Alkohol- och narkotikaanvändning bland ungdomar och vuxna samt olika insatser inom dessa områden, evidensbaserad praktik.
I urval från Stockholms universitets publikationsdatabas
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-e0265481Artikel
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.
A matter of craving–An archeology of relapse prevention in Swedish addiction treatment
2022. Mats Ekendahl, Patrik Karlsson. International journal of drug policyArtikel
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.
Clashing Perspectives: Cannabis Users and Swedish Drug Policy
2021. Josefin Månsson, Mats Ekendahl, Patrik Karlsson. Retreat or Entrenchment? Drug Policies in the Nordic Countries at a Crossroads, 267-290Kapitel
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), 11201-11201Artikel
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.
Fixed and fluid at the same time
2021. Mats Ekendahl, Patrik Karlsson. Critical Public Health, 1-11Artikel
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.
Associations between trust and drinking among adolescents
Lars Sjödin (et al.). Drug and Alcohol ReviewArtikel
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.
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.
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.
How do former smokers perceive information about nicotine products? Evidence from Sweden
Tove Sohlberg, Patrik Karlsson. Drugs and alcohol todayArtikel
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.
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.
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.
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.
Comparisons in the making: youth accounts of cannabis use in Swedish addiction treatment
Mats Ekendahl, Patrik Karlsson. Drugs: Education, Prevention and PolicyArtikel
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.
Evidens och socialt arbete
2021. Anders Bergmark, Patrik Karlsson.Övrigt
Drinking motives and their associations with alcohol use among adolescents in Sweden
Lars Sjödin (et al.). Nordic Studies on Alcohol and DrugsArtikel
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.
Multiple Logics: How Staff in Relapse Prevention Interpellate People With Substance Use Problems
Mats Ekendahl, Patrik Karlsson. Contemporary Drug ProblemsArtikel
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.
Hur bristfällig är samhällsvården egentligen? Några mätproblem i observationsstudier av placerade barn
2020. Patrik Karlsson, Tommy Lundström, Stefan Wiklund. Socialvetenskaplig tidskrift 27 (2), 137-155Artikel
Reply to the commentaries on Bergmark & Karlsson (2020)
2020. Anders Bergmark, Patrik Karlsson. SUCHT 66 (5), 291-292Artikel
Are the well‐off youth in Sweden more likely to use cannabis?
Isabella Gripe (et al.). Drug and Alcohol ReviewArtikel
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.
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.
Evidence Production for Psychosocial Treatment of Substance Use Problems
2020. Anders Bergmark, Patrik Karlsson. SUCHT 66 (2), 85-91Artikel
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
Similar countries, similar factors? Studying the decline of heavy episodic drinking in adolescents in Finland, Norway and Sweden
Kirsimarja Raitasalo (et al.). AddictionArtikel
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.
A total of 18,128 male and 19,121 female 15‐ to 16‐year‐old students.
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.
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.
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.
Cannabis i Sverige - en komplex substans, en enkelspårig drogpolitik?
2020. Mats Ekendahl, Josefin Månsson, Patrik Karlsson. Socionomens forskningssupplement (47), 16-25Artikel
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.
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.
Social inequalities in harmful drinking and alcohol-related problems among Swedish adolescents
Siri Thor, Patrik Karlsson, Jonas Landberg. Alcohol and AlcoholismArtikel
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).
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.
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.
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.
ADHD and social work with children and adolescents
Patrik Karlsson, Tommy Lundström. European Journal of Social WorkArtikel
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.
Missbruk och beroende av alkohol och narkotika – Kunskapsläget för utredningar och insatser inom socialtjänsten
2019. Sam Larsson (et al.).Rapport
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.
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 DrugsArtikel
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.
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”.
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).
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.
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 ResearchArtikel
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.
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.
One explanation to rule them all? Identifying sub-groups of non-drinking Swedish 9th graders
Jonas Raninen (et al.). Drug and Alcohol ReviewArtikel
Individual and school-class correlates of youth cannabis use in Sweden: a multilevel study
Patrik Karlsson (et al.). Nordic Studies on Alcohol and DrugsArtikel
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.
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.
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.
Effects of psychosocial interventions on behavioural problems in youth
2017. Patrik Karlsson, Anders Bergmark, Tommy Lundström. International Journal of Social Welfare 26 (2), 177-187Artikel
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.
The wide-meshed safety net
2017. Hugo Stranz, Patrik Karlsson, Stefan Wiklund. European Journal of Social Work 20 (5), 711-723Artikel
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.
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, 45-51Artikel
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.
