Gambling consumption and harm: a systematic review of the evidence.

The total consumption model (TCM) postulates a close link between total consumption and levels of harm within the population, which has important implications for prevention. This review aimed to explore evidence relating to the application of the TCM and theoretical elements associated with it (i.e. the distribution of harms; the concentration of consumption) to gambling by reviewing evidence pertaining to the distribution of harms across the population; the concentration of gambling consumption; and evidence of the validity of the TCM in gambling. Systematic literature searches were performed using MEDLINE, PsycINFO, and Web of Science databases, restricted to publications between January 1, 2010, and March 29, 2023. The search identified seven studies examining risk curves for gambling harm, of which only two employed continuous consumption measures. This nascent literature suggests mixed evidence for the relationship between gambling consumption (e.g. losses, frequency, expenditure, and expenditure as a percentage of income) and risk of harm. Five publications found that the concentration of gambling consumption was high among those experiencing gambling harms, with some evidence that spending is more concentrated for certain games (e.g. online casinos) than for others (e.g. lotteries). Finally, four studies assessed the TCM, suggesting close association between gambling consumption and problem gambling, lending empirical support to the validity of the TCM. However, robust evidence is nascent and further research is required to assess these relationships.

Patients admitted to treatment for substance use disorder in Norway: a population-based case-control study of socio-demographic correlates and comparative analyses across substance use disorders.

BACKGROUND: Improved knowledge regarding socio-demographic correlates of people with substance use disorders (SUDs) is essential to better plan and provide adequate services for SUD patients and their families, and to improve our understanding of the complex mechanisms underlying progression into and development of various SUDs. This study aimed to: i) describe demographic, economic, and social correlates of people with SUDs in comparison with those of the general population and ii) compare these correlates across SUDs from licit versus illicit substances, as well as across specific SUDs. METHODS: A national population-based case-control study included all SUD patients enrolled in specialized drug treatment in Norway in 2009-2010 (N = 31 245) and a population control sample, frequency-matched on age and gender (N = 31 275). Data on education level, labour market participation, income level and sources, and family/living arrangement were obtained by linkages to national registers. RESULTS: Demographic, economic, and social correlates of SUD patients differed substantially from those of the general population, and across specific SUDs. Among SUD patients, those with illicit - as compared to licit - SUDs were younger (mean quotient = 0.72 [0.71-0.72]), more often had low education level (RR = 1.68 [1.63-1.73]), were less often in paid work (RR = 0.74 [0.72-0.76]) and had lower income (mean quotient = 0.61 [0.60-0.62]). Comparison of patients with different SUD diagnoses revealed substantial demographic differences, including the relatively low mean age among cannabis patients and the high share of females among sedatives/hypnotics patients. Opioid patients stood out by being older, and more often out of work, receiving social security benefits, and living alone. Cocaine and alcohol patients were more often better educated, included in the work force, and had a better financial situation. CONCLUSION: Findings revealed substantial and important differences in socio-demographic correlates between SUD patients and the general population, between SUD patients with illicit and with licit substance use, and across specific SUD patient groups.

Stronger alcohol-violence association when adolescents drink less? Evidence from three Nordic countries.

BACKGROUND: Since 2000, adolescents' alcohol use and heavy episodic drinking (HED) have declined in the Nordic countries. However, little is known about corresponding trends in alcohol-related harm and possible changes in the alcohol-harm association. The aims are to examine (i) whether the decline in HED was accompanied by a decline in alcohol-related violence (AV) and (ii) whether the strength of the HED-AV association changed concomitant with the decline. METHODS: Analysis of data from the European School Survey Project on Alcohol and Other Drugs (ESPAD), conducted among 15-16-year-olds in Iceland, Norway and Sweden in 2007 and 2015 (n = 17 027). Changes in proportions of AV and alcohol use past 12 months, and mean frequency of HED past 30 days were examined using Pearsons χ2-test and F-test, respectively. The HED-AV associations were estimated using logistic regression analysis. RESULTS: HED and AV proportions decreased from 2007 to 2015 in all countries. Among current drinkers (n = 8927), both HED frequency and AV proportion decreased in Norway (P < 0.001) and remained stable in Iceland. In Sweden, AV decreased (P < 0.001) whereas HED remained stable. The magnitude of the HED-AV association increased in Norway (Beta2015-2007 = 0.145, 95% CI 0.054-0.236), remained the same in Iceland and decreased in Sweden (Beta2015-2007 = -0.082, 95% CI -0.158 to -0.005). CONCLUSIONS: Among youth in Iceland, Norway and Sweden, heavy episodic drinking and alcohol-related violence declined from 2007 to 2015. Among drinkers, the strength of the alcohol-violence association was moderated by the extent of heavy episodic drinking.

