Effects of a multi-component alcohol prevention program in the workplace on hazardous alcohol use among employees.

BACKGROUND: The workplace can be affected negatively by hazardous alcohol use, and intervening at an early stage remains a challenge. Recently, a multi-component alcohol prevention program, Alcohol Policy and Managers' skills Training (hereafter, 'APMaT'), was delivered at the organizational level. In a previous outcome evaluation, APMaT appeared to be effective at the managerial level. The current study takes a step further by aiming to evaluate the effectiveness of APMaT in decreasing the alcohol risk level among employees. METHODS: Data from 853 employees (control: n = 586; intervention: n = 267) were gathered through a cluster-randomized study. To analyze changes in the odds of hazardous alcohol use among employees, multilevel logistic regression was applied using group (control vs. intervention), time (baseline vs. 12-month follow-up), and the multiplicative interaction term (group × time) as the main predictors. The intervention effect was further adjusted for sociodemographic characteristics and policy awareness. RESULTS: No statistically significant difference was observed in the odds of hazardous alcohol use, although employees in the intervention group showed a larger decrease compared to the control group. This remained even after adjusting for several factors, including the sociodemographic factors and policy awareness. CONCLUSIONS: The findings are insufficient to determine the effectiveness of APMaT at the employee level at the current stage of the evaluation. Future studies should strive to identify issues with implementation processes in workplace-based alcohol interventions. TRIAL REGISTRATION: The trial was retrospectively registered on 11/10/2019; ISCRTN ID: ISRCTN17250048.

The Association Between Problem Gambling and Suicidal Ideations and Attempts: A Case Control Study in the General Swedish Population.

The association between problem gambling and suicidal behaviours is well established in treatment seeking populations, but less explored among sub-clinical problem gamblers in the general population. The aim of this study was to examine the association between problem gambling (including moderate risk gambling) and suicidal ideations/suicide attempts, in the general Swedish population. Another aim was to compare problem gamblers with and without suicide ideation/attempts. A case-control study nested in the Swelogs cohort was used. Both ideations and attempts were about twice as frequent among the cases compared to the controls. After controlling for socio-economic status and life-time mental health problems, suicidal ideation, but not attempts, remained significantly higher among the cases compared to the controls. The largest difference between attempters and non-attempters were on payment defaults and illicit drug abuse, whereas depression yielded the largest difference between ideators and non-ideators. Problem gambling severity (PGSI 8+) resulted in the smallest difference, compared to the other variables, between attempters and non-attempters. Even though no conclusion regarding the casual relationship can be drawn in this type of study, it seems like sub-clinical levels of problem gambling might have an impact on suicidal ideations whereas for suicide attempts to occur, other factors need to be present. In addition to mental health issues, financial difficulties may be such factors.

Problem gambling and anxiety disorders in the general swedish population - a case control study.

Co-occurring psychiatric comorbidity is high among problem gamblers, and anxiety disorders has repeatedly been linked to problem gambling. Less conclusive, however, is the association between problem gambling and specific anxiety disorders. The aim of this study is to examine the association between problem gambling and specific anxiety disorders in subgroups of gender, age and socio-economic status (SES) in the general Swedish population. A case-control design was employed - nested in the Swedish longitudinal gambling study cohort. All anxiety disorders studied - Panic Disorder, Social Phobia, Generalized Anxiety Disorder (GAD) and Post-Traumatic Stress Disorder (PTSD), were significantly associated with problem gambling, however the pattern differed across subgroups. Social Phobia was the anxiety disorder most commonly associated with problem gambling across subgroups. The strongest associations between problem gambling and various anxiety disorders were found in participants under the age of 25, among females, and in the group with middle SES. In those groups three of the four anxiety disorders studied were significantly associated with problem gambling, with different patterns. Quite remarkably, participants under the age of 25 had three times higher risk of having had GAD compared to their controls. Efforts to prevent an escalation of either gambling or anxiety could target the presented vulnerable groups specifically.

Autistic Personality Traits and Treatment Outcome for Alcohol Use Disorders.

