and heavy episodic drinking (HED). Follow-up assessments comprised eleven items measuring DSM-5 AUD criteria. The study explores prospective associations between these diverse alcohol use measures and the occurrence of AUD, while also calculating population attributable fractions (PAF).

    Findings

    The proportion of drinkers who met the criteria for AUD at follow-up was 31.8%. All baseline measures of alcohol use exhibited associations with subsequent AUD. Notably, the HED group demonstrated the highest prevalence of AUD at 51.4% (p<.001). However, when calculating PAFs, any lifetime alcohol use emerged as the most substantial contributor, accounting for 10.8% of all subsequent AUD cases.

    Conclusions

    This study underscores that alcohol use during mid-adolescence heightens the risk of developing AUD in late adolescence. Among the various measures, heavy episodic drinking presents the highest risk for later AUD. From a public health perspective, preventing any alcohol use emerges as the most effective strategy to mitigate the population-level burden of AUD.

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  • How well do DSM-5 criteria measure alcohol use disorder in the general population of older Swedish adolescents? An item response theory analysis

    2024. Patrik Karlsson (et al.). Addictive Behaviours, 108007-108007

    Artikel

    Background

    This study assesses the psychometric properties of DSM-5 criteria of AUD in older Swedish adolescents using item response theory models, focusing specifically on the precision of the scale at the cut-offs for mild, moderate, and severe AUD.

    Methods

    Data from the second wave of Futura01 was used. Futura01 is a nationally representative cohort study of Swedish people born 2001 and data for the second wave was collected when participants were 17/18 years old. This study included only participants who had consumed alcohol during the past 12 months (n = 2648). AUD was measured with 11 binary items. A 2-parameter logistic item response theory model (2PL) estimated the items’ difficulty and discrimination parameters.

    Results

    31.8% of the participants met criteria for AUD. Among these, 75.6% had mild AUD, 18.3% had moderate, and 6.1% had severe AUD. A unidimensional AUD model had a good fit and 2PL models showed that the scale measured AUD over all three cut-offs for AUD severity. Although discrimination parameters ranged from moderate (1.24) to very high (2.38), the more commonly endorsed items discriminated less well than the more difficult items, as also reflected in less precision of the estimates at lower levels of AUD severity. The diagnostic uncertainty was pronounced at the cut-off for mild AUD.

    Conclusion

    DSM-5 criteria measure AUD with better precision at higher levels of AUD severity than at lower levels. As most older adolescents who fulfil an AUD diagnosis are in the mild category, notable uncertainties are involved when an AUD diagnosis is set in this group.

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  • Is there a gender paradox in the association between conduct problems and cannabis use? A cohort-study among Swedish adolescents

    Patrik Karlsson, Mats Ekendahl, Jonas Raninen. Drug and Alcohol Review

    Artikel

    Introduction

    Conduct 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.

    Methods

    Data 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).

    Results

    CP 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 Conclusion

    The 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.

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  • Media constructions of an illegal drug: the link between cannabis and organized crime in Swedish newspapers

    2023. Mats Ekendahl, Josefin Månsson, Patrik Karlsson. Drugs, 1-10

    Artikel

    Background

    Lately, there has been massive media coverage of gang-related criminality in ‘exposed areas’ in Sweden. Politicians have blamed the illegal drugs trade without questioning the country’s prohibitionist drug policy. This study analyzes how cannabis is constructed in Swedish newspaper articles that mention both organized crime and cannabis. We ask how the drug and its buyers and sellers are described, what discourses are drawn upon, and discuss the relationship between media coverage and drug policy.

    Methods

    We analyzed recent (2021) articles from four newspapers (n = 71) through Critical Discourse Analysis.

    Results

    Cannabis was constructed as a commodity linked to violence and deviance. Agency was attributed to people with power and status (e.g. gang leaders), and recreational cannabis users were described as guilty of feeding organized crime. A combination of economic and moral discourses was used to make the reported events meaningful, and to motivate both prohibition and decriminalization/legalization.

    Conclusion

    The study shows that assumedly neutral journalistic voices emphasized the link between cannabis and violence and problematized cannabis buyers and sellers. This homogenous media coverage will probably contribute to keep the question of cannabis law reform discursively lifeless in Sweden.

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  • Stability and Change in Substance Use Among Swedish Adolescents: A Latent Transition Analysis

    2023. Nicklas Dennermalm, Patrik Karlsson, Mats Ekendahl. Substance Use & Misuse, 1-9

    Artikel

    Background: Research is needed on how substance use patterns develop over time in the general adolescent population. This knowledge is crucial in calibrating prevention and other interventions. Method: The study concerns use of cigarettes, alcohol, and cannabis in a nationally representative cohort of Swedish adolescents (n = 3999). Two waves (9th and 11th school grade) from the Futura01 study were analyzed using latent transition analysis (LTA) and multinomial regression analysis. Results: Four substance use patterns, were identified, ranging from Non-user, Alcohol experienced, Alcohol User to Co-user of cigarettes, alcohol, and cannabis. Statuses thus conveyed a continuum from no use to more advanced use. Half of the individuals remained in their original status between time-points, and half transitioned, most often one step on the continuum. Alcohol user was the most stable status over time (0.78), and the Non-user status the least (0.36). The probability of remaining in the Alcohol experienced status was 0.57, and 0.45 for the Co-user status. There was a low probability of transitioning from alcohol to cannabis use. Females were more likely to belong to Alcohol experienced and males to Co-user statuses, but these associations weakened over time. Conclusions: The study identified transitions across substance use statuses between time-points. These usually concerned different levels of alcohol use, and not into more advanced substance use that included the illegal substance cannabis. The study corroborates that young Swedes belong to a “sober” generation and usually do not transition from legal into illegal substance use during late adolescence, though with some gender differences.

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  • Psychosocial correlates of drinking transitions: A longitudinal study among adolescents in Sweden

    2023. Lars Sjödin, Patrik Karlsson, Jonas Raninen. Drug and Alcohol Review

    Artikel

    Introduction

    Non-drinkers have been shown in older studies to have poorer mental health and social life compared to their alcohol-using counterparts. Given the profound decline in adolescent drinking observed in most high-income countries, this pattern may have changed. This study explores drinking transitions and examines psychosocial factors among adolescents by longitudinal drinking status.

    Methods

    Data were based on two waves of a prospective longitudinal nationwide study (n = 4018). The first wave (T1) of data was collected in 2017 (age 15/16) and the second wave (T2) was in 2019 (age 17/18). Respondents were asked about their past year drinking status, general health, psychosomatic problems, psychiatric medication, school enjoyment, emotional symptoms, peer relationship problems, prosocial ability, friendships satisfaction and satisfaction with relation to mother/father. Comparisons by mean values were assessed and multinomial logistic regressions were used to examine associations.

    Results

    Abstainers and later drinkers differed significantly from early drinkers on 9/10 factors respectively at T1. Fewer psychosomatic problems, less psychiatric medication, higher school enjoyment, more emotional symptoms, higher parental relationship satisfaction, more peer problems and lower friendships satisfaction at T1 were associated with abstaining and/or later drinking. All factors were more strongly associated with abstaining. School enjoyment predicted abstaining but not later drinking.

