Change in self-reported somatic symptoms among patients in opioid maintenance treatment from baseline to 1-year follow-up.

BACKGROUND: High somatic comorbidity is common among patients in treatment for opioid use disorder (OUD). The present study aims to investigate changes in self-reported somatic health conditions and somatic symptoms among patients entering opioid maintenance treatment (OMT) programs. METHODS: We used data from the Norwegian Cohort of Patients in OMT and Other Drug Treatment (NorComt) study. Of 283 patients who entered OMT, 176 were included for analysis at a 1-year follow-up. Participants provided self-reported data during structured interviews on somatic conditions, somatic symptoms, substance use severity measures, and mental distress. A multivariable linear regression analysis identified factors associated with changes in the burden of somatic symptoms. RESULTS: Patients entering OMT reported a high prevalence of somatic conditions at the beginning of treatment, with 3 of 5 patients reporting at least one. The most prevalent condition was hepatitis C, followed by asthma and high blood pressure. Patients reported experiencing a high number of somatic symptoms. The intensity of these symptoms varied across a wide spectrum, with oral health complaints and reduced memory perceived as the most problematic. Overall, for the entire sample, there was no significant change in somatic symptoms from baseline to 1 year. Further analysis indicated that those who reported a higher burden of somatic symptoms at baseline had the greatest improvement at the 1-year follow-up. A higher number of somatic conditions and higher mental distress at baseline was associated with improvements in somatic symptoms burden at follow-up. CONCLUSIONS: Patients in OMT report a range of somatic conditions and somatic symptoms. Given the wide range of symptoms reported by patients in OMT, including some at high intensity levels, healthcare providers should take into consideration the somatic healthcare needs of individuals in OMT populations. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).

Gradual improvement in functioning and mental distress during long-term outpatient SUD treatment - A prospective pre-post study.

Background: Globally, outpatient programs for substance use disorder (SUD) treatment have gained prominence. To assess the broader clinical implications of this trend we investigated shifts in functioning experienced by outpatients undergoing treatment. Methods: We describe the clinical characteristics of a cohort of 93 SUD patients in a Norwegian outpatient treatment clinic. Using paired-samples t-tests, we examined changes in perceived functioning, mental distress, and other clinically relevant outcome variables in a 5-month time interval during the treatment course. Results: We obtained follow-up data for 67 (72%) of the included patients, with no significant difference in patient-related factors between those who completed the treatment course and those who were not assessed at follow-up. Perceived functioning increased significantly from study inclusion (Time 0) (mean 19.8, standard deviation ± 8.8) to its conclusion (Time 1) (24.3, ±9.3; t (66) = 4.5, (95% CI: 2.5-6.5, p < 0.001). We also identified significant improvement in most other measured variables, including mental distress, self-reported sleep quality, restlessness, and obsessive thinking. Substance use-related variables showed a modest, non-significant improvement at T1. Conclusion: During a 5-month course of outpatient treatment, patients' subjective experience of functioning improved significantly. Those with the lowest functioning levels at T0 improved the most. Structured monitoring may be a valuable clinical tool for personalizing intervention, enhancing treatment outcomes, and supporting the clinical decision-making process.

High smoking and low cessation rates among patients in treatment for opioid and other substance use disorders.

BACKGROUND: Smoking is a well-documented cause of health problems among individuals with substance use disorders. For patients in opioid maintenance treatment (OMT), the risk for somatic health problems, including preventable diseases associated with tobacco smoking, increases with age. Our aim was to describe smoking among patients entering substance use disorder (SUD) treatment, investigate changes in smoking from the start of treatment to 1-year follow-up, and explore factors related to smoking cessation. METHODS: We employed data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). Participants were 335 patients entering SUD treatment at 21 participating facilities across Norway. They were interviewed at the start of treatment and at 1-year follow-up. The main outcomes were smoking and smoking cessation by treatment modality. A logistic regression identified factors associated with smoking cessation. RESULTS: High levels of smoking were reported at the start of treatment in both OMT (94%) and other SUD inpatient treatment patients (93%). At 1-year follow-up most patients in OMT were still smoking (87%), and the majority of the inpatients were still smoking (69%). Treatment as an inpatient was positively associated and higher age was negatively associated with smoking cessation. Most patients who quit smoking transitioned to smokeless tobacco or kept their existing smokeless habit. CONCLUSION: As illustrated by the high smoking prevalence and relatively low cessation levels in our sample, an increased focus on smoking cessation for patients currently in OMT and other SUD treatment is warranted. Harm-reduction oriented smoking interventions may be relevant.