ABSTRACT: The importance of personality traits for the outcome of psychiatric treatment, including treatment for alcohol use disorder (AUD), has been widely acknowledged. Also, research on autism spectrum disorders has evolved in recent years, emphasizing that the behavioral traits within these neuropsychiatric disorders exist on a dimension both within and outside the boundaries of psychopathology. In the present study, the relationship between personality traits associated with autistic functioning and level of alcohol use among patients before and after concluded AUD treatment was investigated. The participants (n = 165, diagnosed with AUD) were part of a longitudinal project on AUD treatment. Data from personality questionnaires (Structured Clinical Interview of Personality Disorders II and Temperament and Character Inventory) were used to assess autistic personality traits (APTs) based on behavior within Wing's triad, which were related to background and treatment outcome. The chosen APT items illustrated a personality functioning with an emphasis on social interaction and rigidity. Only certain included questions were indicative of still having a problematic drinking pattern 2.5 years after treatment entry, which adhered to phobic, obsessive-compulsive, and schizoid personality traits, as well as rigidity/stubbornness. Albeit with modest influence, the degree of APTs was associated with heavier drinking at treatment entry, and symptoms relating to social interaction and rigidity were associated with still having a problematic drinking pattern 2.5 years after treatment entry. A higher degree of such traits may result in having problems taking advice from others and establishing treatment alliance, important parts of treatment efficacy, making assessment of such traits relevant to clinicians.

School ethos and adolescent gambling: a multilevel study of upper secondary schools in Stockholm, Sweden.

BACKGROUND: Gambling is not uncommon among adolescents, and a non-trivial minority has serious problems with gambling. Therefore, enhanced knowledge about factors that may prevent against problematic gambling among youth is needed. Prior research has shown that a strong school ethos, which can be defined as a set of attitudes and values pervading at a school, is associated with a lower inclination among students to engage in various risk behaviours. Knowledge about the link between school ethos and adolescent gambling is however scarce. The aim of the study was to investigate the association between teacher-rated school ethos and student-reported gambling and risk gambling, when controlling also for sociodemographic characteristics at the student- and the school-level. METHODS: Data from two separate cross-sectional surveys were combined. The Stockholm School Survey (SSS) was performed among 5123 students (aged 17-18 years) in 46 upper secondary schools, and the Stockholm Teacher Survey (STS) was carried out among 1061 teachers in the same schools. School ethos was measured by an index based on teachers' ratings of 12 items in the STS. Adolescent gambling and risk gambling were based on a set of single items in the SSS. Sociodemographic characteristics at the student-level were measured by student-reported information from the SSS. Information on sociodemographic characteristics at the school-level was retrieved from administrative registers. The statistical method was multilevel regression analysis. Two-level binary logistic regression models were performed. RESULTS: The analyses showed that higher teacher ratings of the school's ethos were associated with a lower likelihood of gambling and risk gambling among students, when adjusting also for student- and school-level sociodemographic characteristics. CONCLUSIONS: This study showed that school ethos was inversely associated with students' inclination to engage in gambling and in risk gambling. In more general terms, the study provides evidence that schools' values and norms as reflected by the teachers' ratings of their school's ethos have the potential to counteract unwanted behaviours among the students.

Snus cessation patterns - a long-term follow-up of snus users in Sweden.

BACKGROUND: Several studies have investigated the role of snus as an aid to become smoke-free, but few have focused on who use snus, how they perceive snus use, why and how they quit, and their perception of being non-snus users. The purpose of this paper is to describe snus cessation patterns. METHODS: Respondents are part of a 7-year follow-up of former smokers in Sweden. Initially, 1400 respondents were contacted regarding participation and 705 answered a web-based survey (response rate 50%). Out of them, 118 had used snus. The analyses include percentage distributions, as well as factor analyses of inventories, and configural frequency analysis in order to examine configurations of snus-related patterns. RESULTS: Over 80% found snus of great importance to succeed with smoking cessation and half of them continued to use snus on a long term. Those who experienced both physical and psychological effects of switching to snus were the ones who continued and vice versa; those who did not experience such effects quit using snus. None made use of professional help but had their own strategies (60%), and most respondents who quit obtained psychological benefits (68%). CONCLUSIONS: The distinction between the concepts smoke-free, tobacco-free, and nicotine-free contributes to nuances in the debate on snus as harm reduction. Continued snus use does not mean that snus is not an effective aid to become smoke-free. Snus cessation is mostly mentioned in relation to advices on how to succeed, but the cessation process has rarely been described; therefore, this study expands the knowledge on this quite neglected topic and contributes to a more nuanced picture of snus cessation.