    Discussion and Conclusions

    Longitudinal drinking status relates to small to moderate systematic psychosocial differences. Adolescents with better mental health, more content relationships with parents and lower friendships satisfaction are more often abstainers. Those generally worse off are more likely early drinkers but they also have better friendships.

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  • Exploring the Link between ADHD and Cannabis Use in Swedish Ninth Graders: The Role of Conduct Problems and Sensation-Seeking

    2023. Patrik Karlsson, Mats Ekendahl, Jonas Raninen. Substance Use & Misuse, 1-9

    Artikel

    Background: Attention deficit hyperactivity disorder (ADHD) has in several studies been linked to substance use, including cannabis use. However, crucial gaps remain regarding how to understand this association. Analyzing the association between ADHD and substance use is complicated because of a pronounced overlap between ADHD, conduct problems, and traits such as sensation-seeking. Objectives: Using data from a large and nationally representative study among Swedish adolescents, this study explored the role of conduct problems, but also of sensation-seeking, in accounting for the association between ADHD and cannabis use. Results: There was a notable association between ADHD and cannabis use that was attenuated when conduct problems were controlled for. The association between cannabis use and conduct problems, in turn, was attenuated when sensation-seeking was controlled for. Individuals with both ADHD and conduct problems were more likely to have used cannabis than individuals with ADHD only, but not compared with individuals with conduct problems only. Conclusions: Whereas conduct problems largely explain the link between ADHD and cannabis use, sensation-seeking seems to account for the association between conduct problems and cannabis use.

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  • Atmospheres of craving: a relational understanding of the desire to use drugs

    2022. Josefin Månsson (et al.). Drugs, 1-9

    Artikel

    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.

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  • Evidence and evidence gaps in assessments and interventions in areas related to social work research and practice – an overview of four evidence maps

    2022. Christel Hellberg (et al.). European Journal of Social Work, 1-14

    Artikel

    This overview of four evidence maps is based on systematic reviews of assessment and interventions in social work practice. The aim was to investigate the evidence and evidence gaps within four important areas for social work research and practice. Descriptive data on search strategies and domains were collected from four evidence maps, on Social Assistance, Substance Dependence, Care for older adults respectively for persons with disabilities. The scientific quality and scientific evidence were assessed. Key findings were summarised by analyzing and discussing common and specific elements in the evidence maps. The overview was undertaken in close collaboration between researchers with expertise in the field and a government agency. The overview identified both evidence and evidence gaps with respect to effects and experiences of interventions and assessment methods in four evidence maps. Evidence maps provide a comprehensive picture of the state of social services research and can thereby be of use to both researchers and practitioners, and in the production of evidence based social work.

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  • Risk factors for substance use in Swedish adolescents: A study across substances and time points

    2022. Nicklas Dennermalm, Patrik Karlsson, Mats Ekendahl. Nordic Studies on Alcohol and Drugs

    Artikel

    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.

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  • Self‐interpellation in narratives about craving: Multiple and unitary selves

    2022. Mats Ekendahl (et al.). Sociology of Health and Illness 44 (9), 1391-1407

    Artikel

    The concept of addiction seeks to explain why people actcontrary to their own best interest. At the centre stageof addiction discourse is craving, conceptualised as astrong urge to use substances. This article analyses howtalk therapies such as relapse prevention and self-helpgroups shape identity constructions and understandingsof craving among clients. Drawing upon interviewswith individuals who have engaged in talk therapies inSweden, we analyse how craving is made up through‘self-interpellation’, that is, personal narratives aboutpast, present or future thoughts, feelings and actions.The main ‘self-interpellation’ included multiple selves,where craving was elided by the true self and only feltby the inauthentic self. Less dominant were narrativeswhich drew on a unitary self that remained stable overtime and had to fight craving. The notion of multipleselves appeared as a master narrative that the participantswere positioned by in their identity constructions.We conclude that this multiplicity seems ontologicallydemanding for people who try to recover from substanceuse problems. A demystification of craving, in whichneither substance effects nor malfunctioning brains areblamed for seemingly irrational thoughts and actions, may reduce the stigmatisation of those who have developedhabitual substance use.

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  • The factor structure of the Strength and Difficulties Questionnaire in a national sample of Swedish adolescents: Comparing 3 and 5-factor models

    2022. Patrik Karlsson (et al.). PLOS ONE 17 (3), e0265481-e0265481

    Artikel

    The Strength and Difficulties Questionnaire (SDQ) is one of the most common screening instruments for emotional and behavioral problems in children and adolescents. Although exploratory factor analyses support the originally proposed 5-factor structure of SDQ as well as a 3-factor model, the evidence from confirmatory factor analyses is more mixed. Some of the difficulties items in SDQ are positively worded and it has been proposed that this leads to method effects, i.e. these items share variance that is due to the method used rather than to a substantive construct. Also, there seems to be minor factors in some subscales. This study tests a series of 3- and 5- factor models pertaining to the factor structure of SDQ, also considering method effects and minor factors. The sample consists of a nationally representative cohort of Swedish adolescents born in 2001 (n = 5549). Results show a relatively better fit of the 5-factor model compared with the 3-factor model although neither of these had a satisfactory fit. Model fit was improved when specifying cross-loadings of the positively worded difficulties items on the prosocial scale as well as minor factors on the hyperactivity scale. Although no model provided a completely satisfactory fit to the data, the results show that the 5-factor model performs better than the 3-factor model and has an acceptable fit. We conclude that for the purposes of epidemiological research, SDQ has acceptable factorial validity, provided that researchers consider method effects and minor factors.

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  • A matter of craving–An archeology of relapse prevention in Swedish addiction treatment

    2022. Mats Ekendahl, Patrik Karlsson. International journal of drug policy

    Artikel

    This article concerns how craving is approached and handled, how it is ‘made up’, in the practice of so-called relapse prevention (RP) for addiction problems. There is a lack of research on what RP in general, and craving in particular, ‘is’ and can become across settings. Drawing upon science and technology studies (STS) and critical addiction research, we analyze how craving is enacted in manuals and training material related to the intervention, and in interviews with professionals in the Swedish treatment system. Adopting an archeological approach, we scrutinize different layers of craving enactments in RP, in search of assumptions that give rise to what John Law refers to as ‘collateral realities’. We identified three collateral realities: 1) ‘The materialization of craving’; 2) ‘The transcendence of the individual’ and 3) ‘The merging of treatment and everyday life’ The data show that the brain, cognition, emotions and behavior are enacted in RP as demarcated targets of intervention that the individual can transcend and control. This approach, in turn, relies on the more foundational tenet that there are no clear-cut boundaries between different identities (I/me/self; body/brain/cognition), between different settings (inside/outside treatment; real/imagined situations) or between different points in time (now/then/before). We discuss the relevance and usefulness of addiction treatment realities where craving is approached as a stable object that can be effectively treated, and where interventions inaugurate neoliberal governance of responsibilized individuals.