Impact of Impulsivity, Hyperactivity, and Inattention on Discontinuation Rate among Opioid-Dependent Patients Treated with Extended-Release Naltrexone.

Previous studies have indicated elevated levels of impulsivity, hyperactivity, and inattention (IHI) among opioid-dependent patients seeking outpatient treatment with extended-release naltrexone (XR-NTX). This led us to hypothesize that IHI may be associated with a higher discontinuation rate for XR-NTX treatment. In a group of 162 patients with opioid dependence, discontinuation prior to the full 24 weeks of the study period (six injections and attending the study visit at 24 weeks) occurred in 49% of the patients, primarily in the early stage of treatment. IHI above the clinical cut-off on the adult ADHD self-report scale (ASRS) was not associated with a risk of premature discontinuation. This finding was not altered when controlling for socio-demographics, substance, use and mental health severity. Conclusively, high levels of IHI per se is not contradictive for XR-NTX treatment in regard to concern for premature discontinuation.

The significance of the social and material environment to place attachment and quality of life: findings from a large population-based health survey.

BACKGROUND: There is an international public health interest in sustainable environments that promote human wellbeing. An individual's bond to places, understood as place attachment (PA), is an important factor for quality of life (QoL). The material environment, such as access to nature (AtN), access to amenities (AtA), or noise, and the social environment, such as social support or loneliness, has the potential to influence PA. The aim of the present study was to explore the relationship between these factors and QoL. METHODS: The study relied on data from 28,047 adults from 30 municipalities in Southern Norway obtained from the Norwegian Counties Public Health Surveys in 2019. Latent regression analyses were used to examine the relationship between the material and social environmental factors and QoL, mediated by PA. RESULTS: We found a relationship between social and material environmental factors and PA. Higher AtN and AtA scores were related to an increase in PA, whereas higher perception of noise problems was related to decreased PA scores. When social environment factors were added to the model, they were even stronger predictors of PA and, in turn, QoL through mediated effects. We also found a strong positive association between PA and QoL (unstandardized ß = 0.88, 95% CI = 0.87-0.90, p < 0.001). The whole model explained 83% of the variance in PA and 65% of the variance in QoL. CONCLUSIONS: Taken together, the findings suggest the relevance of material and social environmental factors for PA and QoL. Therefore, research on public health and QoL should include place-sensitive variables.

Effects of a brief pre-admission telephone reminder on no-show and dropout rates in substance use disorder treatment: a quasi-experimental study.

BACKGROUND: Appointment no-show and early dropout from treatment represent major challenges in outpatient substance use disorder treatment, adversely affecting clinical outcomes and health care productivity. In this quasi-experimental study, we examined how a brief reminder intervention for new patients before their first appointment affected treatment participation and retention. No-shows (not attending any sessions) and dropouts (discontinuation of initiated treatment because of three consecutively missed appointments) were compared between a period with pre-admission telephone calls (intervention) and a period without such reminders (non-intervention). METHODS: Participants were all eligible patients (N = 262) admitted to a Norwegian specialist clinic for substance use disorder treatment. We used the Chi-square test for the no-show analysis. Of the eligible patients, 147 were included in a subsequent dropout analysis. We used the number of visits up to 10 appointments as a measure for time to event. Group differences were analyzed using a Kaplan-Meier plot and the log-rank test. To control for relevant sociodemographic variables, as well as substance use and mental distress severity, we used Cox regression. RESULTS: No-show rates did not differ between the two periods (12% for non-intervention vs. 14% for intervention; χ2 = 0.20, p = 0.653). Of those consenting to participate in the dropout analysis (n = 147), 28 (19%) discontinued treatment within the time frame of 10 appointments, with no differences between the two periods (log-rank test = 0.328, p = 0.567). Controlling for baseline characteristics did not alter this finding. In fact, of the registered covariates at baseline, only higher education level was associated with attrition, linked to a reduced risk for dropout (hazard ratio = 0.85, 95% CI = 0.74-0.98, p = 0.025). CONCLUSION: These findings do not provide support for the systematic use of a brief pre-admission telephone reminder in the current treatment setting. TRIAL REGISTRATION: The study was retrospectively registered 13 Jan 2021 at ClinicalTrials.gov, NCT04707599.