Alcohol Problems among Prisoners: Subgroup Variations, Concurrent Drug Problems, and Treatment Needs.

BACKGROUND/AIMS: Alcohol problems in the prison population are understudied, underdetected, and undertreated. Our aims were to identify subgroups of inmates whose pre-prison drinking behavior indicated a high need for alcohol-related interventions, to assess the prevalence of concurrent alcohol and drug problems, and to compare dual-dependent inmates and those who were alcohol-dependent alone with respect to the severity of their drinking problems. METHODS: Data stemmed from the nationwide Norwegian Offender Mental Health and Addiction (NorMA) study. Both male (n = 1,356) and female (n = 90) inmates took part in the study, representing about 40% of the prison population in Norway at the time of the data collection (2013-2014). Pre-prison substance use problems were assessed using the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). RESULTS: A majority (55%) had an AUDIT positive screen (score ≥8), which is indicative of alcohol problems of some severity, and 18% were possible alcohol-dependent (score ≥20). A positive screen was associated with younger age, lower education, violent offending, driving while intoxicated (DWI), and previous criminal convictions. Two-thirds (68%) of those who screened positive on the AUDIT had also a DUDIT positive screen (score ≥6), and a similar overlap between possible alcohol dependence and possible drug dependence (score ≥25) was observed. Inmates with possible dual dependence (12% of all) had higher mean scores on the AUDIT than those with possible alcohol dependence only (7% of all). CONCLUSIONS: More than half of the prisoners in Norway had AUDIT scores that indicated they could benefit from alcohol-related interventions, and the prevalence was elevated in younger, less educated groups of previously convicted DWI, and violent offenders. Alcohol problems were most often combined with drug problems, and possible dual dependence was associated with particularly severe drinking problems.

Alcohol Use during the COVID-19 Pandemic: Self-Reported Changes and Motives for Change.

BACKGROUND: In Europe, the COVID-19 pandemic triggered a range of restrictive measures, which may have impacted alcohol consumption. OBJECTIVES: We explored perceived changes in alcohol consumption, their association with sociodemographic characteristics and past year alcohol consumption, and self-reported reasons for change after CO-VID-19 restrictions in Norway. METHOD: A web-based survey was sent to Norwegians aged 18 years and older in June-July 2020. Respondents reporting any past year alcohol use (n = 1,200) were asked whether they drank less, approximately the same, or more after the COVID-19 restrictions compared to before and reasons for drinking less or more. RESULTS: Almost a third (29.9%) reported they drank less, whereas 13.3% reported they drank more. Females, younger respondents, and Oslo residents were more likely to report both less and more drinking (p values between 0.001 and 0.029). Past year alcohol use was associated with less drinking (OR = 0.93; p < 0.001) and more drinking (OR = 1.07; p < 0.001). More drinking was also associated with living with child(ren) (p = 0.023) and high educational level (p = 0.029). The most frequently reported reasons for drinking less pertained to fewer social occasions and less on-premise drinking, whereas reasons for drinking more pertained to treating oneself to something good and fewer consequences of drinking more. CONCLUSIONS: After the COVID-19 restrictions were implemented, a substantial proportion of Norwegians changed their drinking behaviour.

Change in prevalence of self-harm from 2002 to 2018 among Norwegian adolescents.