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  • Normalization of Non-Drinking? Health, School Situation and Social Relations among Swedish Ninth Graders That Drink and Do Not Drink Alcohol

    2021. Jonas Raninen (et al.). International Journal of Environmental Research and Public Health 18 (21), 11201-11201

    Artikel

    Alcohol consumption is a major contributor to the disease burden among adolescents. The adolescent alcohol abstainer is still often depicted as problematic in the research literature and in prominent theoretical frameworks. However, over the past two decades, there has been a marked trend of declining youth drinking in Sweden. The declining trend has led to a shift in the majority behaviour of youth, from drinking to non-drinking. It is plausible that this trend has also shifted the position of non-drinkers. This paper examines the position of non-drinkers in a nationally representative sample of Swedish adolescents. A survey was carried out in 2017 in 500 randomly selected schools. A total of 5549 respondents (15–16-year-olds) agreed to participate and answered the questionnaire. A minority (42.8%) had consumed alcohol during their lifetime. The results show that non-drinkers had better health and school performance when compared to drinkers. The results also showed that there were no differences in the social position between non-drinkers and drinkers. These findings are new and indicate a changed position of non-drinkers among Swedish adolescents. With non-drinking being the majority behaviour among Swedish adolescents this seems to have shifted the position of non-drinkers. There is a need for research on the long-term importance of not drinking during adolescence.

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  • Fixed and fluid at the same time

    2021. Mats Ekendahl, Patrik Karlsson. Critical Public Health, 1-11

    Artikel

    This article explores how professionals within Swedish addiction treatment (n = 18) describe and make sense of relapse prevention (RP). RP is known as a self-control programme for maintaining behavioural change, helping people deal with high-risk situations. However, since self-control techniques have been incorporated widely in the addiction treatment field, the specificities of RP have become vague. To grasp what RP ‘is’, we draw on John Law’s and Annemarie Mol’s thoughts on how logics enact objects and realities. We thus follow critical scholarship in Science and Technology Studies and view treatment as a local knowledge-making practice that may depart from how it was originally designed. A key question is how RP is potentially transformed and made-to-matter when moved from the controlled settings of theorising and experimental studies to practice. The professionals used a logic of fixity to make RP stable, structured and evidence-based, easily distinguishable from other interventions. They also used a logic of fluidity to explain how and why they tinkered with it and adapted it to the preferences of both staff and attendees. The two logics enacted two different realities of addiction treatment: one in which RP is standardised, temporally demarcated and can solve most addiction problems, and another where interventions must be individualised, continuous and adapted to local settings and needs. It did not appear contradictory to ‘make up’ RP as both fixed and fluid; the two realities exist side by side, but with different material effects.

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  • Associations between trust and drinking among adolescents

    Lars Sjödin (et al.). Drug and Alcohol Review

    Artikel

    Introduction

    Trust is closely linked with health, but previous research on its association with alcohol use has yielded mixed findings. The aim of this study is to examine: (i) how two different dimensions of trust (general/institutional) are associated with alcohol use among adolescents; (ii) how these dimensions interact with alcohol use; and (iii) whether the associations are moderated by sex, parenting, health, school satisfaction or economic disadvantage.

    Methods

    A nationwide sample of 5549 adolescents (aged 15–16 years) in Sweden answered a questionnaire in school. General and institutional trust were measured with five items each. Logistic regressions were used to examine associations between drinking and the trust dimensions, and the cross-combinations of these. Moderation by sex, parenting, health, school satisfaction and economic disadvantage was tested.

    Results

    General and institutional trust were both significantly associated with drinking. High scores on both dimensions simultaneously were associated with the lowest probability of drinking, and low scores on both with the highest. Low institutional trust had a stronger association than low general trust. The combination of high institutional/low general trust was more protective than low institutional/high general trust. The association between general trust and drinking was moderated by school satisfaction, and the relationship between institutional trust and drinking was moderated by parental support and control.

    Discussion and Conclusions

    High trust is associated with a lower probability of past-year drinking among 15–16-year-olds. Parents and schools can be useful in endeavours to prevent low-trusting individuals in this age group from drinking.

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  • How do former smokers perceive information about nicotine products? Evidence from Sweden

    Tove Sohlberg, Patrik Karlsson. Drugs and alcohol today

    Artikel

    Purpose

    Health promotion strategies often attempt to change people’s behavior through targeting their risk perceptions. These perceptions may, however, be moderated by other factors. This study therefore aimed at investigating the trustworthiness and consistency of risk information, as well as respondent perceptions of the adequacy of amount received among a representative sample of former smokers, and how this information is related to gender, age, education level and whether using nicotine or not.

    Design/methodology/approach

    The respondents are part of a seven-year follow-up of former smokers in Sweden. Initially, 1400 respondents were contacted, whereof 705 (response rate 50%) answered a Web-survey. The majority (85 %) was still nicotine-free but some made use of nicotine in different forms. The data analysis includes descriptive statistics and logistic regressions.

    Findings

    Most respondents trusted risk information whether offered by the public authorities or came from other sources such as media, and generally perceived that there was an adequate amount. However, there were some differences between the products, where quite a few distrusted information on Nicotine Replacement Therapies (NRTs) and some perceived the information on snus and NRTs as contradictory and too little.

    Originality/value

    Knowledge about how former smokers perceive information regarding negative aspects of cigarette use may facilitate more effective risk communication with current smokers, and it may also be important for communicating information about other nicotine products to those who are trying to or who already have quit smoking.

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  • Comparisons in the making: youth accounts of cannabis use in Swedish addiction treatment

    Mats Ekendahl, Patrik Karlsson. Drugs: Education, Prevention and Policy

    Artikel

    Research shows that cannabis is understood differently across cannabis cultures. In Sweden, young cannabis users are seen as vulnerable, problem-burdened and increasingly embracing drug-liberal attitudes. Despite low prevalence rates, youth cannabis use is considered a high-profile problem that warrants prohibition. Previous studies show that staff in Swedish addiction treatment legitimize resolute interventions by making up young users as irrational. The treated young people claimed instead that starting to use cannabis and quitting were informed decisions. In this article, we revisit interviews with 18 young clients in Swedish addiction treatment, and examine the data with a focus on comparisons (e.g. A is unlike B). We perceive comparison as a tool in the formation of narrative identity, rather than a logical outcome of accounts. We ask what is compared with what in young people’s accounts of cannabis use, and what these comparisons reveal about their thoughts on well-being, the self and the setting. The interviewees used comparisons that drew on cultural, institutional and organizational narratives when they discussed cannabis. Taken together, their accounts instantiated ideas about powerful drug effects, the primacy of the neoliberal subject and the potential of cannabis addiction. We discuss whether these accounts mirror rather than challenge drug prohibition.

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  • Drinking motives and their associations with alcohol use among adolescents in Sweden

    Lars Sjödin (et al.). Nordic Studies on Alcohol and Drugs

    Artikel

    Aims:Previous studies have shown a close association between drinking motives and drinking behaviour among adolescents. However, there is a lack of evidence from the Nordic countries since few studies covering this topic have been carried out in this context. The present study among Swedish adolescents aims to examine (1) the prevalence of different drinking motives, (2) how drinking motives are associated with drinking frequency and heavy drinking frequency, and (3) whether the associations are moderated by sex.