Infralow neurofeedback in the treatment of substance use disorders: a randomized controlled trial.

BACKGROUND: Infralow neurofeedback (ILF-NF) was recently developed as a subtype of traditional, frequency-based neurofeedback that targets cerebral rhythmic activity below 0.5 Hz and improves brain self-regulation. The efficacy of ILF-NF in the treatment of substance use disorder has not yet been evaluated, but clinical evidence suggests that it may prevent relapse by improving functioning in various life domains. The current study aimed to fill this research gap and extend empirical evidence related to this issue. METHODS: Ninety-three patients with substance use disorders at an outpatient unit in Norway were randomized to receive 20 sessions (30 minutes each) of ILF-NF training combined with treatment as usual (TAU), or TAU alone. The primary outcome was quality of life post-treatment as an overall measure of functioning. We analyzed between-group differences using Student t tests. RESULTS: We found no significant differences in quality of life between groups. We found similar nonsignificant results for most of the secondary outcome measures, including drug use, sleep, anxiety and depression. Compared to TAU, the ILF-NF + TAU group reported significantly lower restlessness scores post-treatment (mean difference -1.8, 95 % confidence interval -3.1 to -0.5; p = 0.006).Limitations: This study was limited by broad inclusion criteria and a lack of placebo control (sham neurofeedback treatment). CONCLUSION: ILF-NF offered limited additional benefit when combined with TAU, except in the area of restlessness. Future studies could further investigate the relationship between ILF-NF, restlessness and substance use in targeted subpopulations to illuminate relapse mechanisms. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: NCT03356210.

Successful outcomes with low-threshold intervention for cannabis use disorders in Norway - an observational study.

AIMS: Cannabis is the most commonly used regulated drug by European youths. Yet, few cannabis-specific interventions have been examined in Europe. The Cannabis Cessation Program (CCP) was developed in Sweden in the 1990s and has been implemented in some Norwegian municipalities. The present study aimed to examine outcomes of this intervention in the Norwegian setting. METHOD: The respondents (N = 102) were recruited in four community-based CCPs in Norway. We examined their changes in cannabis use, other substance use, mental distress, well-being, sense of coherence (SoC), and social networks, from baseline (T0) to post-treatment (T1) and up to a 3-month follow-up period (T2). Changes were evaluated with pair-wise t-tests. RESULT: Seventy-six participants (75%) completed the 8-week program, according to plan. All participants reported a significant reduction in cannabis use at T1 (average reduction ~16 days per month) and at T2 (N = 59; ~13 days per month). Among those that completed the program, 67% was abstinent from cannabis at T1 and 37% was abstinent at T2. An intention-to-treat analysis showed that 50% (51/102) and 22% (22/102) were abstinent from cannabis use at T1 and T2, respectively. In parallel to abstinence, we observed a substantial reduction in mental distress and an increase in well-being and SoC. Respondents socialized with fewer friends with current substance use, but drug-free social networks were not expanded. CONCLUSION: Our findings suggested that the CCP was a valuable, low-threshold manual-based intervention for cannabis use disorders. It showed considerable potential for reducing individuals' cannabis use. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov no. NCT04989205. Registered 12 July 2021, i.e., the study was retrospectively registered.

A mediational analysis of adverse experiences in childhood and quality of life in adulthood.

OBJECTIVES: This study examined associations of three prevalent adverse childhood experiences (ACEs) - parents' problematic alcohol use (PPAU), parental separation/divorce, and lack of support from a trusted adult-with adult quality of life (QoL), and potential mediators of associations. METHODS: Data were from a representative survey (N = 28,047) in Norway that assessed ACEs, QoL, and potential mediators: enduring perceptions of childhood hardships (Difficult Childhood Questionnaire; DCQ), current mental distress, and current social isolation. Latent regression analyses examined potential mediators. RESULTS: Each ACE was positively associated with perceptions of childhood as difficult (higher DCQ scores). In turn, ACEs were negatively associated with adult QoL through indirect effects. Lack of support from a trusted adult had the strongest negative association with adult QoL, compared to PPAU and parental separation/divorce. The association between the ACEs and QoL was explained through the mediators of mental distress and social isolation. CONCLUSIONS: Of the examined ACEs, lack of support from a trusted adult had the strongest negative impact on adult QoL. Adult support to vulnerable children could potentially ameliorate adult consequences of ACEs. In addition, adults reporting difficulties due to childhood adversities may benefit from therapeutic interventions that address both psychological distress and isolation.