BACKGROUND: Self-harm is prevalent among adolescents and associated with mental health problems and negative life-events. Few studies have examined changes in its prevalence related to these factors. This study explored whether changes in prevalence of self-harm among adolescents had occurred, and to what extent changes in associated factors may have contributed. METHODS: Two cross-sectional school-based surveys among adolescents (grades 8-10) in Norway were conducted in 2002 (N = 5842) and in 2017/18 (N = 29 063). Past year prevalence of self-harm and identical variables on risk factors was analyzed in hierarchical logistic regression to examine whether and to what extent changes in self-harm correlates could explain periodical change in prevalence of self-harm. RESULTS: An increase from 4.1% to 16.2% in self-harm prevalence was observed from 2002 to 2017/18. The increase was relatively larger among girls compared to boys and among 8th graders compared to 10th graders. Among the assessed risk factors for self-harm, depressive symptoms increased, while anti-social behavior, exposure to violent acts and drinking to intoxication decreased. The increase in depressive symptoms contributed to explain increase in self-harm. This contribution was outweighed by the decrease in other risk factors. CONCLUSIONS: Self-harm prevalence increased 4-fold among Norwegian adolescents over a 15-year period. While exposure to several risk factors for self-harm changed substantially in this period, these risk factors could in sum not explain any of the increase in self-harm.

The handling of evidence in national and local policy making: a case study of alcohol industry actor strategies regarding data on on-premise trading hours and violence in Norway.

BACKGROUND: Effective alcohol policy measures conflict with the interests of the alcohol industry. In this study we addressed how various alcohol industry actors in Norway have responded to research findings and police data relating to the possible impacts of changes in on-premise trading hours on violent offending. METHODS: A content analysis of documents was undertaken. The documents comprised i) hearing statements from policy processes on on-premise trading hours at the national level, and in 15 Norwegian cities, and ii) newspaper articles and other media coverage of this topic in Norway. RESULTS: Alcohol industry actors employed a range of strategies to shape the use of evidence regarding on-premise trading hours and violence. Nationally, the relevance of the international research literature was questioned before the publication of an unfavourable national study which was criticized directly. This led to commissioned attacks on the findings, constructing what were claimed to be disagreements between experts, emphasis on the complexity of violence and the role of confounding variables, and deflecting attention to alternative interventions. The handling of evidence at the local level was importantly different, where different industry actors and forms of evidence, notably police data, were involved in debates. CONCLUSION: Alcohol industry actors employed various strategies to shape perceptions and use of evidence to advance their interests. The particular strategies and arguments changed over time as new data and research became available, and also varied between the national and the local levels, and by categories of industry actors.

Prevalence of ethyl glucuronide and ethyl sulphate among patients injured when driving or at work.

AIMS: Presence of EtG or EtS among patients injured when driving or at work may indicate that very low BAC or residual effects of alcohol at the time of the accident may be associated with increased accident risk. The aim of this study was to assess: whether the alcohol metabolites EtG and EtS were present in a sample of patients injured when driving or injured at work, even if their blood alcohol concentration was negative; and, if EtG and EtS were present, what characterized these patients. METHODS: Blood samples from patients admitted for treatment of injuries at a Norwegian emergency department were tested for alcohol, EtG and EtS. All samples were also analysed for medicinal and illicit psychoactive substances. RESULTS: One hundred and ninety-two injured patients who were admitted <12 h after injury were included in the study. EtG or EtS were the most prevalent substances in the sample (17%), and a substantial proportion of the patients who tested negative for all other substances tested positive for EtG or EtS (8%). These patients were older than the rest of the sample and drank alcohol more often, according to their self-report. CONCLUSION: EtG and EtS were prevalent among patients injured when driving or injured at work, including patients negative for all other substances. EtG and EtS should be included in future case-control studies of psychoactive substance use among injured patients to investigate the possible association between residual alcohol effects and injuries.

The total sale of prescription drugs with an abuse potential predicts the number of excessive users: a national prescription database study.