    Methods:A nationally representative sample (n = 5,549) of Swedish adolescents (aged 15–16 years) answered a questionnaire in school. Of these, 2,076 were drinkers and were included in our study. Eighteen items from the Modified Drinking Motives Questionnaire-Revised (Modified DMQ-R) were used. Bivariate relationships between motives and drinking were examined with correlations. Linear regression models were used to assess the links between motives and drinking. Moderating effects of sex were examined with interactions.

    Results:Most common were social motives, followed by enhancement, coping-anxiety, coping-depression, and conformity motives. Coping-depression motives were slightly more common among girls. Conformity motives were associated with a lower frequency of drinking and heavy drinking while enhancement, social and coping-depression motives were associated with a higher frequency of both outcomes. No associations were found for coping-anxiety motives. No moderation effect of sex was found.

    Conclusions:Approach motives (social/enhancement) are the most prevalent drinking motives among Swedish adolescents. These also have the strongest association for both frequency of drinking and frequency of heavy drinking. This shows that Swedish adolescents drink to achieve something positive, rather than to avoid something negative, raising implications for prevention and intervention.

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  • Multiple Logics: How Staff in Relapse Prevention Interpellate People With Substance Use Problems

    Mats Ekendahl, Patrik Karlsson. Contemporary Drug Problems

    Artikel

    This study analyzes how staff in Swedish alcohol and other drug (AoD) treatment interpellate service users as people who can benefit from relapse prevention. Relapse prevention is a widely used intervention. Research is scarce, however, on how relapse prevention is practiced locally and how treatment staff perceive the relationship between AoD use as a problem and relapse prevention as a solution. Drawing on Actor-Network Theory and critical studies of AoD issues within this tradition, we elucidate how staff through specific interpellative logics enact service users, their individual characteristics, and living conditions. The data derive from interviews with 18 professionals working with assessment, counseling, case-management, therapy, and healthcare at AoD treatment agencies in the Stockholm region. The results show that the participants drew on four interpellative logics, and thereby enacted service users as four different object types. Region and network logics pinpointed that individuals have stable observable characteristics that determine their problems and eligibility for treatment (e.g., living conditions, diagnoses). Fluid and fire logics emphasized that their characteristics also vary depending on context and can be present and absent at the same time (e.g., harms, agency). This flexible interpellation of service users echoes the tendency among treatment staff to embrace sometimes irreconcilable understandings of AoD problems and to enact multiple realities of addiction. This suits a professional field where many factors are thought to cause and help resolve problems, but where the treatment supply is often limited to specific interventions. We conclude that it is easier to create a reasonable match between the service delivered and the potential service user if the characteristics of the latter are considered diverse and flickering. This exemplifies Carol Bacchi’s tenet that problem representations are adjusted to fit the solution at hand.

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  • Are the well‐off youth in Sweden more likely to use cannabis?

    Isabella Gripe (et al.). Drug and Alcohol Review

    Artikel

    Introduction and Aims

    Results from previous research are inconsistent regarding the association between socioeconomic status (SES) and cannabis use among adolescents. Since there are risks associated with cannabis use, a social gradient in cannabis use may contribute to reproducing socioeconomic differences in life opportunities. The aim of this study was to assess the association between childhood SES and cannabis use among youth in Sweden.

    Design and Methods

    We used repeated cross‐sectional data from three waves (2014–2016) of the Swedish national school survey among 11th graders. The analysis encompassed 9497 individuals in 668 school classes. Childhood SES was measured through parents' highest education, as reported by the students. Cannabis use was measured in terms of lifetime use and frequency of use. Data were analysed using multi‐level mixed‐effects Poisson regression.

    Results

    Adolescents with at least 1 parent with university/college education had 17% (incidence rate ratio 1.17, confidence interval 1.05, 1.30) higher risk of lifetime use of cannabis compared with those whose parents had no university/college education, adjusting for sex, SES of the school environment, academic orientation, truancy, risk assessment and parental permissiveness. Among life‐time users of cannabis, risk for frequent cannabis use was 28% (incidence rate ratio 0.72, confidence interval 0.53, 0.97) lower for those with at least 1 parent with university or college education.

    Discussion and Conclusions

    Childhood SES, in terms of parental education, was associated with cannabis use among Swedish adolescents. Adolescents from families with lower SES were less likely to ever try cannabis, but at higher risk for frequent use.

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  • Evidence Production for Psychosocial Treatment of Substance Use Problems

    2020. Anders Bergmark, Patrik Karlsson. SUCHT 66 (2), 85-91

    Artikel

    Aims: In the article at hand we intend to discuss to what extent hitherto efforts towards standardization and quality assurance have been able to achieve stability concerning the production of evidence, and whether an actual evidence-based practice for psychosocial interventions for alcohol and drug problems is anywhere truly in the making. Methods: To explain several methodological inadequacies we make use of a perspective commonly referred to as the actor-network theory (ANT). This is characterized by a strong interest in detailed analysis of how an innovation or an idea is transformed due to interaction with its situated and specific conditions.The empirical material is taken from four earlier studies of our own hands. Results: We have given examples of how an unsystematic handling of different control group designs can lead to serious misinterpretations of intervention effects. The same goes for researcher allegiance, the use of different types of criteria in order to rank different types of evidence, unmotivated restrictions on the inclusion of evidence in a given systematic review, or as in the case of several US clearinghouses. to use extremely weak criteria when discriminating between what is evidence-based and what is not. Conclusions: We suggest that all of these shortcomings are directly or indirectly related to translations, modifications or neglect to adhere to methodological rules intended to produce a reduction of biases and increase standardization

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  • Similar countries, similar factors? Studying the decline of heavy episodic drinking in adolescents in Finland, Norway and Sweden

    Kirsimarja Raitasalo (et al.). Addiction

    Artikel

    Aims

    To (1) examine several factors associated with trends in heavy episodic drinking (HED) in Finland, Norway and Sweden, (2) investigate similarities in these associations across the countries and (3) analyse the contribution of these factors to the trend in HED and the differences across the countries.

    Design and Setting

    Observational study using five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from Finland, Norway and Sweden between 1999 and 2015.

    Participants

    A total of 18,128 male and 19,121 female 15‐ to 16‐year‐old students.

    Measurements

    Monthly HED, perceived access to alcohol, truancy, parental control, leisure time activities and daily smoking. The Cochran–Armitage test was used to examine linear time trends in HED. Logit regression models using the Karlson–Holm–Breen (KHB) method were fitted for each country separately, including all the independent variables together with time and adjusted for family status, parental education and gender.

    Findings

    In Finland, Norway and Sweden, perceived access to alcohol, truancy and daily smoking decreased significantly between 1999 and 2015 while risk perceptions, parental control and participation in sports increased in the same period. The confounding percentage of all the independent variables related to the trend in HED was 48.8%, 68.9% and 36.7% for Finland, Norway and Sweden, respectively. Decline in daily smoking (p<.001) and perceived access to alcohol (p<.001) were positively and increase in parental control (p<.001) negatively associated with the decline in HED in all three countries. Changes in truancy, going out with friends, and engaging in sports and other hobbies had little or no impact on the decline in HED or displayed no consistent results across the countries.