Levels of Impulsivity, Hyperactivity, and Inattention and the Association with Mental Health and Substance Use Severity in Opioid-Dependent Patients Seeking Treatment with Extended-Release Naltrexone.

The level of impulsivity, hyperactivity, and inattention (IHI) is higher among patients with substance use disorder (SUD) than in the general population. However, the prevalence of such symptoms in patients seeking treatment with an opioid antagonist, such as extended-release naltrexone (XR-NTX), is unknown. We screened 162 patients with opioid use disorder (OUD) seeking treatment with XR-NTX in Norway using the Adult ADHD Self-Report Scale (ASRS) to estimate the prevalence of IHI alongside an assessment of mental and physical health and substance use. Sixty-six patients scored above the clinical cut-off on the ASRS. Higher levels of IHI were significantly associated with a longer history of frequent amphetamine use, current alcohol use, and greater mental distress. Mental distress was the strongest factor associated with higher levels of IHI. The introduction of screening for IHI and mental distress in opioid maintenance treatment and XR-NTX would likely improve the quality of care and enable clinicians to tailor interventions to the needs of patients with high levels of IHI to prevent treatment discontinuation.

Perceived family cohesion, social support, and quality of life in patients undergoing treatment for substance use disorders compared with patients with mental and physical disorders.

PURPOSE: Support from family and other social network elements can be important in helping patients to cope with practical and emotional consequences of diseases. The aim of the study was to examine perception of family and social support and quality of life (QoL) in patients undergoing treatment for substance use disorders (SUDs). We compared them with patients in treatment for mental disorders (MDs) and physical disorders (PDs). METHODS: We used data from a national multicenter study that recruited patients (N = 518) from three treatment domains; SUD treatment units, MD treatment units, and PD treatment units (severe neurological conditions or cancer). Data on family cohesion, social support, and QoL were compared across patient groups. In addition, data on health variables was collected. We used a multiple linear regression procedure to examine how health and support variables were associated with QoL. RESULTS: Family cohesion and social support in the SUD and MD groups were rated at similarly low levels, substantially lower than in the PD group. The SUD group exhibited a somewhat lower QoL than did the PD group, but their QoL was still in the near-to-normal range. In contrast, the MD group had markedly low QoL. When examining factors associated with QoL, we found that greater family cohesion and social support were positively associated with QoL. Mental distress was the strongest factor, and was negatively associated with QoL (beta - 0.15, 95% CI = - 0.17/- 0.14, p < 0.001). CONCLUSION: Service providers need to be aware of the weaker networks and less regulatory family and/or social support available to patients with SUDs. Providers should focus consistently on the social networks of patients and include patients' families in treatment processes.

Associations between parental alcohol problems in childhood and adversities during childhood and later adulthood: a cross-sectional study of 28047 adults from the general population.

BACKGROUND: Adverse childhood experiences (ACE) are related to adverse physical and mental health outcomes. However, few larger studies based on a general population sample with age groups ranging from young adults to elderly have investigated whether parental alcohol problems increase the risk of offspring subjective reports of ACE both during childhood and current adult adversities. The purpose of this study was to examine the associations between parental alcohol problems and adversities during childhood and later in adulthood. METHODS: The 28,047 respondents were adults (> 18 years old) from the general population who participated in the Norwegian Counties Public Health Survey. The study had a cross-sectional design and included respondents' evaluations of childhood experiences and current adult adversities. The short version of the Children of Alcoholics Screening Test (CAST-6, cut-off ≥3) measured parental alcohol problems. Multivariable logistic regression was adjusted for gender, age, and education. RESULTS: Growing up with parental alcohol problems strongly increased the risk of experiencing a dysfunctional family environment during childhood (odds ratio [OR] 6.84; 95% confidence interval [CI] 6.36-7.36), perceiving childhood as difficult (OR 5.01; 95% CI 4.58-5.49), and reporting a lack of support from a trusted adult (OR 3.07; 95% CI 2.86-3.29). Parental alcohol problems were associated with a modestly increased risk of harmful alcohol use (OR 1.38; 95% CI 1.29-1.48), but the association with struggling with bad memories was strong (OR 4.56; 95% CI 4.17-4.98). CONCLUSIONS: Parental alcohol problems increased the risk of offspring experiencing adversities during both childhood and adulthood. Providing supportive services to these children and their families and addressing this issue as part of treatment is important to prevent alcohol related harm.