Autistic traits in mentalization-based treatment for concurrent borderline personality disorder and substance use disorder: Secondary analyses of a randomized controlled feasibility study.

Autism is suggested to be a dimensional construct and often represents a comorbid state. However, research on the clinical implications of the presence of autistic traits is scarce. This study aimed to investigate the impact of subclinical autistic traits in mentalization-based treatment (MBT) for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Based on the data of a randomized controlled feasibility study by Philips, Wennberg, Konradsson, and Franck (2018), secondary analyses were conducted. It was tested, if patients' (N = 46) levels of autistic traits were associated with treatment outcome measured in the course of and after treatment using interviews and self-report measures. Participants' autistic traits were not associated with the change in the severity of BPD throughout and at the end of the treatment. However, results showed associations between autistic traits and the change in patients' consumption of alcohol in the course of MBT. Furthermore, there was an association between autistic traits and the change in mentalizing capacity at the end of MBT, indicating that elevated autistic traits were associated with an improvement in mentalizing capacity. Autistic traits on a subclinical level do not appear to be a complicating factor in MBT for concurrent BPD and SUD. On the contrary, in terms of mentalizing capacity autistic traits might be associated with a larger potential for improvement or facilitate treatment outcome. Further research is needed to explore the role of higher autistic traits in treatment of this special patient group.

Alcohol habits in Sweden during 1997-2018: a repeated cross-sectional study.

Aims: This study describes changes in alcohol habits in age and gender strata among the Swedish general population during the 21-year period following the Swedish EU membership in 1995. Methods: The Alcohol Use Disorders Identification Test (AUDIT) was distributed as a postal questionnaire to randomly selected cross-sectional samples every fourth year, starting in 1997. Results: Six samples were included in this study. A comparison between 2014 and 2018 showed a tendency to decreasing average total AUDIT scores, particularly among men and in the youngest age group (Cohen's d = 0.28). Conclusion: The results should be understood in the context of declining response rates in this type of survey.

Concurrent validity of the Alcohol Use Disorders Identification Test (AUDIT) in relation to Alcohol Use Disorder (AUD) severity levels according to the brief DSM-5 AUD diagnostic assessment screener.

Aims: The Alcohol Use Disorders Identification Test (AUDIT) is a well-established and widely used screening instrument. It has been shown that AUDIT has good criterion validity in relation to alcohol abuse and dependence according to DSM-IV, but it has not yet been validated following the introduction of the DSM-5 diagnostic system. The aim of this study was to evaluate concurrent validity for the AUDIT in relation to self-reported DSM-5 severity levels for Alcohol Use Disorder (AUD) in a Swedish general population sample. Methods: A postal questionnaire, containing the AUDIT and the 13-item brief DSM-5 AUD diagnostic assessment screener, was sent to a random sample of 1,500 persons drawn from the Swedish population, aged between 17 and 80 years and having a public residence address in Sweden. To evaluate the concurrent validity of AUDIT in relation to DSM-5 severity criteria for AUD, a Receiver Operating Characteristics (ROC) curve analysis was conducted. Results: Area under the curve (AUROC) showed excellent differentiation between AUD or not, mild (.93), moderate (.92) and severe (.99). Higher individual AUDIT scores were associated with more severe levels of AUD according to the DSM-5 screener. The optimal cutoff scores approximate earlier research on the DSM-IV and were identified as 5, 7 and 13 points, respectively, for mild, moderate and severe AUD. Conclusions: Our findings indicate that AUDIT is a valid screener for detecting concurrent AUD at three severity levels in the Swedish general population.

TAQ1A1 Allele of the DRD2 Gene Region Contribute to Shorter Survival Time in Alcohol Dependent Individuals When Controlling for the Influence of Age and Gender. A Follow-up Study of 18 Years.

