Peter Larm

Multiple adverse outcomes over 30 years following adolescent substance misuse treatment

Objective:  To compare outcomes over 30 years experienced by individuals who as adolescents entered substance misuse treatment and a general population sample.

Long-term outcomes of adolescents treated for substance misuse

INTRODUCTION Little is known about the long-term outcome of substance misuse by teenagers, this is especially true for gender specific consequences. OBJECTIVES To examine the prevalence of death, physical illnesses related to substance misuse, mental illness, substance misuse, criminality, and poverty in adulthood among two cohorts of individuals who as adolescents had consulted for substance misuse problems, to estimate the effect of sex on adverse outcomes, and to compare cohort effects. METHODS Individuals who had consulted a substance misuse clinic as adolescents during 1968-1971 and 1980-1984 were followed until 2002. Adverse outcomes were documented using information from Swedish national registers. RESULTS In the older cohort followed to age 50, only one-in-five escaped all six adverse outcomes, while over half of subjects experienced at least two or more. Sex and the severity of adolescent substance misuse and delinquency were predictors of adverse outcomes. More women than men experienced physical illness and poverty in the older cohort while more men than women were convicted of criminal offences in both cohorts and presented continued substance misuse in the younger cohort. Men in the younger as compared to the older cohort had higher rates of substance misuse and criminal convictions. CONCLUSIONS Adolescents seeking help for substance misuse problems are at elevated risk for multiple adverse outcomes later in life. Outcomes differ for women and men and by severity of adolescent misuse and delinquency. Few cohort differences in adult outcomes exist.

Adolescent Antisocial Behavior as Predictor of Adverse Outcomes to Age 50: A Follow-Up Study of 1,947 Individuals

The study examined associations between antisocial behavior (ASB) before age 15 and eight adverse outcomes from age 21 to 50 among 1,623 men and 324 women who as adolescents consulted a clinic for substance misuse problems. Outcomes were documented using Swedish national registers and included death, hospitalization for physical illnesses related to substance misuse, mental illness, self-inflicted harm, substance misuse, convictions for violent and nonviolent crimes, and poverty. ASB before age 15 was associated with increased odds of all outcomes in adulthood except hospitalization for mental illness after adjusting for low family socioeconomic status, sex, Sex × ASB, and substance misuse in adulthood and with an increased number of adverse outcomes up to age 50. No gender differences were detected.

The association between maltreatment in childhood and criminal convictions to age 24: a prospective study of a community sample of males from disadvantaged neighbourhoods

While many studies have observed a positive association between maltreatment in childhood and criminality in adolescence and adulthood, others have failed to detect such an association. Most studies, however, have not examined different types of maltreatment, nor taken account of other family and childhood factors that are predictive of criminality. Using data from a prospective, longitudinal investigation of a community sample of 1,037 males, we calculated hierarchical logistic regression models to estimate the associations of boys’ self-reports of neglect, emotional abuse, and physical abuse at ages 10 and 12, with convictions for criminal offenses from age 12 to 24, after taking account of conduct problems, hurtful and uncaring behaviours (HUB), and parent’s criminality. At ages 10 and 12, boys’ reports of neglect, emotional abuse, and physical abuse, were not associated with criminal convictions for non-violent or for violent crimes from age 12 to 24. Among boys who did not engage in HUB towards others reports of emotional abuse were associated with subsequent criminality, while this association disappeared among the boys engaging in such behaviours. In this community sample of males, levels of each type of maltreatment were low and there were no direct associations with subsequent criminal convictions. The findings add to emerging evidence that the characteristics of the child and parents, as well as the type of maltreatment modify the association with future criminal offending.