    Conclusions

    The decline in adolescent heavy episodic drinking in Finland, Norway and Sweden between 1999 and 2015 appears to be associated with a decline in adolescent daily smoking and perceived access to alcohol and an increase in parental control.

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  • Cannabis i Sverige - en komplex substans, en enkelspårig drogpolitik?

    2020. Mats Ekendahl, Josefin Månsson, Patrik Karlsson. Socionomens forskningssupplement (47), 16-25

    Artikel

    I Sverige är cannabis, särskilt ungdomars bruk av substansen, kontroversiella ämnen som uppmärksammas såväl i media och politik som bland myndigheter och allmänhet. I denna artikel presenterar vi ett forskningsprojekt som belyser det svenska cannabisbruket, med fokus på vilka som gör det, deras åsikter och motiv, samt hur det kan gå till när de möter preventionsinsatser. Våra resultat pekar mot att cannabisbruk kan ha många olika betydelser och funktioner i människors liv, samt att den svenska förbudspolitiken sätter ramarna för hur användare förstår sina handlingar och hur de bemöts av omgivningen. Yttre inflytande från en drogliberal omvärld har dock inneburit att det knappast längre går att identifiera en allenarådande ”berättelse” om vad cannabis är, vilka effekter substansen har och vad som kännetecknar användarna. Vårt projekt understryker vikten av en mer nyanserad politik och praktik i förhållande till cannabisbruk i Sverige.

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  • Cannabis use under prohibitionism – the interplay between motives, contexts and subjects

    Mats Ekendahl, Josefin Månsson, Patrik Karlsson.

    Artikel

    A key question in drugs research is why people use psychoactive substances. Diverse motives such as boredom, habit, and pain relief have served as explanations, but little is known about how adult cannabis users motivate their use in prohibitionist policy contexts, like Sweden. The aim is to explore what motives a sample of adult Swedish cannabis users refer to when they give meaning to their use. We ask: what aspects of cannabis use (e.g. drug effects, individual characteristics and social contexts) are emphasized in their accounts, and how are such aspects combined to describe motives and justify use? In this study, motives are perceived as culturally situated action, and our analysis is based on online text messages (n = 238) and interviews (n = 12). Participants emphasized either the characteristics of the use situation (motives such as party, relaxation and social function) or of him-/herself as an individual (motives such as mindfulness, identity marker and somatic function). They often mentioned medical and recreational motives in the same account, and carefully presented themselves as rational individuals. The motives reflect that the drugs discourse is increasingly medicalized, that responsibility is highly esteemed in contemporary societies, and that cannabis use is still stigmatized in Sweden.

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  • Social inequalities in harmful drinking and alcohol-related problems among Swedish adolescents

    Siri Thor, Patrik Karlsson, Jonas Landberg. Alcohol and Alcoholism

    Artikel

    Aims

    The study aims to examine how socio-economic status (SES) among youth is related to binge-drinking and alcohol-related problems using three SES indicators: (i) SES of origin (parental education level), (ii) SES of the school environment (average parental education level at student’s school) and (iii) SES of destination (academic orientation).

    Methods

    Cross-sectional data on upper secondary students (n= 4448) in Sweden. Multilevel logistic and negative binomial regression were used to estimate the relationship between each SES indicator and binge-drinking and alcohol-related problems, respectively.

    Results

    Only SES of destination was significantly associated with binge-drinking, with higher odds for students in vocational programmes (OR= 1.42, 95% CI= 1.13–1.80). For the second outcome, SES of destination (rr=1.25; 95%CI=1.08–1.45) and SES of the school environment (rr=1.19, 95% CI=1.02–1.39) indicated more alcohol-related problems in vocational programmes and in schools with lower-educated parents. After adjustment for drinking patterns, the relationship remained for SES of the school environment, but became non-significant for SES of destination.

    Conclusion

    Our results suggest that the SES gradient among youth is stronger for alcohol-related problems than for harmful drinking. By only focusing on SES differences in harmful alcohol use, researchers may underestimate the social inequalities in adverse alcohol-related outcomes among young people. Our findings also support the notion that the environment young people find themselves in matters for social inequalities in alcohol-related harm.

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  • ADHD and social work with children and adolescents

    Patrik Karlsson, Tommy Lundström. European Journal of Social Work

    Artikel

    This article aims to alert social work researchers and practitioners to the importance of engaging in research and debate about how to approach and understand ADHD among children in general and locked-after children in care in particular. Social work researchers have largely been absent from academic discussions about the ‘ADHD epidemic’ despite the fact that the prevalence of ADHD diagnosis and medication is very high in child welfare populations. The social work profession can make important contributions to understanding a phenomenon that is common among children and adolescent clients, that is often co-morbid with other conditions such as conduct disorder and that is linked to social adversity. We argue that research on ADHD in the child welfare systems should be a top priority in social work, and outline some important questions that need to be addressed by both researchers and social workers.

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  • Risk and responsibilization: resistance and compliance in Swedish treatment for youth cannabis use

    Mats Ekendahl, Josefin Månsson, Patrik Karlsson.

    Artikel

    There is a lack of research on how youth make sense of substance abuse treatment. The aim of this article was to explore how young people in Stockholm, Sweden, perceive outpatient treatment for cannabis use, position themselves as subjects in relation to it, and how they respond to staff’s appeals to rationality and responsible action. The data, consisting of 18 interviews with clients recruited from six treatment centers, were explored using narrative and thematic analysis. Results show that the young clients understood their histories in a responsibilized way where the risk information about cannabis they received was considered crucial. Those who resisted treatment rejected cannabis problematizations by staff, did not value interventions and felt that they had control over their use. Those who complied with treatment said that cannabis problematizations helped them acknowledge their own difficulties, handle substance dependence and mature. We conclude that treatment resistance among young cannabis users would perhaps be prevented if the adult world acknowledged that some believe it is rational and responsible to use cannabis. While the criminal offense of substance use is often expiated through ‘treatment’ in Sweden, young clients establishing a substance use identity could possibly be avoided if cannabis was not equated with risk.

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  • Has illicit drug use become normalised in groups of Swedish youth? A latent class analysis of school survey data from 2012 to 2015

    Patrik Karlsson (et al.). Nordic Studies on Alcohol and Drugs

    Artikel

    Background:

    It is often assumed that illicit drug use has become normalised in the Western world, as evidenced for example by increased prevalence rates and drug-liberal notions in both socially advantaged and disadvantaged youth populations. There is accumulating research on the characteristics of young illicit drug users from high-prevalence countries, but less is known about the users in countries where use is less common. There is reason to assume that drug users in low-prevalence countries may be more disadvantaged than their counterparts in high-prevalence countries, and that the normalisation thesis perhaps does not apply to the former context.

    Aim:

    This article aims to explore to what extent such assertions hold true by studying the characteristics of young illicit drug users in Sweden, where prevalence is low and drug policy centres on zero tolerance.

    Material and Method:

    We draw on a subsample (n = 3374) of lifetime users of illicit drugs from four waves of a nationally representative sample of students in 9th and 11th grade (2012–2015). Latent class analysis (LCA) on ten indicators pertaining to illicit drug use identified four classes which we termed “Marijuana testers”, “Marijuana users”, “Cannabinoid users” and “Polydrug users”.

