The Childhood Trauma Questionnaire-Short Form (CTQ-SF) used with adolescents - methodological report from clinical and community samples.

Purpose: The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is a widely used retrospective screening tool for childhood maltreatment in adults. Its properties are less known in adolescents. The objective was to investigate acceptability and psychometric properties when used in adolescents. Method: A community sample of adolescents (n=1885) in four waves (from 13 or 14 to 17 years old) and a clinical sample (n=74, mean age 18), both from Sweden, were used to assess acceptability and different aspects of validity and reliability. Results: The CTQ-SF was found to be well-accepted. As expected, the community sample scored lower than the clinical sample on all maltreatment-scales and showed stability over-time. In the community sample, internal consistencies were substantial or excellent for all scales except Physical neglect, and in the clinical sample this was found for all scales. One-year test-retest consistencies of subscales were substantial or almost perfect, and for all scales, they increased from early to mid-adolescence. Directed inconsistencies on item level decreased from early to mid-adolescence. Convergent validity was shown in relation to scales on family climate, parental relations, and emotional health also from early adolescence. Discriminant analyses showed more moderate discriminatory ability although almost seven times better than by-chance. Conclusions: The CTQ is well accepted and can be trusted to provide consistent and valid self-reports from the age of 14 on childhood maltreatment. Some caution is advised when used with younger adolescents, since the test-retest stability is then weaker, and the interpretation of the M/D scale is more ambiguous.

Prevalence and comorbidity in a Swedish adolescent community sample - gambling, gaming, substance use, and other psychiatric disorders.

BACKGROUND: This study investigates a broad spectrum of psychiatric disorders, substance use disorders, gambling, and internet gaming disorders in Swedish 18-year-old boys and girls with the aim of estimating the prevalence of disorders and comorbidity. METHODS: We used a two-phase design with screening to detect candidates for clinical interviews. Screening included 949 adolescents (55.6% girls), out of which 758 adolescents (57.0% girls) were selected for interview with at least one of four instruments: M.I.N.I., ADDIS, NODS and IGDS. Of these, 387 (61.2% girls) were interviewed. Gender separated prevalence was estimated on the assumption that those selected but not interviewed had the same distribution as those interviewed based on similar outcomes above screening cut-offs. Comorbidity between types of disorders was estimated on similar assumptions. In addition, comorbidity between dyads of the ten most common specified disorders was calculated based on recorded data without these assumptions. RESULTS: We estimated that 14.6% met the criteria of a substance use disorder (SUD), mostly concerning alcohol and more frequent in girls than in boys. Those meeting the criteria lifetime of at least one of 16 other psychiatric disorders were 26.7%, more than twice as frequent in girls compared to boys, and with depression being the most common disorder. Gambling and gaming disorders were found almost exclusively in boys, of which 5.8% met the criteria for gambling, and 2.3% for gaming disorders. Of girls with a SUD, 40% also had a psychiatric disorder, while on the other hand more than 28% of girls with a psychiatric disorder also had a SUD. In boys with a SUD, 22% had another psychiatric disorder, while 15% of those with a psychiatric disorder also had a SUD. CONCLUSIONS: Psychiatric comorbidity is common in SUDs in adolescents, which calls for screening and diagnostic efforts in young patients presenting with symptoms of SUDs. Girls with SUDs are at higher risk of also suffering from psychiatric conditions. Gambling and gaming disorders appear in a substantial minority of adolescents and warrant further study of their comorbidity. Since prevalences and comorbidity were estimated on the assumptions mentioned, some caution in interpreting the results is needed.

Does one Size Fit All?-Linking Parenting With Adolescent Substance Use and Adolescent Temperament.

Using longitudinal Swedish data from 1,373 early-adolescent youths, this study aims to answer the question of whether the previously established protective function of parental knowledge and its sources-adolescent disclosure, parental solicitation, and parental control-on substance use among early-adolescents is moderated by the adolescent's temperament. Adolescent temperament moderated several links between parental knowledge and its sources and adolescent substance use. The most pronounced moderating results were found for those adolescents with fearless, socially detached and thrill-seeking tendencies. For these "detached thrill-seekers", bidirectional links between adolescent disclosure and substance use, and negative links between parental solicitation and substance use were found. We recommend, therefore, that adolescent temperament is considered when designing parenting programs.

Opioid maintenance treatment: trajectories in and out of treatment.