Adverse childhood experiences and impact on quality of life in adulthood: development and validation of a short difficult childhood questionnaire in a large population-based health survey.

PURPOSE: A short adverse childhood experiences (ACEs) measure is needed with non-intrusive items that include subjective evaluations of childhood. We validated a short Difficult Childhood Questionnaire (DCQ) that assesses ACEs using personal perceptions of events. METHODS: The study relied on 2019 data from a representative survey (N = 28,047) in Norway. We examined the DCQ's factor structure, internal consistency, and discriminant validity in a multi-group confirmatory factor analysis. As a group variable, we used whether the respondent had the ACE of parental alcohol use disorder (adult children of alcoholics; ACOA). To assess the DCQ's convergent validity, we used latent regression analysis with adulthood quality of life (QoL) as the outcome and mental distress and loneliness as potential mediators. RESULTS: The DCQ's latent mean was 0.86 (95% CI 0.82-0.90, p < 0.001) higher in the ACOA versus the non-ACOA group. The effect size suggested a large magnitude of this difference. The DCQ score was negatively associated with QoL and positively associated with mental distress and loneliness. For the score's QoL effect [- 0.84 (95% CI - 0.87 to - 0.80, p < 0.001)], - 0.80 was indirect, and - 0.04 was direct. Thus, most of the association of DCQ with QoL occurred via mediators. CONCLUSIONS: The results confirmed the DCQ's discriminant and convergent validity and highlight this tool as an empirically supported approach to assess ACEs. Because of its brevity and psychometric strengths, the DCQ is useful for research and likely suited to mental health treatment settings.

One size doesn't fit all: a thematic analysis of interviews with people who have stopped participating in Narcotics Anonymous in Norway.

BACKGROUND: For persons with substance use disorders (SUDs), 12-step groups (TSGs) are the most available and used peer-based recovery resource, worldwide. However, disengagement is common, and attrition may partly be due to practices and procedures within these groups that are unacceptable to a portion of the population with SUDs. Our overall aim was to identify problematic issues related to Narcotics Anonymous (NA) participation in Norway, to inform addiction professionals' strategies when referring persons to addiction-related self-help groups (SHGs). METHODS: In this qualitative study, we interviewed ten individuals who had previously participated regularly in NA for at least 6 months, to examine their reasons for disengagement. We interpreted the interviews using thematic analysis. RESULTS: We identified three themes: (1) 'The model did not fit', either the strategies utilized in NA (e.g., meeting format and step working) or NA's explanatory model of addiction, (2) 'Negative experiences spurred frustration', and (3) 'The safe place can become a cage'. The respondents believed that a main aim of recovery was reintegration into society, such that SHG participation should not be an end goal, but rather a platform for normalization back into society. Despite their negative experiences and strong critique, respondents still regarded NA as a valuable recovery resource, but pointed out that one size does not fit all. CONCLUSION: Addiction professionals should recognize possible problems related to TSG participation, to help prevent negative experiences and possible harms to individuals. Professionals should also inform individuals about alternative support groups, to help them find the recovery resource best suited to them.

Discrepancy in Ratings of Shared Decision Making Between Patients and Health Professionals: A Cross Sectional Study in Mental Health Care.