    Findings:

    Indications of social advantage/disadvantage such as peer drug use, early substance-use debut and truancy varied across groups, particularly between “Marijuana testers” (low scores) and “Polydrug users” (high scores).

    Conclusions:

    Our findings corroborate the idea that the majority of those who have used illicit drugs in the Swedish youth population have tried marijuana a few times only. We discuss whether or not the comparably large share of socially advantaged “Marijuana testers” in a comparably small sample of lifetime users can be interpreted as a sort of normalisation in a prohibitionist drug policy context.

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  • EU citizens begging and sleeping rough in Swedish Urban Areas: social work perspectives on problems and target groups

    Mats Ekendahl, Patrik Karlsson, Renate Minas. Nordic Social Work Research

    Artikel

    EU citizens from Central and Eastern Europe travelling to cities in other countries to make a better living have become an issue of major political concern across Europe. This study explores how professionals from Swedish municipal social service organizations in urban areas construct the phenomenon of poor visiting EU citizens. The impact of social constructions on the practice and design of policies makes it important to analyse how target groups, such as poor visiting EU citizens, are characterized and what normative assumptions are made about them. The study is theoretically based on Schneider and Ingram’s work on ‘Social Constructions of Target Populations’. Interviews with social workers in the three largest cities in Sweden were conducted. The results suggest a clear ambivalence among interviewees regarding how to conceptualize EU citizens. They were careful not to highlight any subgroups, instead defining the group as consisting of different individuals with varying needs. While the interviewees constructed members of the target group in a way similar to what Schneider and Ingram describe as dependents, they also attributed them with some agency. We conclude that this may be a reflection of the political and organizational setting in which social work with poor visiting EU citizens is conducted in Sweden.

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  • Logics of Legitimation in Swedish Treatment for Youth Cannabis Use: The Problem Representations of Social Workers in a Prohibitionist Policy Context

    Mats Ekendahl, Patrik Karlsson, Josefin Månsson.

    Artikel

    Liberal views on cannabis use are widespread in many Western countries, but prohibitionism remains strong in Sweden. According to Swedish drug policy, comprehensive prevention and treatment interventions are necessary because young people are considered particularly vulnerable to cannabis-related harm. In this article, we examine how staff at Swedish outpatient treatment centers for young substance users (called “MiniMaria”) use different logics when legitimizing their work in youth treatment. We also analyze how this legitimizing process contributes to both justifying solutions and constituting the cannabis “problem” that MiniMaria centers are established to handle. This will shed light on what “drug reality” the staff make up through their articulations. Eighteen interviews with social workers from six MiniMaria centers in the Stockholm region were analyzed. To illustrate how staff made sense of their work, we used the concepts of “problem representation”, “legitimation”, and “logics”. We identified four logics: A scientific and a structural logic linked to knowledge claims, policy goals, and organizational setting, and a professional and a procedural logic linked to work experience, client interaction, and therapeutic methods. Participants used logics to emphasize that the character of the cannabis problem demands wide-ranging interventions and to explain how they made youth cannabis users realize they need treatment. The structural logic of drug prohibitionism was only mentioned as a last resort when other logics were not applicable, for example, when a young person refused to engage in treatment and quit using cannabis. The strategic use of logics provided MiniMaria with a moral legitimacy that represented youth cannabis use as a high-profile problem and young people as in need of protection and control. This legitimizes prevention of youth cannabis use in a national setting where cannabis prevalence and harm remains relatively low.

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  • Individual and school-class correlates of youth cannabis use in Sweden: a multilevel study

    Patrik Karlsson (et al.). Nordic Studies on Alcohol and Drugs

    Artikel

    Background and aims:

    The school-class context is a crucial social environment for young people but substance use researchers have largely overlooked potential influences operating at this level. This study explores associations between school-class and individual-level factors and cannabis use in Swedish youth.

    Data and methods:

    Data comprised four waves (2012–2015) of the Swedish Council for Information on Alcohol and Other Drugs’ (CAN) nationally representative school surveys among individuals in 9th and 11th grade. For the present analyses, we had data on totally 28,729 individuals from 2377 unique school classes. Multilevel logistic regressions predicted lifetime and 10+ times use of cannabis from both individual-level predictors and school-class-level measures derived from the individual-level variables.

    Results:

    There were individual-level associations between most predictor variables and cannabis use. An early debut of tobacco use and binge drinking as well as low cannabis related risk perceptions had strong associations with cannabis use. Conversely, several school-class-level variables had aggregate relationships with cannabis use, most notably the overall level of risk perceptions in the school class. Some of the school-class factors predicted cannabis use over and above the individual-level covariates, suggesting the presence of contextual effects. Surprisingly, while female gender was negatively related with cannabis use at the individual level, a higher proportion of females in the classroom increased the odds for lifetime cannabis use even after controlling for individual and other contextual-level covariates.

    Conclusions:

    Youth cannabis use is related to various factors at both the individual and school-class level in Sweden. Truancy and perceived risk related to cannabis use had contextual associations with cannabis use. The positive contextual association between a higher proportion of females in the classroom and lifetime use should be explored further.

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  • Effects of psychosocial interventions on behavioural problems in youth

    2017. Patrik Karlsson, Anders Bergmark, Tommy Lundström. International Journal of Social Welfare 26 (2), 177-187

    Artikel

    Research indicates that a number of psychosocial interventions are effective for reducing behavioural problems in youth. These interventions are now often included on best practice lists aiming to facilitate informed treatment choices among practitioners. However, analyses in neighbouring research areas have highlighted serious shortcomings in how primary studies are analysed and how studies are synthesised in research reviews. This study took a closer look at the evidence of efficacy for psychosocial interventions that aim to reduce behavioural problems in youth, as shown in systematic research reviews by the Cochrane and the Campbell Collaborations (n = 8). The findings suggest a bias towards overemphasising the efficacy of the interventions in several reviews, an over-confidence in the validity of the findings in some reviews and, overall, a somewhat uncertain evidence base for the efficacy of the interventions. Systematic reviews are crucial for summarising research but more attention to methodological issues may be needed in this area.

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  • The wide-meshed safety net

    2017. Hugo Stranz, Patrik Karlsson, Stefan Wiklund. European Journal of Social Work 20 (5), 711-723

    Artikel

    This article explores and analyses, with the help of both client and social worker data on 423 applications for social assistance in Sweden, (i) the extent to which social assistance benefits and labour market strengthening measures are granted and (ii) factors concerning clients as well as social workers that are associated with the granting of benefits. Considering (i), the results show that social assistance is granted in about 74% of cases while only 6% of applicants are granted additional labour market strengthening measures. With regard to (ii), the results indicate that the granting of benefits seems to depend on abroad spectrum of factors at both the client and the social worker levels. For example, more experienced social workers are less willing to grant social assistance while chances increase when an applicant is already registered at the local public employment service and/or social insurance office. Moreover, the granting of benefits also co-varies withmore or less invariable factors at the client level: social workers are in general more generous towards women and people born outside Sweden, but rather less generous vis-à-vis single parents. The findings are discussed in terms of workfare and professionalization among social workers.