BACKGROUND: Prescription drug sales may vary considerably across regions and over time. This study aimed to assess whether there is an association between mean drug sales and prevalence of excessive use in a range of psychotropic prescription drugs with an abuse potential, and if so, whether the variation in mean drug sales mostly reflects variation in the prevalence of excessive use or mostly reflects variation in non-excessive use. METHODS: Data on all filled prescriptions taken from the Norwegian prescription database for 10 drugs with an abuse potential (pain relievers, anxiolytics, and hypnotics) during one calendar year (2005) in Norway (n = 4,053,624) included number of defined daily doses (DDD). These were aggregated to individual level (n = 815,836) and county level (n = 19). RESULTS: Analyses of individual level data showed that the distribution of drug use was skewed; those who used more than 365 DDD per year accounted for almost half of the sales of both anxiolytics and hypnotics. At the county level, the mean sales per inhabitant and the prevalence of excessive users were closely correlated, but both prevalence of non-excessive use and prevalence of excessive drug use were associated with the county-wise variation in mean drug sales. CONCLUSION: Despite a strong individual control of access to psychotropic drugs through health personnel' prescribing, a small proportion of users account for a large fraction of the sales of these drugs. The sales vary significantly between regions and this variation is closely associated with the prevalence of excessive users. This suggests that sales figures as such may be used as an indicator to monitor variations in excessive use between regions and over time, and to evaluate interventions targeting over-prescription and excessive use.

Is Drinking with Parents Associated with High-Risk Drinking among Adolescents?

BACKGROUND/AIMS: What are the implications of drinking with parents (DWP) on adolescents' drinking behavior? We expanded the meagre body of research on this controversial issue by assessing the association between the frequency of DWP and adolescent high-risk drinking, taking a number of parental factors into account. METHOD: Data stemmed from a subsample of 14-17-year-old current drinkers (n = 7,616) who participated in a cross-sectional Norwegian school survey (response rate: 84%). RESULTS: One in four reported DWP during the past year. The higher the frequency of DWP, the higher was the prevalence of high-risk drinking. Parental drunkenness, permissive alcohol-related parenting, and indicators of suboptimal parenting more generally also correlated with DWP. After controlling for these confounders, only frequent DWP remained significantly associated with high-risk drinking. CONCLUSIONS: DWP was related to adolescent high-risk drinking, yet the association was in part attributable to parents' drinking and parenting style. The risk of involvement in high-risk drinking was about the same for adolescents reporting no DWP and infrequent DWP, while it was significantly elevated among those reporting frequent DWP. This study thus demonstrated that the frequency of DWP matters and that parents who drink with their adolescent children differ from other parents in important ways.

Cannabis use and violence: Is there a link?

BACKGROUND: While several studies suggest that cannabis users are at increased risk of interpersonal violence, it is not clear to what extent the association is causal. Our paper aims to assess the association between cannabis use and violence by using a method that diminishes the risk of confounding. METHODS: We analysed data on cannabis use and violent behaviour from the second (1994) and third (1999) waves of the Young in Norway Longitudinal Study (cumulative response rate: 68.1%, n = 2681). We applied fixed-effects modelling to estimate the association between these behaviours, implying that changes in the frequency of violence were regressed on changes in the frequency of cannabis use. The effects of time-invariant confounders were hence eliminated. In addition, we included two time-varying covariates. RESULTS: The elasticity estimate implies that a 10% increase in cannabis use frequency is associated with a 0.4% increase in frequency of violence (p=.024). CONCLUSIONS: Analyses of panel data on Norwegian youths reveals a statistically significant association between cannabis use and violence.

Changes in attitudes towards restrictive alcohol policy measures: the mediating role of changes in beliefs.

AIM: From 2005 to 2009, increased support for restrictive alcohol policy measures was observed in the Norwegian population. This article addresses whether this increase was mediated by changes in belief about the effectiveness of restrictive measures and belief about the harm caused by drinking. METHOD: The data were derived from five surveys conducted during the period 2005-2009 (N = 7244). In each survey, we used identical measures of attitudes towards regulation of price and availability, belief in the effectiveness of such measures and belief in the association between overall consumption and harm. RESULTS: During the period, there was an increase in support for restrictive policy measures; in belief in the effectiveness of these measures and in belief in the harm caused by drinking. Increased support for restrictive measures was partly mediated by changes in beliefs in terms of statistically significant indirect effects from both belief in the effectiveness of such measures and belief in the harm caused by drinking. Half of the increased support for restrictive measures could be attributed to changes in beliefs. CONCLUSION: Strengthening people's belief in the effectiveness of restrictive measures and in the harm caused by drinking may increase public support for restrictive alcohol policy measures.