PROBLEM: Although efficacy studies of opioid maintenance treatment (OMT) have shown evidence of treatment benefits, there is still need for studies on its effectiveness in natural clinical processes. This study investigates the development in health, substance use and social conditions of those who applied for OMT, including those denied access or discharged. METHOD: First, persons assessed for admittance in 2005-2011 (n = 127) were categorized into four trajectory groups based on whether they were admitted or denied (n = 19), discharged (n = 31), readmitted (n = 21) or had been undergoing OMT without interruption (n = 56). Second, 99 of these, the analytical sample, were interviewed at follow-up using (a) the Addiction Severity Index (ASI) for seven problem-areas and housing, and (b) self-rated change in 11 problem areas. The ASI was compared to baseline interviews after 55 months (mean). Third, outcomes within groups was studied in relation to alternative interventions. RESULTS: Within the analytical sample, those denied OMT showed no improvements at group level, those discharged had some improvements, more if readmitted than if not and those with uninterrupted OMT showed the most comprehensive improvements. Those outside OMT, denied and discharged, had considerable mortality risks related to ongoing drug use, especially in lack of well-planned alternative interventions. CONCLUSION: Improvements strongly relate to access to OMT. This study underscores that access to OMT improves the situation in all areas investigated and decreases the risk for drug-related death. It underscores the importance of two major risk situations, i.e. being denied OMT and being discharged.

Aspects of the parent-adolescent relationship and associations with adolescent risk behaviors over time.

Parents' actions and knowledge of adolescents' whereabouts play key roles in preventing risk behaviors in early adolescence, but what enables parents to know about their adolescents' activities and what links there are to adolescent risk behaviors, such as substance use and delinquent behavior, remain unclear. In this study, we investigated whether different aspects of the parent-adolescent relationship predict parental knowledge, and we examined the direct and indirect longitudinal associations between these aspects of the parent-adolescent relationship and adolescents' self-reported delinquent behavior and substance use. The participants were 550 parents and their adolescent children from two small and two midsized municipalities in Sweden. Parental data were collected when the adolescents were 13 years old (mean), and adolescent data on risk behaviors were collected on two occasions, when they were 13 and 14 years of age (mean). Structural path analyses revealed that adolescent disclosure, parental solicitation, and parental control predicted parental knowledge, with adolescent disclosure being the strongest source of parental knowledge and the strongest negative predictor of adolescent risk behaviors. Parenting competence and adolescents' connectedness to parents were indirectly, through adolescent disclosure and parental solicitation and parental control, associated with substance use and delinquent behavior. Some paths differed for boys and girls. In conclusion, confident parenting and a close parent-adolescent relationship in which adolescent disclosure is promoted, seem protective of adolescent engagement in risk behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Type of opioid dependence among patients seeking opioid substitution treatment: are there differences in background and severity of problems?

BACKGROUND: The study explores differences and similarities in background and problem severity among those seeking Opioid Substitution Treatment (OST), comparing those who primarily had misused "opiates", e.g. heroin, morphine and opium, with those who primarily had misused other opioids. METHODS: Patients (n = 127) assessed for possible admittance in OST are compared based on the Addiction Severity Index. Two groups based on primary type of opioid misused are compared (opiates vs. other opioids). RESULTS: In the global severity ratings there were no significant differences between the groups other than tautological artefacts concerning heroin. There were few specific differences between the groups. The opiate group more often had Hepatitis C and more often had legal problems related to financing their misuse. Injection of drugs was the main method of administration in both groups, i.e. 90 % for mostly opiates vs. 75 % for mostly other opioids. A great majority in both groups, 96 % vs. 91 %, had misused most other types of drugs. Both groups were found to have severe problems in all areas investigated. CONCLUSIONS: The study demonstrates great similarities in problem severity among those seeking OST, both those who primarily had misused opiates and those who primarily had misused other opioids.

Drug List as a Cognitive Support to Provide Detailed Information on a Patient's Drug Use: A Comparison of Two Methods Within the Assessment of Drug Misuse and Dependence.

BACKGROUND: It is important to identify the type of drugs a patient has used, especially when polydrug misuse has increased and new drugs and patterns of misuse are quickly spread. OBJECTIVES: In order to acquire sufficient information about drug use, an effective and simple form of mapping is needed. METHODS: Persons actualized for Opioid Substitution Treatment (n = 135) were interviewed about their drug-history in a two-stage model. First, they were asked to write down the drugs misused, and dot those injected with a felt pen. Second, they were asked to do the same on a drug list provided as a cognitive support. For a subsample of 50 persons, the drug list included four fictive drugs to evaluate possible over-reporting. RESULTS: The use of a drug list did not take longer than the traditional way of using open questions, i.e. about 5-8 minutes. Using a drug list gave a cognitive support resulting in a much higher proportion/number of reported drugs. The majority, 97%, used more than one drug. None of the patients who were given the drug list that included fictive drug names reported having used any of them. The respondents reported 43 additional substances to the 125 given on the list which improve our knowledge of the drug scene. CONCLUSIONS/IMPORTANCE: Using a drug-list was superior to open questions; it does not take more time and provides additional, clinically relevant information than open questions. Using a drug-list also gives improved knowledge of new drugs entering the local drug scene.