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  • Does the familial transmission of drinking patterns persist into young adulthood? A 10-year follow up

    2016. Patrik Karlsson, Charlotta Magnusson, Johan Svensson. Drug And Alcohol Dependence 168, 45-51

    Artikel

    Background

    Parental drinking has been shown to be associated with offspring drinking. However, the relationship appears to be more complex than often assumed and few studies have tracked it over longer time periods.

    Aims

    To explore the long-term (10-year) transmission of familial drinking during adolescence to offspring drinking patterns in young adulthood.

    Design

    Swedish longitudinal study, assessing the relationship between familial drinking in 2000 and offspring drinking in 2010 using simultaneous quantile regression analysis (n = 744).

    Data

    Data on familial drinking was gathered from the Swedish level-of-living surveys (LNU) and from partner LNU in 2000 while data on offspring drinking in young adulthood was gathered from LNU 2010. Drinking among offspring, parents and potential stepparents was measured through identical quantity-frequency indices referring to the past 12 months in 2010 and 2000 respectively.

    Results

    Young adults whose families were abstainers in 2000 drank substantially less across quintiles in 2010 than offspring of non-abstaining families. The difference, however, was not statistically significant between quintiles of the conditional distribution. Actual drinking levels in drinking families were not at all or weakly associated with drinking in offspring. Supplementary analyses confirmed these patterns.

    Conclusion

    The association between familial drinking and offspring drinking in young adulthood exhibits clear non-linear trends. Changes in the lower part of the familial drinking distribution are strongly related to drinking in young adults, but the actual levels of drinking in drinking families appear less important in shaping the drinking patterns of the offspring in young adulthood.

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  • People processing in Swedish personal social services

    2016. Hugo Stranz, Stefan Wiklund, Patrik Karlsson. Nordic Social Work Research 6 (3), 174-187

    Artikel

    By utilising data on nearly 1 200 individuals subject to investigations in the three Swedish personal social services (PSS) domains – child welfare (CW), social assistance (SA) and substance abuse treatment (SAT) – this article aims at describing and analysing the individuals processed in PSS as well as the outcome of the filtering process. Specific attention is paid to the extent the PSS domains differ in these respects. The main findings are: (i) a large proportion of clients subject to investigation are men, singles (most common without children in SA and SAT) and a born outside of Sweden (CW and SA). In terms of overall predicaments, SAT raw material seem more exposed than that of SA whereas there are fairly low concentration of abuse and neglect in CW; (ii) recidivism rates are high in all PSS domains: about half of the sample are already known by the agencies; (iii) out-screening are similar in SA and SAT (about 25%) but substantially higher in CW (about 50%). The investigative process is associated with considerably low external and in particular internal referring, indicating an apparent silo mentality between the PSS domains.

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  • Psychosocial interventions for substance-abusing parents and their young children

    2016. Karin Heimdahl, Patrik Karlsson. Addiction Research and Theory 24 (3), 236-247

    Artikel

    The aim of this scoping review was to give an overview of efficacy research on psychosocial interventions aimed at substance-abusing parents with children of up to the age of three. Throughout the overview, there was a focus on underlying assumptions and how the problem descriptions motivating the interventions corresponded with the solutions, i.e. the interventions in question. The data consisted of peer reviewed intervention studies (n = 22) identified through literature searches in online databases. Randomised controlled trial studies as well as quasi-experimental and pre-post studies were included. The results showed that all the studies included bar one focused exclusively on women as parents. Moreover, while the problem descriptions in the studies tended to be quite broad, framing parental substance abuse as a problem influenced by social and structural conditions, the solutions presented in the form of interventions generally had a narrower focus, addressing the individual parent from a psychological perspective only. In conclusion, the review points out the need for developing and evaluating interventions aimed at substance-abusing fathers as well as mothers, and also underscores the importance of these interventions being focused on a broader range of factors rather than just addressing deficits at the level of the individual.

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  • The user in Swedish abstinence-oriented opioid substitution therapy

    2016. Mats Ekendahl, Patrik Karlsson. Evidence in European social drug research and drug policy, 51-67

    Kapitel

    The idea of placing the views of service users at the centre of evidence-based practice has been praised in theory but rather neglected in empirical drug treatment research. Knowledge is scarce about how users’ perspectives are handled in policy and practice. In this chapter, we explore how Swedish opioid substitution treatment (OST) was perceived by users themselves and how their views were taken up by the Swedish National Board of Health and Welfare in developing new treatment regulations for OST. We argue that, despite the current valorisation of ‘the user’s voice’ across the health professions, the concept basically has no meaning in Swedish drug policy. The user preferences we identified (such as a desire for less suspicious staff, and acceptance of some drug use on top of their prescription) appeared to be more or less impossible to realise given the core prohibitionist values underpinning Swedish OST policy. While user involvement is commonly described as a keystone in the ‘evidence movement’, our analysis, of a contemporary policymaking process in the field of drug treatment, indicates that it served more as a rhetorical device than as a sine qua non of OST.

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  • ADHD på kartan, om geografiska skillnader i medicinering till barn och unga

    2015. Patrik Karlsson, Tommy Lundström. Socialmedicinsk Tidskrift 92 (5), 553-565

    Artikel

    ADHD är den snabbast växande psykiatriska diagnosen bland unga i Sverige. Till många av de diagnostiserade förskrivs också läkemedel. I artikeln analyseras geografiska skillnader i förskrivning. De kommunala skillnaderna är mycket stora men skillnaderna kan bara i viss grad förklaras av variabler på kommunal nivå. Kommunernas tillhörighet till landsting tycks ha stor betydelse för nivån på förskrivning och systemfaktorer som olikartad organisering, mer eller mindre explicit policy och professionell hållning diskuteras som tänkbara förklaringar till skillnader som inte endast kan ha att göra med förekomst av fenomenet.

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  • Compared with what? An analysis of control group typies in Cochrane and Campbell reviews of psychosocial treatment efficacy with substance use disorders

    2015. Patrik Karlsson, Anders Bergmark. Addiction 110 (3), 420-428

    Artikel

    Background and Aims

    A crucial, but under-appreciated, aspect in experimental research on psychosocial treatments of substance use disorders concerns what kinds of control groups are used. This paper examines how the distinction between different control group designs has been handled by the Cochrane and the Campbell Collaborations in their systematic reviews of psychosocial treatments of substance abuse disorders.

    Methods

    We assessed Cochrane and Campbell reviews (n = 8) that were devoted to psychosocial treatments of substance use disorders. We noted what control groups were considered and analysed the extent to which the reviews provided a rationale for chosen comparison conditions. We also analysed whether type of control group in the primary studies influenced how the reviews framed the effects discussed and whether this was related to conclusions drawn.

    Results

    The reviews covered studies involving widely different control conditions. Overall, little attention was paid to the use of different control groups (e.g. head-to-head comparisons vs. untreated controls) and what this implies when interpreting effect sizes. Seven of eight reviews did not provide a rationale for the choice of comparison conditions.

