Mads Uffe Pedersen

A Simple Risk Scoring System for Prediction of Relapse after Inpatient Alcohol Treatment

Predicting relapse after alcoholism treatment can be useful in targeting patients for aftercare services. However, a valid and practical instrument for predicting relapse risk does not exist. Based on a prospective study of alcoholism treatment, we developed the Risk of Alcoholic Relapse Scale (RARS) using items taken from the Addiction Severity Index and some basic demographic information. The RARS was cross-validated using two non-overlapping samples, and tested for its ability to predict relapse across different models of treatment. The RARS predicted relapse to drinking within 6 months after alcoholism treatment in both the original and the validation sample, and in a second validation sample it predicted admission to new treatment 3 years after treatment. The RARS can identify patients at high risk of relapse who need extra aftercare and support after treatment.

Evidence-Based Practice in “the Real World”

The term evidence-based practice (EBP) has developed into a mantra not just within the medical area of treatment, but within the psychosocial realm of treatment as well. Today, decision-makers and funding authorities are increasingly demanding that psychosocial treatment should be evidence-based and that the different types of treatment facilities should attempt to adapt to this, inter alia by providing offers that are reputed to be evidence-based. In this article, EBP is viewed under a slightly different perspective than the one usually used when discussing it. It is claimed that evidence-based counselling and therapeutic methods only account for a small part of the strategies that are relevant for treating clients with substance and/or alcohol misuse. In the first part of the article, EBP is defined and placed in relation to evidence-based counselling/therapy (EBC/T). In the articles second part, the relevance of – not least – EBC/T in the “real world” is discussed. The real world is defined as, among other things, “what clients receive, not what they are offered” and “what clients need, not what the system needs”. This is illustrated by discussing two Danish research projects that demonstrate, inter alia, that what is received does not have much in common with what is offered.

Abstinence-orientated residential rehabilitation of opioid users in Denmark: Do changes in national treatment policies affect treatment outcome?

Aims: Significant changes in the Danish drug-abuse treatment system occurred from 1998 to 2008, allowing the opportunity to study their impact on outcomes for opiate dependent patients. This paper examines whether such changes are related to possible changes in abstinence rates of two cohorts of drug users. Methods: We compared survival curves and the month-by-month probability of abstinence between cohorts of drug abusers who were followed for one year after treatment for opioid dependence in 1998 (n = 305) and in 2008 (n = 204). Of the 1998 cohort, 192 were interviewed face-to-face and 61 were found through national drug-abuse treatment registers. Of the 2008 cohort 112 were interviewed face-to-face and 42 were found through national drug-abuse treatment registers. Results: Survival curves did not differ between the two cohorts. After controlling for age and gender, people from the 2008 cohort had a higher frequency of month-to-month rates of abstinence. A higher proportion of clients received new treatment after their index treatment in 2008. Clients from the 1998 cohort who did not receive new treatment used drugs more often than clients who did not receive treatment in 2008. At the same time, the proportion of clients who received residential rehabilitation treatment for opiate dependence increased substantially by 2008. Conclusions: Total abstinence rates are highly consistent over time and seem to change little with changes in systems of care. However, changes in care that improve access to treatment may reduce the overall burden of opioid addiction to both individuals and society.

Mapping risk factors for substance use: Introducing the YouthMap12

BACKGROUND In adolescence, psychological problems and regular use of alcohol, cigarettes, cannabis and other drugs (AOD) tend to cluster together, strongly indicating that certain groups of young people are at elevated risk of developing a problematic use of AOD. OBJECTIVE The aim of the present study was to develop an easy-to-implement screening instrument to identify subgroups of young people with different psychological problems at risk of problem use of AOD. METHOD 3589 randomly selected young Danes between 15 and 25years of age, from a national survey (n=2702) and a municipality survey (n=887), answered a 12-item questionnaire (YouthMap12) with 6 items identifying externalizing problems (EP6) and 6 items identifying internalizing problems (IP6). Latent class analysis (LCA) was used to characterize groups at risk, and associations were estimated between EP6 and IP6 and regular use of AOD, and between latent class membership and regular use of AOD. RESULTS LCA identified 6 classes with varying degrees of externalizing and internalizing problems: 70% of youth were in the low problem score class, and the remaining 30% were at various levels of risk. Regular use of cigarettes, cannabis and alcohol was strongly associated with classes characterized by externalizing problems, while over-the-counter and prescription medicine was strongly associated with classes characterized by internalizing problems. CONCLUSIONS Youth at risk of problem use of AOD can be identified using a simple and easily administered instrument.