The buffering effect of tangible social support on financial stress: influence on psychological well-being and psychosomatic symptoms in a large sample of the adult general population

IntroductionFinancial stress is an important source of distress and is related to poor mental and physical health outcomes. The present study investigated whether tangible social support could buffer the effect of financial stress on psychological and psychosomatic health.MethodsTwo separate postal surveys were sent to random samples in five counties in Sweden in 2004 and 2008, with a total of 84 263 respondents. The questionnaires included questions about financial stress, tangible social support, psychosomatic symptoms, and psychological well-being (General Health Questionnaire-12).ResultsIndividuals with high financial stress and low tangible social support had six to seven times increased odds ratios for low psychological well-being and many psychosomatic symptoms. By contrast, individuals with high financial stress and high tangible social support had only two to three times increased odds ratios for low psychological well-being and three to four times increased odds ratios for many psychosomatic symptoms, suggesting a buffering effect of tangible social support. Consistent with the buffering hypothesis, there were significant interactions between financial stress and social support, particularly in relation to low psychological well-being.ConclusionsSocial support had its strongest effect at high levels of financial stress. The question whether the altering of our social networks may improve physical health is important for the prevention of ill health in people experiencing financial stress. Strengthening social networks may have the potential to influence health-care costs and improve quality of life.

Trajectories of resilience over 25 years of individuals who as adolescents consulted for substance misuse and a matched comparison group

AIMS To examine trajectories of resilience over 25 years among individuals who as adolescents received treatment for substance misuse, the clinical sample (CS) and a matched general population sample (GP). DESIGN Comparison of the CS and GP over 25 years using Swedish national registers of health care and criminality. SETTING A substance misuse clinic for adolescents in an urban area in Sweden. MEASUREMENTS Resilience was defined as the absence of substance misuse, hospitalizations for physical illnesses related to substance misuse, hospitalization for mental illness and law-abiding behaviour from ages 21 to 45 years. PARTICIPANTS The CS included 701 individuals who as adolescents had consulted a clinic for substance misuse. The GP included 731 individuals selected randomly from the Swedish population and matched for age, sex and birthplace. FINDINGS A total of 52.4% of the GP and 24.4% of the CS achieved resilience in all domains through 25 years. Among the CS, another one-third initially displayed moderate levels of resilience that rose to high levels over time, one-quarter displayed decreasing levels of resilience over time, while 9.3% showed little but improving resilience and 8.8% showed no resilience. Levels of resilience were associated with the severity of substance misuse and delinquency in adolescence. CONCLUSIONS Individuals who had presented substance misuse problems in adolescence were less likely to achieve resilience over the subsequent 25 years than was a matched general population sample, and among them, four distinct trajectories of resilience were identified. The severity and type of problems presented in adolescence distinguished the four trajectories.

Teachers' Ratings of Childhood Behaviours Predict Adolescent and Adult Crime among 3016 Males and Females

Objective: To examine associations of teacher-rated conduct problems (CP) and hurtful and uncaring behaviours (HUB) at age 6 and 10 with criminal convictions up to age 24 among 1593 males and 1423 females, and to determine whether aggressive behaviour at age 12 mediated the associations of CP and HUB with criminal convictions. Method: Teachers assessed HUB and CP at ages 6 and 10 and ratings above the 90th percentile at each age and within each sex were used to assign participants to 1 of 4 groups. Teachers assessed proactive, reactive, indirect, and verbal aggression at age 12. Juvenile and adult criminal records were obtained. Results: High CP and HUB males, aged 6, were 4 times more likely than males with lower ratings to acquire convictions for violent crimes and 5 times more likely to acquire convictions for nonviolent crimes by age 24. High HUB and CP females, aged 6, were 5 times more likely than females with lower ratings to have a conviction for a nonviolent offence by age 24. Among males, both aged 6 and 10, high HUB without CP were associated with elevations at risk of convictions for violent and nonviolent crimes, while among females the elevations at risk were limited to convictions for nonviolent crimes. Different types of aggressive behaviour mediated associations of high HUB and CP with subsequent criminal convictions, but not the association of HUB without CP and crime. Conclusions: Teachers in elementary schools rated behaviours that, from age 6 onward, significantly predicted criminal convictions into early adulthood.

Individuals developing schizophrenia are hidden among adolescent substance misusers.