Minimization of Childhood Maltreatment Is Common and Consequential: Results from a Large, Multinational Sample Using the Childhood Trauma Questionnaire.

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale-originally designed to assess a positive response bias-are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ's MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ's discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias-as detected by the MD subscale-has a small but significant moderating effect on the CTQ's discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.

European laws on compulsory commitment to care of persons suffering from substance use disorders or misuse problems- a comparative review from a human and civil rights perspective.

BACKGROUND: Laws on compulsory commitment to care (CCC) in mental health, social and criminal legislation for adult persons with alcohol and/or drug dependence or misuse problems are constructed to address different scenarios related to substance use disorders. This study examines how such CCC laws in European states vary in terms of legal rights, formal orders of decision and criteria for involuntary admission, and assesses whether three legal frameworks (criminal, mental and social law) equally well ensure human and civil rights. METHODS: Thirty-nine laws, from 38 countries, were analysed. Respondents replied in web-based questionnaires concerning a) legal rights afforded the persons with substance use problems during commitment proceedings, b) sources of formal application, c) instances for decision on admission, and d) whether or not 36 different criteria could function as grounds for decisions on CCC according to the law in question. Analysis of a-c were conducted in bivariate cross-tabulations. The 36 criteria for admission were sorted in criteria groups based on principal component analysis (PCA). To investigate whether legal rights, decision-making authorities or legal criteria may discriminate between types of law on CCC, discriminant analyses (DA) were conducted. RESULTS: There are few differences between the three types of law on CCC concerning legal rights afforded the individual. However, proper safeguards of the rights against unlawful detention seem still to be lacking in some CCC laws, regardless type of law. Courts are the decision-making body in 80 % of the laws, but this varies clearly between law types. Criteria for CCC also differ between types of law, i.e. concerning who should be treated: dependent offenders, persons with substance use problems with acting out or aggressive behaviors, or other vulnerable persons with alcohol or drug problems. CONCLUSION: The study raises questions concerning whether various European CCC laws in relation to substance use disorder or misuse problems comply with international ratified conventions concerning human and civil rights. This, however, applies to all three types of law, i.e. social, mental health and criminal legislation. The main differences between law types concern legal criteria, reflecting different national priorities on implicit ambitions of CCC - for correction, for prevention, or for support to those in greatest need of care.

Reliability of ADDIS for diagnoses of substance use disorders according to ICD-10, DSM-IV and DSM-5: test-retest and inter-item consistency.

BACKGROUND: This study investigates test-retest and inter-item consistency of Alcohol Drog Diagnos InStrument (ADDIS), a structured interview to diagnose substance use disorders according to ICD-10, DSM-IV and DSM-5. ADDIS, the Swedish version of SUDDS, is the only instrument in Swedish that produces diagnostic proposals specific to all drug categories, and for all three diagnostic systems. Screening of stressful life events, anxiety, and depression is also included. METHODS: Thirty patients at addiction treatment facilities were interviewed for diagnostic assessment and re-interviewed after one week. RESULTS: ADDIS has excellent internal consistency. There is also very high test-retest correlation on number of fulfilled criteria for all diagnostic systems. Agreement of diagnostic proposals is substantial, mean absolute agreement is excellent, and mean systematic correlation is almost perfect. CONCLUSION: ADDIS is a reliable tool for specific diagnostic assessment of SUDs.

Validity of the Swedish SCID and ADDIS diagnostic interviews for substance use disorders: sensitivity and specificity compared with a LEAD golden standard.