Effect of a small increase in off-premises trading hours on alcohol sales in Norway: A stepped-wedge cluster-randomized controlled trial.

BACKGROUND AND AIMS: Evidence of the effect of limiting off-premises alcohol trading hours is still scarce. This study tested the effect of a small extension in trading hours on alcohol sales in alcohol monopoly outlets in Norway. DESIGN: The extension of trading hours was implemented within a stepped-wedge cluster-randomized trial design. Eligible state monopoly outlets (n = 229) were clustered into trade districts (n = 62), which were block-randomized to one of three sequences regarding date of implementation: 1 September 2020 (n = 21 districts, 82 outlets), 1 December 2020 (n = 21 districts, 73 outlets) and 1 March 2021 (n = 20 districts, 74 outlets). Outcomes were followed-up for a 1-year period. SETTING AND PARTICIPANTS: Study participants were state monopoly outlets in urban and rural trade districts in all parts of Norway. MEASUREMENTS: Monthly alcohol sales in litres of pure alcohol per trade district and per outlet were measured from March 2020 to March 2022 (primary outcome). We applied a linear mixed-effect model with two-way fixed effects within a difference-in-difference framework. As a robustness check we considered the effects of cross-border trade and effects in subgroups of outlets. Trading hours in monopoly outlets were extended by 1 hour on Saturdays. The extension was permanent. Pre-intervention periods and not-yet-treated units served as control conditions. FINDINGS: We did not find a statistically significant effect of the small extension in trading hours on monthly alcohol sales (i) per trade district [average treatment effect: -185.5 litres, 95% confidence interval (CI) = -1159.9, 788.9] and (ii) per outlet (-35.3 litres, 95% CI = -142.1, 72.0). These findings were consistent across estimation methods and model specifications. CONCLUSION: There is no clear evidence that a small extension in off-premises trading hours affected alcohol sales in monopoly outlets in Norway.

Changes in co-use of alcohol and cannabis among Nordic adolescents in the 21st century: Results from the European School Survey Project on Alcohol and Other Drugs study.

INTRODUCTION: In the 21st century, there has been a decline in alcohol use among adolescents in most Nordic countries, while trends of cannabis use have diverged. We explore how alcohol and cannabis use, respectively, and co-use of the two substances, have changed among Nordic adolescents. Three hypotheses are used to frame the study: (i) cannabis use has substituted alcohol use; (ii) there has been a parallel decline in both substances; and/or (iii) there has been a 'hardening' of users, implying that alcohol users increasingly use cannabis. METHODS: Data from the European School Survey Project on Alcohol and Other Drugs, conducted among 15- to 16-year-olds in Denmark, Finland, Iceland, Norway and Sweden (N = 74,700, 49% boys), were used to explore trends of past-year alcohol and cannabis use in the period 2003-2019. RESULTS: The proportion of adolescents reporting alcohol use decreased significantly in all Nordic countries except Denmark. The proportion of those using cannabis only was low (0.0%-0.7%) and stable in all countries. The total number of substance use occasions declined among all adolescents in all countries but Denmark. Among alcohol users, cannabis use became increasingly prevalent in all countries but Denmark. DISCUSSION AND CONCLUSIONS: We found no support for the 'parallel decline hypothesis' in alcohol and cannabis use among Nordic adolescents. Partially in line with the 'substitution hypothesis', cannabis use accounted for an increasing proportion of all substance use occasions. Our results suggests that the co-use of alcohol and cannabis has become more common, thus also providing support to the 'hardening' hypothesis.

Early onset of drinking and risk of heavy drinking in young adulthood--a 13-year prospective study.