    Conclusions

    Cochrane- and Campbell reviews of the efficacy of psychosocial interventions with substance use disorders seem to underappreciate that use of different control group types yields different effect estimates. Most reviews have not distinguished between different control group designs and therefore have provided a confused picture regarding absolute and relative treatment efficacy. A systematic approach to treating different control group designs in research reviews is necessary for meaningful estimates of treatment efficacy.

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  • The credibility of risk information about licit substances

    2015. Mats Ekendahl, Patrik Karlsson. Nordic Studies on Alcohol and Drugs 32 (4), 395-410

    Artikel

    AIMS – Providing risk information on licit substances is a central health promotion strategy. Thereis, however, very little knowledge about public attitudes on this information. In this exploratorystudy we analyse the extent to which Swedish adults: 1) trust risk information regarding alcohol,cigarettes and wet snuff (“snus”) provided by public authorities, 2) perceive risk informationregarding alcohol, cigarettes and snus as consistent, and 3) have received an adequate amountof risk information from public authorities regarding these substances. The aim is also toinvestigate if certain characteristics among participants are related to their perceptions of suchrisk information. METHODS – A questionnaire was mailed to a random sample of individuals aged18 to 70 (n=1623, 54% response rate). Descriptive statistics and logistic regression techniqueswere used to process data. RESULTS – Participants trusted risk information concerning cigarettes,snus and alcohol provided by public authorities, and reported that they had received an adequateamount of it. Information about cigarettes was seen as more trustworthy and consistent thaninformation about alcohol and snus. The study suggests that attitudes on risk information aresubstance-specific and associated in complex ways with gender, age, education and experience ofown substance use. CONCLUSION – While only a first attempt to map an under-investigated area,our study highlights complexities in how people perceive risk information about licit substances. Italso indicates that the general population in Sweden receives what is seen as an adequate amountof knowledge from public authorities, and finds it consistent and trustworthy.

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  • Procedures and claims among US evidence-producing organizations

    2014. Patrik Karlsson, Anders Bergmark, Tommy Lundström. Evidence & Policy 10 (1), 61-76

    Artikel

    We explore how four evidence-producing organisations in the US go ahead when they rate the evidence base for psychosocial interventions, using the Incredible Years programme as our case study. The findings demonstrate variation in the procedures and resulting evidence claims across the organisations, with some organisations being strict and some being permissive. The presence of such conflicting practices highlights central challenges for the evidence-based practice framework and its ambition of obtaining uniform evidence statements. We conclude that practitioners and policy makers should be aware of such variation in order to be able to make informed decisions regarding which programmes to use.

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  • The trustworthiness and credibility of risk information about licit substances

    2014. Mats Ekendahl, Patrik Karlsson. Paper presented at 40th Annual Alcohol Epidemiology Symposium of the Kettil Bruun Society, Torino, Italy, 9 - 13 June 2014.

    Konferens

    Aims: Providing risk information regarding licit substances is a central strategy in public health promotion. The aim of this paper is to explore the extent to which a random sample of Swedes: 1) trust risk information regarding alcohol, cigarettes and wet snuff (“snus”) provided by public authorities, 2) perceive risk information regarding alcohol, cigarettes and snus as contradictory, and 3) have received an adequate amount of risk information from public authorities regarding these licit substances. Methods: A questionnaire was mailed to Swedish adults aged 18 to 70 (n=1623, 54% response rate). Descriptive statistics and logistic regression techniques were used to process data. Results: Participants trusted risk information concerning cigarettes, snus and alcohol provided by public authorities, and reported that they had received an adequate amount of information. Information about cigarettes was seen as more trustworthy and consistent than information about alcohol and snus. Conclusion: The study suggests that attitudes toward risk information are substance-specific and associated with gender, age, education and experience of own substance use. While highlighting complexities in how people perceive risk information, our data also illustrate that the general population in Sweden seems to be quite well equipped when it comes to risk information about licit substances.

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  • Implementing guidelines for substance abuse treatment

    2012. Patrik Karlsson, Anders Bergmark. Nordic Studies on Alcohol and Drugs 29 (3), 253-265

    Artikel

    AIMS - We critically discuss the campaign "Knowledge to Practice". A popular assumption within the evidence-based practice (EBP) framework is that guidelines for best practices are useful for increasing the inflow of research into practice. In Sweden, an initiative known as "Knowledge to Practice" (KTP) has since 2008 been devoted to implementing the National Board of Health and Welfare's guidelines for substance abuse treatment in practice. MATERIAL - Our critical discussion is based on an analysis of available documents describing the KTP campaign. RESULTS - We argue that the implementation process is marred with problems all the way from the beginning, where the guidelines are produced, to the final stage of local "adoption". The vague character of the guidelines coupled with unclear usages of key concepts such as "service user involvement" and EBP as well as a perspective of EBP that in certain respects undermine the legitimacy of its own mission lead us to raise serious doubt about KTP. CONCLUSSIONS - We conclude that KTP can be seen as a clear example of a general unawareness of the two main, largely incompatible "models" of EBP identified in the literature. Further, KTP may as a consequence of this have had the unintended effect of disseminating vague and unclear conceptions of EBP to practitioners.

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  • Personal experiences of drinking and alcohol-related risk perceptions

    2012. Patrik Karlsson. Nordisk Alkohol- og narkotikatidsskrift (NAT) 29 (4), 413-427

    Artikel

    Aims - To explore the association between subjective experiences of drinking and alcohol-related risk perceptions. Methods - The data is based on a questionnaire with questions about beliefs, use habits and experiences of alcohol and tobacco sent to a random sample of 3,000 Swedes aged 18 to 70 years (response rate= 1,623 individuals, or 54%). In this study, those respondents who had ever been drinking alcohol were included (1,536 individuals). The data were analysed statistically by cross tabs and multiple logistic regression. Results - With some exceptions, the results generally showed that differences in subjective experiences of drinking were related to risk perceptions of alcohol consumption. In particular, those who had more negative than positive subjective experiences of alcohol consumption had substantially higher risk perceptions than those who had more positive than negative experiences, controlling for alcohol consumption and potential confounders. There were also several significant differences between individuals differently involved in alcohol consumption, net of subjective experiences. Conclusions - Subjective experiences of alcohol consumption appear to be an important construct in relation to alcohol-related risk perceptions. To understand the link between personal experiences and risk perceptions pertaining to alcohol consumption, both objective measures of personal experiences and subjective measures should be considered.

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  • The relationship between affective associations with alcohol and binge drinking

    2012. Patrik Karlsson. Journal of Substance Use 17 (1), 41-50

    Artikel

    This article explores the relationship between affective associations with alcohol and binge drinking. Prior research on the proximal determinants of alcohol consumption has typically focused on cognitive factors such as outcome expectancies, leaving aside affect (i.e. emotional factors). Participants in this study were a random, nationally representative sample of Swedes aged between 18 and 70 (n = 1623, response rate 54%). The results showed that affective associations with alcohol are related to binge drinking, even after controlling for gender, age, education, family situation and perceived risk. This article concludes that affective associations probably should be considered in explanatory frameworks of alcohol consumption, although more research is needed on the causal relationship of affective associations to drinking habits.

     

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