OBJECTIVE: The study explores agreement on diagnoses and diagnostic criteria for substance use disorders between two structured assessment interviews, the Structured Clinical Interview for the DSM-IV (SCID) and the Alkohol/Drog Diagnos InStrument (ADDIS). Both interviews are compared with a golden standard (GS), based on a LEAD model (Longitudinal, Expert, All Data). METHOD: Patients were interviewed concerning substance use problems by trained interviewers using SCID and ADDIS separately and blind to each other's results. SCID and ADDIS interviews were compared with each other, and both were compared with a GS. RESULTS: Satisfactory agreement exists between SCID and ADDIS on criteria as well as final diagnostic suggestions, although ADDIS tended to propose dependence diagnoses somewhat more often than SCID. Agreement between SCID and GS is moderate. Sensitivity of SCID is satisfactory, as is specificity for lifetime diagnoses, while specificity for current diagnoses is perfect. ADDIS demonstrates substantial to perfect agreement with GS on dependence diagnoses and moderate agreement on abuse diagnoses (both lifetime and current), as well as showing excellent to perfect overall sensitivity and specificity. Both instruments are in almost perfect agreement with the GS on severity ratings. CONCLUSION: Both ADDIS and SCID can be used to ensure good standards in the diagnostic assessment of substance use disorders (both alcohol and drugs), with and without psychiatric comorbidity. Significant outcomes. Both SCID and ADDIS are in good agreement with the GS based on a LEAD model concerning substance use disorders.

Sense of coherence of reindeer herders and other Samis in comparison to other Swedish citizens.

BACKGROUND: Samis are indigenous people in north Europe. In the territory called Sápmi (Lapland), reindeer herding is the traditional base for the Sami economy. The relation between living conditions and positive health of the Swedish Samis has been sparsely studied. As health is closely linked to sense of coherence (SOC), an understanding of the background factors to SOC may contribute knowledge that might be useful in promoting living conditions and health. METHODS: The study examines relations between the level of SOC and background factors from surveys in a Sami population (n=613) in comparison to a non-Sami population (n=525) in Sweden, and in comparison between 2 subsamples of Samis, that is, herders and non-herders. RESULTS: There are more similarities than differences between the Sami and non-Sami populations. However, dividing the Sami population, reindeer herders had significantly lower SOC, and in specific the subcomponent manageability, that is, less ability to use available resources to meet different demands in life, compared to non-herders. CONCLUSIONS: In addition to age and health, predictors of SOC are related to the life form of reindeer husbandry and the belonging to the herding community.

Childhood maltreatment affects the serotonergic system in male alcohol-dependent individuals.

BACKGROUND: Reduced central serotonergic neurotransmission has been demonstrated in individuals with excessive alcohol consumption and/or alcohol dependence. Childhood maltreatment has also been found to have a negative impact on central serotonergic neurotransmission. The aim of this study was to evaluate the impact of childhood maltreatment on central serotonergic dysfunction in alcohol-dependent individuals. METHODS: Adult men with a diagnosis of alcohol dependence (n = 18) were recruited from outpatient treatment units for alcoholism. Central serotonergic neurotransmission was assessed by a neuroendocrine method, that is, the prolactin (PRL) response to the selective 5-HT reuptake inhibitor citalopram. Childhood maltreatment was assessed retrospectively by the Childhood Trauma Questionnaire. RESULTS: Alcohol-dependent individuals with childhood experience of emotional abuse had significantly lower PRL response compared with those without such abuse (3 ± 5 and 64 ± 24 mU/l, respectively; t = 6.51, p < 0.001). Among those who reported childhood emotional abuse, 4 of 7 individuals had flat PRL responses in comparison with none in those with no report of such abuse (p < 0.01). CONCLUSIONS: This is the first study to show that self-reported childhood maltreatment, in particular emotional abuse, in male alcohol-dependent individuals is associated with a quite dramatic (more than 90%) reduction in central serotonergic neurotransmission. It should, however, be noted that the number of individuals is relatively small, and the results should therefore be considered as preliminary.

Factors associated with involuntary admissions among patients with substance use disorders and comorbidity: a cross-sectional study.

BACKGROUND: To investigate factors associated with involuntary admissions to hospital pursuant to a social services act of patients with substance use disorder by comparing the socio-demographic characteristics, substance use, and psychiatric comorbidities with voluntarily admitted patients. METHODS: This cross-sectional study compared two groups admitted to combined substance use disorder and psychiatry wards. Sixty-five patients were involuntarily admitted pursuant to the Social Services Act and 137 were voluntarily admitted. The International Classification of Diseases and Related Health Problems was used for diagnostic purposes regarding substance use disorders, type and severity of psychiatric problems, and level of functioning. Socio-demographic variables were measured using the European Addiction Severity Index, and the Symptom Checklist-90-R instruments were used to evaluate the range of psychological problems and psychopathological symptoms. Logistic regression was performed to investigate the relationship between involuntary admissions and patients characteristics. RESULTS: Patients who had been involuntarily admitted were more likely to be females, had utilized public welfare services more often, presented more severe substance use patterns, and had a history of more frequent visits to physicians for somatic complaints in the last 6 months, they also had fewer comorbid mental disorders. Still, considerable burdens of comorbid substance use disorders and mental disorders were observed both among involuntary and voluntary admitted patients. CONCLUSIONS: More attention is required for involuntarily admitted patients in order to meet the needs associated with complex and mixed disorders. In addition, treatment centers should offer diagnostic options and therapy regarding substance use, psychiatric and somatic disorders.

