Clinical cutoffs of the Alcohol Use Disorder Identification Test for identification of DSM-5 alcohol use disorder: A psychometric evaluation in treatment-seeking patients.

The AUDIT is considered a gold-standard self-rating instrument used in various settings for the identification of alcohol use disorders. Although the AUDIT is widely used, there is not yet a consensus concerning the clinical cutoff for the identification of an alcohol use disorder according to the DSM-5. The current study aimed to investigate the optimal gender-based cutoffs on both AUDIT and AUDIT-C for different levels of AUD severity according to DSM-5. METHODS: A sample (n=271) was collected from two clinical trials including adult individuals with no AUD, and AUD recruited at a specialized addiction clinic, in Stockholm, Sweden. Receiver operating characteristic curves were estimated for AUDIT and AUDIT-C scores on AUD severity levels using dichotomized variables for each diagnostic level. Optimal cutoff scores were decided based on the measures of sensitivity, specificity and Youden's Index. RESULTS: The optimal cutoff score for both men and women was 7 on the AUDIT as the diagnostic threshold, i.e., mild AUD. For both moderate and severe AUD, the optimal cutoff score was 18/16 in men/women. On AUDIT-C, the optimal cutoff score was suggested to be 6/4 in men/women, and was suggested as one common cutoff score for all levels of AUD. DISCUSSION: In a treatment-seeking sample, gender-based cutoffs on AUDIT were not motivated, instead seven was suggested as the common diagnostic threshold for a mild AUD. On AUDIT-C, a general cutoff for all levels of AUDs was suggested, and gender specific cutoffs were justified to achieve optimal sensitivity to detect an AUD.

Take-Home Naloxone and risk management from the perspective of people who survived an opioid overdose in Stockholm - An analysis informed by drug, set and setting.

BACKGROUND: Take-Home Naloxone (THN) programs were introduced in Sweden in 2018 - a country with one of the highest rates of overdose mortality in the EU and a severe stigmatisation of people who inject drugs. This qualitative study builds on the international research that has expanded a previously narrow and medical focus on overdose deaths. It uses Zinberg's framework to look beyond the role of the "drug" to include the attitudes and personality of the person ("set") and contextual factors ("setting"). This study explores the impacts of THN from the perspective of overdose survivors. METHODS: Between November 2021 and May 2022 semi-structured interviews were conducted with 22 opioid overdose survivors, recruited among clients of the Stockholm needle and syringe program. All the participants had been treated with naloxone in an overdose situation. The interviews were processed through thematic analysis using deductive and inductive coding in accordance with the theoretical framework. RESULTS: Interviewees included men and women who used different types of drugs. THN has impacted on "drug" in terms of naloxone-induced withdrawal symptoms and peers having to deal with survivors' emotions. Exploring "set" revealed feelings of shame following naloxone revival for the person who overdosed. Despite such reactions, participants retained an overwhelmingly positive attitude towards THN. Participants integrated THN into their risk management practices ("setting") and some acknowledged that THN provided a new way to treat overdoses without necessarily needing to interact with authorities, especially the police. CONCLUSION: The THN program has influenced "drug, set and setting" for participants, providing increased safety at drug-intake and transferring overdose management and the burden of care to the community. The lived experience of participants also exposes the limitations of THN indicating that there are additional unmet needs beyond THN programs, particularly in terms of "setting".

Health literacy and changes in pattern of drug use among participants at the Stockholm Needle Exchange Program during the COVID-19 pandemic.

BACKGROUND AND AIMS: People who inject drugs may be particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to underlying health problems, stigma and social vulnerabilities. Harm reduction services, including needle exchange programs (NEP), have been subjected to varying degrees of disruption in the world, especially in the beginning of the coronavirus disease 2019 (COVID-19) pandemic. Compared to responses in other countries, Sweden's initial strategy toward limiting the spread and impact of COVID-19 was less restrictive to its citizens with no imposed general societal lockdown. In this study, we investigate changes in drug use patterns, utilization of NEP associated health services, COVID-19 health literacy and the prevalence of SARS-CoV-2 antibodies among NEP clients in Stockholm during the COVID-19 pandemic. METHODS: NEP visits and services provided (needles/syringes, HIV and hepatitis C tests and treatment, naloxone distributed) and overall mortality among NEP clients between January 1 and October 31, 2020, were used for trend analyses in comparison with corresponding 2019 data. Between July 27 and October 2, 2020, NEP clients (n = 232) responded to a 27 item COVID-19 Health Literacy Questionnaire. SARS CoV-2 IgG antibody tests (n = 779) were performed between June 15 and October 31, 2020. RESULTS: During the COVID-19 pandemic number of clients, client visits, naloxone distribution and HCV tests remained stable compared to 2019, while distribution of needles/syringes increased (p < 0.0001); number of HIV tests and HCV treatments decreased (p < 0.05); and mortality decreased (< 0.01). Overall, the level of health literacy concerning transmission routes and protective measures was high. SARS-CoV-2 antibody prevalence was 5.4% (95% CI 4.0-7.2). CONCLUSIONS: The Stockholm NEP managed to maintain a high level of clients and services during the pandemic. In general, COVID-19 health literacy was adequate and the overall SARS-CoV-2 antibody prevalence was low compared to the general population, which highlights a need for prioritized and targeted COVID-19 vaccination among PWID.

Individual postdecision processes in group settings.

In two experiments Differentiation and Consolidation Theory (Diff Con) (Svenson, 1992) was used to investigate individual postdecision making processes in three-member groups. It was predicted that in groups in which the subjects preferred different alternatives (conflict groups), subjects would consolidate their own preferred alternative, and not the group's final decision. A second hypothesis was that no consolidation would be indicated in groups in which all members preferred the same alternative (non-conflict groups). The results showed that in conflict groups, the members who gave up their preferred alternative (minority members) consolidated their own preference, thereby significantly regretting the group decision. In contrast, members who got their own will through in the majority decision (majority members) showed no consolidation of the group decision. The corresponding pattern of results was replicated in a second experiment, using a different decision situation. The results indicated that perceptions of social support, agreement in a group and decreasing responsibility for a group's decision, could all partly substitute consolidation by attractiveness restructuring.