BACKGROUND: A defined goal in mental health care is to increase the opportunities for patients to more actively participate in their treatment. This goal includes integrating aspects of user empowerment and shared decision-making (SDM) into treatment courses. To achieve this goal, more knowledge is needed about how patients and therapists perceive this integration. OBJECTIVE: To explore patient experiences of SDM, to describe differences between patient and therapist experiences, and to identify patient factors that might reduce SDM experiences for patients compared to the experiences of their therapists. METHODS: This cross-sectional study included 992 patients that had appointments with 267 therapists at Sørlandet Hospital, Division of Mental Health during a 1-week period. Both patients and therapists completed the CollaboRATE questionnaire, which was used to rate SDM experiences. Patients reported demographic and treatment-related information. Therapists provided clinical information. RESULTS: The analysis included 953 patient-therapist responder pairs that completed the CollaboRATE questionnaire. The mean SDM score was 80.7 (SD 20.8) among patients, and 86.6 (SD 12.1) among therapists. Females and patients that did not use medication for mental health disorders reported higher SDM scores than males and patients that used psychiatric medications (83.3 vs. 77.7; p < 0.001 and 82.6 vs. 79.8; p = 0.03, respectively). Patients with diagnoses involving psychotic symptoms reported lower SDM scores than all the other patients (66.8 vs. 82.3; p < 0.001). The probability that a patient would report lower SDM scores than their therapist was highest among patients that received involuntary treatment (OR 3.2, p = 0.02), patients with treatment durations longer than 2.2 years (OR 1.9, p = 0.001), and patients that required day care or in-patient care (OR 3.2, p = 0.01 and OR 3.2, p < 0.001, respectively). CONCLUSION: We showed that both therapists and patients reported good SDM experiences in decisional situations, which indicated that SDM was implemented well. However, the SDM scores reported by in-patients and patients with prolonged or involuntary treatments were significantly lower than scores reported by their therapists. Our findings suggested that it remains a struggle in mental health care to establish a common understanding between patients and therapists in decisional processes regarding treatments for some patient groups.

Can a Smartphone App for Cannabis Cessation Gain a Broader User Group than Traditional Treatment Services?

BACKGROUND: Treatment demand for cannabis use disorders is increasing in Europe. Mobile phone- and internet-based interventions for cannabis users can possibly help meet the need. The purpose of this study was to examine whether a recently developed Norwegian Cannabis Cessation app reaches a broader or different user group compared to community-based Cannabis Cessation programs (CCP, Nordic abbreviation: HAP). METHOD: The app respondents (n = 148) were recruited through an online link in the app. A comparative sample (n = 102) was recruited in three municipally based CCPs in Norway. We examined whether app users differed from the CCP population in sociodemographics, substance use, mental health, and well-being. RESULT: The app group included more women than the CCP group (46% versus 26%, χ2 = 10.9, P = .001), but otherwise the groups were similar for sociodemographic variables. Severity of cannabis use did not differ between groups, but the app sample exhibited a higher depressiveness score on the Hopkins Symptom Checklist (mean difference, 0.24; 95% CI 0.04-0.44; P = .018) and lower perceived well-being (3.4 point lower score on the Outcome Rating Scale; 95% CI -5.7 to -1.2; P = .003). Well-being was negatively associated with being in the app group, being older, and having higher levels of mental distress, and was positively associated with the perceived ability to make changes ('self-efficacy of quitting'). CONCLUSION: The higher proportion of women in the app group indicated that the app did capture an expanded segment of the cannabis-using population. The app can be an alternative for those who are not yet prepared to seek treatment in formal healthcare services. The high level of depressive symptoms and lower levels of well-being among the app respondents suggest that some app users might need additional support.

Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport.

This cross sectional study examined patients' perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting. The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire. Diagnosis and treatment information were obtained at the clinical visits and from patient records.Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study. The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86-89) and a convergent validity toward the available variables. The MedSupport mean score was 3.8 (standard deviation.9, median 3.8). Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support. Patients diagnosed with behavioral and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.The MedSupport inventory was suitable for assessing the patients' perceived support from health care service regarding their medication. Awareness of differences in patients' perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.

How do psychological characteristics of family members affected by substance use influence quality of life?