An exploratory prospective study of young people’s drinking during a holiday

Background Heavy drinking and drug use is increasingly recognised as a problem in relation to holidays at nightlife resorts. However, studies conducted on the subject to date have relied on retrospective accounts of drinking, and little is known about the course of drinking, consequences and experiences during such holidays. Methods A prospective study was carried out in Sunny Beach, Bulgaria, of 112 Danish tourists aged 16 to 25 years, 68% of whom were male. Participants completed questionnaires within one day of arrival at the resort, and subsequently on days 3 and 5 of the holiday. Results The response rate was adequate, with 81% providing complete data on all three occasions, and 93% providing complete data on at least two of the three occasions. During the holiday, participants cut down on their drinking significantly. Men drank more than women. The group of people with whom individuals travelled had a significant influence on their drinking. We also analysed predictors of several adverse outcomes. Individuals who travelled for the purpose of socialising drank more, whereas those who travelled to participate in sports activities drank less. Conclusion The study demonstrates the efficaciousness of prospective surveys as a methodology for onsite monitoring of substance use and other behaviours of young people during holidays. The study showed that young people drink like the members of the group they are with, but experience the consequences of drinking independently.

Addiction research centres and the nurturing of creativity. The Centre for Alcohol and Drug Research: social science alcohol and drug research in Denmark.

AIMS The purpose of this paper is to introduce the social science alcohol and drug research undertaken by the Centre for Alcohol and Drug Research (CRF) and at the same time offer an insight into the development in Danish alcohol and drug research throughout the past 15-20 years. METHOD A review of articles, books and reports published by researcher from CRF from the mid-1990s until today and an analysis of the policy-making in the Danish substance use and misuse area. RESULTS CRF is a result of the discussions surrounding social, health and allocation policy questions since the mid-1980s. Among other things, these discussions led to the formal establishment of the Centre in 1991 under the Aarhus University, the Faculty of Social Science. Since 2001 the Centre has received a permanent basic allocation, which has made it possible to appoint tenured senior researchers; to work under a more long-term research strategy; to function as a milieu for educating PhD students; and to diversify from commissioned research tasks to initiating projects involving more fundamental research. Research at the Centre is today pivoted around four core areas: consumption, policy, prevention and treatment. CONCLUSION The emergence, continuation, financing and character of the research taking place at CRF can be linked closely to the specific Danish drug and alcohol discourse and to the division of the responsibility for alcohol and drug research into separate Ministries.

Post-traumatic stress disorder symptom clusters predicting substance abuse in adolescents

The majority of studies exploring the mental health disorders, post-traumatic stress disorder (PTSD) and substance use disorders (substance abuse (SA) and dependence), have shown high co-morbidity rates in adolescents, indicating a well-established relationship. However, only a few studies have attempted to examine the functional mechanisms believed to underlie this common form of co-morbidity, and no studies have been carried out in adolescent samples. Knowledge is thus lacking on how specific PTSD symptom clusters may account for the development of specific types of problematic substance use in adolescents. Therefore, we studied this issue in relation to alcohol abuse (AA) and drug abuse (DA) in a probability sample of Danish 15–18-year-olds (n = 1988) in the form of an online survey using self-report questionnaires following the Diagnostic and statistical manual of mental disorders, fourth edition [DSM-IV; APA. (1994). Washington, DC: Author]. After demographic and substance-related variables were cont...

Research in substance abuse treatment: Contributions by the Centre for Alcohol and Drug Research

This article describes contributions from the Centre for Alcohol and Drug Research (CRF), Faculty of Business and Social Sciences, Aarhus University, within treatment for alcohol and drug problems. This article focuses on three key research areas: evaluation research and development of monitoring systems/registers, development of screening and treatment methods, and treatment system research. Some of the important findings from the studies conducted within these three areas will be presented and the impact that these findings have had on Danish treatment policy will be described.

Multidisciplinary social science drug and alcohol research in Denmark

The purpose of this introductory chapter is to briefly sketch out the history of the Centre for Alcohol and Drug Research (CRF) established in 1991 and identify the central characteristics of the research that has been done at the Centre. However, in order to understand the genre of drug and alcohol research developed at CRF, we first contextualize the Centre both specifically within Danish society, and the Nordic countries overall.

Prospective associations between childhood externalising and internalising problems and adolescent alcohol and drug use: The Bergen Child Study

Aims: The literature on associations between internalising problems and subsequent alcohol/drug use and problems shows mixed results, and it is important to consider different aspects of internalising problems along with co-occurring externalising problems. Methods: In a longitudinal study (n = 2438) followed up when the subjects were 7–9, 11–13, and 16–19 years of age, we investigated associations between parent/teacher-reported externalising and internalising problems (Strengths and Difficulties Questionnaire, SDQ) and adolescent self-reported alcohol and illicit drug use and problems. Socioeconomic status (SES), gender, and age were included as potential confounding variables. We also adjusted for the potential confounding effects from externalising problems on the association between internalising problems and alcohol/drug use, and vice versa. Results: Externalising problems were positively associated with all measures of alcohol/drug use and problems (adjusted odds ratios [AORs] ranging from 1.24 to 1.40, all p < .05), while internalising problems were negatively associated with all measures of alcohol/drug use (AORs ranging 0.83 to 0.88, all p < .05). Full-scale SDQ externalising problems were somewhat stronger and more robust predictors of adolescent alcohol/drug-related problems compared with SDQ externalising subscales, while only full-scale SDQ internalising problems were negatively associated with alcohol/drug-related problems. All estimates were similar across genders. Conclusions: Childhood externalising problems are positively associated while internalising problems are negatively associated with alcohol/drug use and problems in late adolescence.