Compulsory commitment to care of substance misusers: international trends during 25 Years.

PURPOSE: The study explores international trends in law on compulsory commitment to care of substance misusers (CCC), and two subtypes - civil CCC and CCC within criminal justice legislation - as well as maximum length and amount of applications of such care. METHOD: The time period covers more than 25 years, and a total of 104 countries and territories. The study is based on available data in three times of observation (1986, 1999 and 2009). Applications of CCC in number of cases are studied on European level for the years 2002-2006. Trends are analyzed using nonparametric tests and general linear models for repeated measures. Findings are discussed from contextual analysis. RESULT: There is a trend towards decrease in the number of countries worldwide having civil CCC legislation after the millennium, while CCC under criminal law has increased since the mid-1980s, resulting in some total net decrease. The shift results in longer mean duration of CCC and an increase in the number of cases sentenced. CONCLUSION: There is a risk that the shift from civil CCC to penal CCC implies more focus on young out-acting males in compulsory treatment and that the societal responsibility for more vulnerable persons might be neglected.

Psychometric properties of the Swedish version of the Childhood Trauma Questionnaire-Short Form (CTQ-SF).

Childhood maltreatment is delicate to assess both in clinical work and in research. There is a need for assessment tools that can be easily administered in an ethical and non-intrusive way that meets requirements of conceptual validity for various types of maltreatment and is sensitive to levels of severity. This study explores the psychometric properties of the Swedish translation of one such tool-the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein and Fink, 1998). The CTQ-SF was administered to seven samples (total n=659)-five clinical samples and two non-clinical student samples. The factor structure supports the construct validity of the global maltreatment scale, four of the five maltreatment subscales (emotional abuse, physical abuse, sexual abuse and emotional neglect) and the minimization/denial (MD) scale, but not the physical neglect (PN) subscale. All items are highly correlated with their respective subscale. The discriminant validity is satisfactory. Highly significant correlation with social desirability gives further support for the MD-scale and to the recommendation of how to apply it. Internal consistency of PN is acceptable and for all other scales satisfactory. Swedish norm groups tend to score lower than similar American norm groups on abuse scales but higher on the neglect scales. Percentiles for seven gender-specific norm groups are presented. The weaknesses of the PN-scale are discussed and new constructs are proposed. The Swedish version of the CTQ-SF has the same construct validity and internal consistency as the original, including less homogeneity of the PN scale.

Caring while living apart.

In recent years, researchers have paid increasing attention to the issue of care in the new types of family and partner relationships. The aim of this study is to examine expectations and attitudes concerning care among elderly people in LAT (Living Apart Together)- relationships in Sweden, that is, people who have a long-term intimate relationship, but who do not share a common home. Questionnaires were completed by 116 elderly people in LAT-relationships. Partners are ranked as the main providers of care, especially by men, but there is considerable variation in the answers. This seems to be principally related to the degree of flexibility in this type of relationship. Some individuals see a LAT-relationship as a marriage-like relationship, while others see it primarily as a type of relationship that guarantees them the possibility of maintaining their own independent way of life.

Personality factors and drug of choice in female addicts with psychiatric comorbidity.

Female addicts (N= 108) with a mean age of 37.2 were tested using the Temperament and Character Inventory (TCI) in 1996-97. In a representative sub-sample (N = 49) assessed with the Structured Clinical Interview. DSMIIIr (SCID), 82% manifested an axis-1-syndrome (lifetime), and 53% a personality disorder. Of the 108 addicts, 42 preferred alcohol, 14 heroin, 33 amphetamines, and 19 benzodiazepines. Maturity was low, but there were no differences in maturity between drug preference groups. Results indicated that those less mature were more "novelty-seeking" and "harm-avoidant", while those maturer tended to be more persistent. Less mature persons answered less consistently. They agreed more with different items and their answers were more rare when compared to the general population. Heroin addicts were less sentimental and helpful and more aware of their own resources. Benzodiazepine and amphetamine addicts were more self-transcendent and self-forgetful. Among the relatively more mature, benzodiazepine addicts scored higher than heroin and alcohol addicts on "true" and rare answers. In conclusion, maturity and the drug of choice among female addicts were related to different TCI scales.