PURPOSE: Addiction is a major health stressor for families, representing an under-researched area with important policy implications. The current aim was to validate the Composite Codependency Scale, which captures the psychological characteristics of affected family members, and assess quality of life as mediated by family functioning. METHODS: Close relatives (n = 271) of patients in treatment for substance use disorder (SUD) participated in a 4-day psychoeducational program. We also recruited a general population sample (n = 393) via an online social media site. Data were analyzed using multigroup confirmatory factor analysis (MGCFA) and a latent regression model. Differences in subscale latent means were applied to ascertain how the scale discriminated the two populations. RESULTS: MGCFA yielded a shortened, nine-item partial scalar invariant scale (SCCS) that allowed comparison of latent means. The SCCS discriminated between family members and the general population, with family scoring higher on all three scale dimensions. By effect size, family had higher means (mean differences; 95% confidence intervals) for 'emotional suppression' (0.48; 0.36-0.59; p < 0.001; effect size, 0.92), 'interpersonal control' (0.47; 0.36-0.59; p < 0.001; effect size, 0.97), and 'self-sacrifice' (0.20; 0.10-0.29; p < 0.001; effect size, 0.43). Higher SCCS scores were associated with greater family dysfunction (ß = 1.00, 95% CI 0.63-1.36; p < 0.001) and worse quality of life (ß = - 0.23, 95% CI - 0.30 to - 0.16; p < 0.001), confirming the concurrent validity of the SCCS. CONCLUSION: When family members of people with addictions had the psychological characteristics of suppressing their emotions, believing they could fix others' problems, and neglecting their own for others' needs, they also had more family dysfunction and poorer quality of life. The SCCS offers a valid instrument for addressing the life situation of affected families. This scale can help clinicians focus on family members within health services, especially within SUD treatment services.

Use of drugs for alcohol use disorder in Norway 2004­16. / Bruk av medikamenter for alkoholbrukslidelser i Norge 2004­16.

BACKGROUND: Alcohol use disorder can lead to serious illness and early death. The lifetime prevalence rate among the Norwegian population is estimated at 7-10 %. Many patients are never admitted to any kind of treatment programme, and it is assumed that few of those who are treated receive medicinal treatment. There are a variety of drugs on the market that can help reduce alcohol consumption and maintain abstinence. We wanted to gain an insight into the prescription prevalence rate and practice for these drugs. MATERIAL AND METHOD: We obtained encrypted data from the Norwegian Prescription Database of everyone who received drugs for alcohol use disorder in the period 2004-2016. The drugs included were disulfiram, acamprosate, naltrexone 50 mg and nalmefene. RESULTS: The annual prescription prevalence rate increased from 0.85 to 1.13 per 1000 during the observation period. Half of all patients only received prescribed drugs once, and Disulfiram was the most commonly prescribed drug. There was a slight increase in the prevalence rate in age groups up to and including 55 years, and a significant increase for the over-55s. CONCLUSION: There was a slight increase in the prescription prevalence rate during the observation period. Disulfiram was the most commonly prescribed drug. The prescription increase was greatest among women and in the group of over-55s.

Perceived quality of life in partners of patients undergoing treatment in somatic health, mental health, or substance use disorder units: a cross-sectional study.

BACKGROUND: This study explores (1) differences in socio-demographic, social/familial, and health variables and perceived quality of life (QoL) among partners of patients with somatic illness, mental illness, or substance use disorder (SUD); and (2) identifies factors associated with QoL. METHODS: Participants (N = 213) in this cross-sectional study were recruited from inpatient or outpatient services in five hospitals in Norway, 2013-2014. QoL was measured by the QoL-5, a generic five-item questionnaire. Differences between groups were examined using Chi-square for categorical variables and Kruskal-Wallis for contiuous variables. Multiple linear regression analyses were used to examine factors associated with QoL. RESULTS: The mean QoL score was similar to that of a general population sample, and 13% of the sample had a markedly low QoL. Partners in the SUD group experienced worse socio-demographic conditions in terms of occupation and income, but QoL did not differ significantly among the three groups. In a regression model, perceived family cohesion was positively associated with QoL while psychological distress (Symptom Checklist-10) was negatively related to it. The model explained 56% of the variance in QoL. CONCLUSIONS: When patients are ill, clinicians should consider the partners' QoL, and brief QoL tools can be used to identify those who are struggling most. Reduced QoL is associated with higher psychological distress and lower family cohesion. Treatment initiatives focusing on these themes may serve as preventive measures to help the most vulnerable families cope with their difficult life situation.