BACKGROUND Strategies are needed to identify youth developing schizophrenia. The present study aimed to determine whether adolescents treated for substance misuse were at elevated risk to develop schizophrenia, whether this risk has changed since the late 1960s, and whether substance misuse in adolescence predicted poorer outcomes through adulthood. METHOD In a Swedish city, since the mid-1960s there has been only one clinic for adolescent substance misuse. Three samples from this clinic were studied: 1992 individuals treated from 1968 to 1971 followed to age 50 years; 1576 treated from 1980 to 1984 followed to age 35 years; and 180 treated in 2004 followed to age 22 years. Each clinical sample was matched on age, sex and place of birth to an equal, or larger, number of randomly selected individuals from the general population. Schizophrenia, substance use disorders, physical disorders related to substance misuse, criminal convictions, poverty and death were identified using national registers. RESULTS Individuals treated for substance misuse in adolescence were at increased risk to subsequently develop schizophrenia: in males the increase was approximately four-fold and in females between five- and seven-fold. There was no difference in risk for those treated in 1968-1971 and from 1980 to 1984 when cannabis use increased from 37.6% to 49.8% of the clinical samples. Among males who developed schizophrenia, treatment for substance misuse was associated with increased risk of substance use disorders and criminal convictions through adulthood. CONCLUSIONS Treatment programmes for adolescents misusing substances include a disproportionate number developing schizophrenia. Early detection and treatment have the potential to improve long-term outcomes.

Violent, nonviolent, and substance-related offending over the life course in a cohort of males and females treated for substance misuse as youths

Most studies on adolescent offending heterogeneity are based on general population samples, and few include individuals with substance misuse or look specifically at substance-related offending. It is also unclear how offender subtypes develop after young adulthood or how offending heterogeneity varies between genders. This study aimed to identify subgroups of offending among adolescents with misuse problems and to examine associations with offending in adulthood. The study included 1,992 females and males that consulted a clinic for adolescents with misuse problems between 1968 and 1971. Latent Class Analyses were conducted to identify subgroups based on violent and nonviolent offending before age 20. Participants were then followed until age 50 and reexamined regarding violent, nonviolent, and substance-related crimes. Associations between subgroups before age 20 and subgroups age 21-50 were examined. Before age 20, three subgroups were identified among the females and six among the males. Males were more specialized in their offending and demonstrated higher levels of offending. Results pointed to both stability and decrease of violent and nonviolent offending, and to the emergence of substance-related offending in adulthood in both genders. The connection between substance-related crimes and general delinquency in adulthood among individuals treated for substance misuse suggests that interventions should also address substance misuse for reducing the overall volume of crime. This study also highlights the importance of including females in research on offending heterogeneity.

Adolescent non-drinkers: Who are they? Social relations, school performance, lifestyle factors and health behaviours: Health among non-drinking adolescents

INTRODUCTION AND AIMS Traditionally, non-drinking adults or young adults have been associated with health deficits rather than health benefits. However, as the proportion of Swedish non-drinking adolescents has doubled since 2000, their health profiles are of interest. The aim of the present study is to examine whether social relations, school characteristics, lifestyle factors or health behaviours distinguish adolescent non-drinkers from adolescent drinkers, and if their health profiles have changed from 2004 to 2012. DESIGN AND METHODS Data from the Survey of Adolescent Life in Vestmanland, a health survey biennially distributed to all 9th graders (15-16 years) in a medium-sized Swedish county, was used. In total, 2872 students in 2004 and 2045 students in 2012 were included. RESULTS Non-drinkers were distinguished from drinkers in both 2004 and 2012 by elevated parental supervision, a lower rate of school truancy and lower rates of cannabis use, use of other illicit drugs, daily smoking and lower scores on antisocial behaviour, but more problems of getting new friends. No differences between 2004 and 2012 were found. DISCUSSION AND CONCLUSIONS Non-drinkers presented more adaptive and healthier behaviours than their drinking peers, but it is difficult to determine whether their health benefits were related to their improved alcohol status or to the more general trend towards adaptation that occurred from 2004 to 2012 among adolescents.