BACKGROUND: Prevention programs often aim at preventing early onset of drinking (EOD) on the grounds that this may curb heavy drinking in adulthood. While many studies have shown an association between EOD and adult alcohol use disorders, these findings could be inflated by retrospective reports or insufficient control for confounders. This study examined the association between EOD behavior assessed in early adolescence and heavy drinking in adulthood, controlling for deviant behavior and parental heavy drinking. METHODS: Data were collected prospectively over a 13-year period from 1,311 Norwegian school students. At t1 (ages 13 to 14 years), onset of drinking behavior (any drinking and heavy episodic drinking), conduct problems (CP), other problem behaviors, and parental heavy drinking were assessed. At t2 (ages 26 to 27 years), heavy drinking behavior was assessed in terms of heavy episodic drinking frequency and AUDIT score. RESULTS: EOD behavior was associated with CP, other problem behaviors, and parental heavy drinking in early adolescence. A higher risk of heavy drinking in adulthood was found among those with EOD behavior, yet after control for CP, this association became small and statistically nonsignificant. Among low-risk individuals (i.e., those with no CP at t1), there was no association between EOD behavior and heavy drinking in adulthood, while there was a significant association among those with CP. CONCLUSIONS: EOD behavior appears not per se responsible for heavy drinking in adulthood unless being part of a broader array of problem behaviors.

Not early drinking but early drunkenness is a risk factor for problem behaviors among adolescents from 38 European and North American countries.

BACKGROUND: Many studies have reported that the earlier the age at first drink (AFDrink) the higher the later drinking levels and related problems. However, unless adolescents proceed into drunkenness, it is unclear why consuming small quantities at early age should lead to later problems. This study investigates the link between AFDrink and problem behaviors (smoking, cannabis use, injuries, fights, and low academic performance) among 15-year-olds who did and did not proceed into drunkenness. Among those with drunkenness experience, we tested whether AFDrink predicted problem behaviors over and above the age at first drunkenness (AFDrunk). METHODS: Multilevel structural equation models were estimated based on a sample of 44,801 alcohol-experienced 15-year-olds from 38 North American and European countries and regions who participated in the Health Behaviour in School-aged Children cross-national survey. RESULTS: Overall, there was a significant association between AFDrink and all 5 problem behaviors. However, this was the case only among those with drunkenness experiences but not among those never drunk. Among the former, AFDrunk was a strong predictor for all 5 problem behaviors, but time from first drink to first drunk did not predict problem behaviors. CONCLUSIONS: Not early alcohol initiation but early drunkenness was a risk factor for various adolescent problem behaviors at the age of 15, that is, there was not consistent relationship for the time before the first drunkenness (i.e., since first drinking). Besides targeting early drinking, particular efforts are needed to impede early drunkenness to prevent associated harm in adolescence and beyond.

Associations between heavy episodic drinking and alcohol related injuries: a case control study.

BACKGROUND: Alcohol is a significant risk factor for injuries. This study addresses 1) whether the risk of alcohol related injury increases with frequency of heavy episodic drinking (HED) in a linear fashion, and 2) whether a small group of high risk drinkers accounts for the majority of alcohol related injuries. METHODS: We applied a case - control design. Cases were BAC positive injured patients (n = 534) and controls were respondents to a general population survey in Norway (n = 1947). Age and gender adjusted association between self-reported past year HED frequency and alcohol related injury risk was estimated in logistic regression models for all alcohol related injuries and for violence injuries and accident injuries separately. RESULTS: An increase in HED was associated with an increase in risk of alcohol related injury, resembling a linear risk function. The small fraction of high risk drinkers (6.6%) accounted for 41.6% of all alcohol related injuries, thus lending support to the validity of the prevention paradox. CONCLUSION: There is a strong relationship between frequency of heavy episodic drinking and risk of alcohol related injuries, yet the majority of alcohol related injuries are found among drinkers who are not in the high risk group.

Nonsuicidal self-harm and suicide attempts in adolescents: differences in kind or in degree?