To explore the long-term (10-year) transmission of familial drinking during adolescence to offspring drinking patterns in young adulthood.
Swedish longitudinal study, assessing the relationship between familial drinking in 2000 and offspring drinking in 2010 using simultaneous quantile regression analysis (n = 744).
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.
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.
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.
People processing in Swedish personal social services
2016. Hugo Stranz, Stefan Wiklund, Patrik Karlsson. Nordic Social Work Research 6 (3), 174-187Artikel
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.
Psychosocial interventions for substance-abusing parents and their young children
2016. Karin Heimdahl, Patrik Karlsson. Addiction Research and Theory 24 (3), 236-247Artikel
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.
Samverkan kring gravida med missbruksproblem
2016. Karin Heimdahl, Patrik Karlsson.Rapport
The user in Swedish abstinence-oriented opioid substitution therapy
2016. Mats Ekendahl, Patrik Karlsson. Evidence in European social drug research and drug policy, 51-67Kapitel
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.
ADHD på kartan, om geografiska skillnader i medicinering till barn och unga
2015. Patrik Karlsson, Tommy Lundström. Socialmedicinsk Tidskrift 92 (5), 553-565Artikel
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.
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), 420-428Artikel
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.
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.
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.
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.
Omtanke eller misstanke?
2015. Ekendahl Mats, Patrik Karlsson.Rapport
Riktade insatser till gravida och spädbarnsföräldrar med problematiskt bruk av alkohol, narkotika och läkemedel och psykisk ohälsa
2015. Karin Heimdahl, Patrik Karlsson.Rapport
The credibility of risk information about licit substances
2015. Mats Ekendahl, Patrik Karlsson. Nordic Studies on Alcohol and Drugs 32 (4), 395-410Artikel
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.
Procedures and claims among US evidence-producing organizations
2014. Patrik Karlsson, Anders Bergmark, Tommy Lundström. Evidence & Policy 10 (1), 61-76Artikel
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.
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.
Brukarnöjdhet i beroendevården - en studie av patientinflytande, behandlingstilltro och samordnade insatser
2013. Mats Ekendahl, Patrik Karlsson.Rapport
Riktade psykosociala insatser till gravida och småbarnsföräldrar med problematiskt bruk av alkohol och narkotika:en litteraturstudie
2013. Karin Heimdahl, Patrik Karlsson.Rapport
Riktade psykosociala insatser till gravida och småbarnsföräldrar med psykisk ohälsa
2013. Karin Heimdahl, Patrik Karlsson.Rapport
Evidence-based practice - anything goes?
2012. Patrik Karlsson, Anders Bergmark. Nordic Studies on Alcohol and Drugs 29 (3), 281-282Artikel
Implementing guidelines for substance abuse treatment
2012. Patrik Karlsson, Anders Bergmark. Nordic Studies on Alcohol and Drugs 29 (3), 253-265Artikel
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.
Integrerade etiologiska analyser och drogprevention
2012. Patrik Karlsson. Socialvetenskaplig tidskrift 19 (3-4), 217-231Artikel
Personal experiences of drinking and alcohol-related risk perceptions
2012. Patrik Karlsson. Nordisk Alkohol- og narkotikatidsskrift (NAT) 29 (4), 413-427Artikel
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.
The relationship between affective associations with alcohol and binge drinking
2012. Patrik Karlsson. Journal of Substance Use 17 (1), 41-50Artikel
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.
Between a rock and a whirlpool? Measurement problems in assessing risk perceptions of illicit drug use
2011. Patrik Karlsson. Nordic Studies on Alcohol and Drugs 28 (2), 149-157Artikel
Föräldrars och andra vuxnas betydelse för alkoholkonsumtionen
2011. Stig Elofsson, Patrik Karlsson.Rapport
Alternatives to the deficit model of adolescent drug use
2010. Patrik Karlsson. Pleasure, pain and profit. European perspectives on drugs, 21-34Kapitel
Inneboende problem i informationsbaserad, universell prevention
2010. Patrik Karlsson. Nordic Studies on Alcohol and Drugs 27 (3), 259-268Artikel
Nya grepp i preventionsarbetet?
2009. Patrik Karlsson, Anders Bergmark. Nordisk Alkohol- och Narkotikatidskrift 26 (1), 5-19Artikel
2009. Patrik Karlsson. Alkohol och droger, 87-100Kapitel
Ungdomar och alkohol
2009. Patrik Karlsson. Socionomen (8), 16-19Artikel
Explaining Small Effects of Information-based Drug Prevention
2008. Patrik Karlsson. Journal of Alcohol and Drug Education 52 (3), 9-17Artikel