PURPOSE: The purpose of the present study was to measure the prevalence of self-harm (SH) behaviours and examine potential differences in characteristics among adolescents reporting on self-harm (SH), depending on whether they had attempted suicide (SA), performed nonsuicidal self-harm (NSSH), or both. METHODS: Cross-sectional survey of 11,440 adolescents aged 14-17 years in the city of Oslo, Norway. Responses regarding measures of lifetime SH and risk factors were collected. The response rate was 92.7%. Data were analysed by segregating SH responses into the categories of NSSH, SA, and NSSH + SA. RESULTS: Among all respondents, 4.3% reported NSSH, 4.5% reported SA, 5.0% reported both NSSH and SA, and 86.2% reported no SH. The group reporting to have engaged in both behaviours comprised more girls and reported more suicidal ideation, problematic lifestyles, poorer subjective health, and more psychological problems compared with the other groups. The four groups could be distinguished by one discriminant function that accounted for most of the explained variance. CONCLUSIONS: Our findings suggest that NSSH and SA are parts of the same dimensional construct in which suicidal ideation carries much of the weight in adolescents from a school-based sample. They also indicate the group of adolescents who seems to alternate between NSSH and SA is more burdened with mental ill-health and behavioural problems compared with others. These adolescents should therefore be targeted by clinicians and school health personnel for identification and provision of adequate help and services.

Mortality and alcohol-related morbidity in patients with delirium tremens, alcohol withdrawal state or alcohol dependence in Norway: A register-based prospective cohort study.

BACKGROUND AND AIMS: Little is known about long-term consequences of delirium tremens (DT). This study aimed to compare all-cause and cause-specific mortality and alcohol-related morbidity between patients with: (i) DT, (ii) alcohol withdrawal state (AWS) and (iii) alcohol dependence (AD). DESIGN: A national longitudinal health registry study with linked data from the Norwegian Patient Registry and the Norwegian Cause of Death Registry. SETTING: Norway. PARTICIPANTS: All patients registered in the Norwegian Patient Registry between 2009 and 2015 with a diagnosis of AD (ICD-10 code F10.2), AWS (F10.3) or DT (F10.4) and aged 20-79 years were included (n = 36 287). MEASUREMENTS: Patients were categorized into three mutually exclusive groups; those with DT diagnosis were categorized as DT patients regardless of whether or not they had received another alcohol use disorder diagnosis during the observation period or not. Outcome measures were: annual mortality rate, standardized mortality ratios (SMR) for all-cause and cause-specific mortality and proportion of alcohol-related morbidities which were registered in the period from 2 years before to 1 year after the index diagnosis. FINDINGS: DT patients had higher annual mortality rate (8.0%) than AWS (5.0%) and AD (3.6%) patients, respectively. DT patients had higher mortality [SMR = 9.8, 95% confidence interval (CI) = 8.9-10.7] than AD patients (SMR = 7.0, 95% CI = 6.8-7.2) and AWS patients (SMR = 7.8, 95% CI = 7.2-8.4). SMR was particularly elevated for unnatural causes of death, and more so for DT patients (SMR = 26.9, 95% CI = 21.7-33.4) than for AD patients (SMR = 15.2, 95% CI = 14.2-16.3) or AWS patients (SMR = 20.1, 95% CI = 16.9-23.9). For all comorbidities, we observed a higher proportion among DT patients than among AWS or AD patients (P < 0.001). CONCLUSIONS: People treated for delirium tremens appear to have higher rates of mortality and comorbidity than people with other alcohol use disorders.

A nationwide study on time spent on social media and self-harm among adolescents.

Self-harm among adolescents has increased in many countries, but few studies have examined possible explanations. One explanation could be the changes in the way adolescents socialize and use of social media. We explored the relationship between past year self-harm and time spent on social media, employing data from a nationwide cross-sectional survey among students in grades 8 through 11 in Norway (N = 37,268). The association was estimated in logistic regression models and we adjusted for identified confounders and stratified on gender, age group and depressive symptoms. A total of 16.1% of the study population reported to have self-harmed in the past year. This proportion was elevated among those spending more than 3 h daily on social media (unadjusted OR = 2.74 (CI 2.58.-2.90)). Adjustment for confounders modified the association (OR = 1.49 (CI 1.39-1.60)). In stratified analyses, adjusted OR did not differ significantly by gender or age The association between time spent on social media and self-harm was weaker among adolescents with severe depressive symptoms (adjusted OR = 1.38 (CI 1.22-1.55)), than among those with mild or no symptoms (adjusted OR = 1.70 (CI 1.56-1.86)). Risk of self-harm was elevated among those who spent 3 or more hours daily on social media, also after controlling for other factors. Further studies are needed to explore the nature and underlying mechanisms of this association. Strengthening the evidence will help informing the development of adequate measures to prevent self-harm.