AIMS: To investigate the influence of the A1 allele of the TAQ1A polymorphism in the dopamine D2 receptor (DRD2) gene region on mortality in adult individuals with alcohol dependence. METHODS: The study sample consisted of 359 alcohol-dependent individuals treated for severe alcohol withdrawal symptoms in 1997. Years of survival was studied in an 18-year follow-up. In the analyses, gender and age were controlled for. RESULTS: At the 18-year follow-up, 53% individuals had deceased. The analyses showed that older age (P < 0.001), male gender (P < 0.05) and carrying the A1 allele (P < 0.01) all significantly and independently contributed to shorten years of survival. Among the deceased individuals, the genotype A1+ was the only significant contributor to shorten years of survival. CONCLUSIONS: An important contribution of the present study is that in alcohol dependence the Taq1A1 allele of the DRD2 gene region is a risk factor for premature death of similar importance as the well-known risk factors of age and gender. SHORT SUMMARY: We investigated the influence of A1 allele of the TAQ1A polymorphism in DRD2 receptor gene region on mortality in alcohol-dependent individuals in an 18-year follow-up. Age, gender and the A1 allele contributed to shorten years of survival. Among the deceased, the A1+ was the only contributor to shorten years of survival.

Mentalization-Based Treatment for Concurrent Borderline Personality Disorder and Substance Use Disorder: A Randomized Controlled Feasibility Study.

AIMS: There is a scarcity of clinical trials on psychological treatments for concurrent borderline personality disorder (BPD) and substance use disorder (SUD). Mentalization-based treatment (MBT) have shown efficacy in several trials on BPD. The aim of the present study was to examine the feasibility and effectiveness of MBT for concurrent BPD and SUD. METHODS: Patients (n = 46) with concurrent BPD and SUD were randomized either to MBT in combination with SUD treatment (n = 24) or to SUD treatment alone (n = 22). Outcome was measured after 18 months using objective data, as well as interview and self-report measures. RESULTS: There was no significant difference between the groups on any outcome variable. No suicide attempts occurred in the MBT group in contrast to 4 suicide attempts that occurred in the control group - a difference that did not reach statistical significance (p = 0.06). A majority of the therapists did not show sufficient MBT adherence and quality. CONCLUSION: MBT for patients with concurrent BPD and SD does not appear to be harmful; on the other hand, it is possibly helpful in reducing the risk involved in suicide attempts.

Motivational interviewing does not affect risk drinking among young women: A randomised, controlled intervention study in Swedish youth health centres.

AIM: The aim of this study was to analyse risk and binge drinking at 12-month follow-up in young women with risk drinking who received motivational interviewing compared with controls. METHODS: Young women attending Swedish youth health centres were randomised into intervention or control groups. The intervention group members were asked about their alcohol consumption by a midwife/social worker using the Alcohol Use Disorders Identification Test Consumption. A score of ⩾5 was used as the cut-off value for risk drinking. Participants with risk drinking in the intervention group received motivational interviewing within the same visit. Participants in the control group had a regular visit with a midwife/social worker and answered the same questions about alcohol consumption in a questionnaire after their visit. A questionnaire with the same questions was administered to participants 12 months after baseline. RESULTS: Of 1445 eligible young women, 1051 (73%) consented to randomisation and were enrolled in the study. The follow-up rate was 54%. There was a significant decrease in risk- and binge drinking, from baseline to follow-up, in both the intervention and the control groups. Generalised estimating equation analyses demonstrated no significant effect between groups. Of participants who did not have risk drinking at baseline, about 20% in both groups had developed high-risk drinking by the 12-month follow-up. CONCLUSIONS NO SIGNIFICANT DIFFERENCES IN RISK DRINKING BETWEEN YOUNG WOMEN WHO RECEIVED MOTIVATIONAL INTERVIEWING AND CONTROLS WERE FOUND THERE WAS A LARGE INTRA-INDIVIDUAL MOBILITY IN YOUNG WOMEN'S RISK DRINKING BEHAVIOUR THIS HIGHLIGHTS THE IMPORTANCE OF FINDING RELIABLE SCREENING TOOLS THAT CAN CAPTURE THE MOBILITY IN DRINKING BEHAVIOUR IN YOUTH MORE RESEARCH IS NEEDED BEFORE RECOMMENDATIONS CAN BE MADE.

Gambling Motives in a Representative Swedish Sample of Risk Gamblers.

Motives for gambling have been shown to be associated with gambling involvement, and hence important in the understanding of the etiology of problem gambling. The aim of this study was to describe differences in gambling motives in different subgroups of lifetime risk gamblers, categorized by: age, gender, alcohol- and drug habits and type of game preferred, when considering the level of risk gambling. A random Swedish sample (n = 19,530) was screened for risk gambling, using the Lie/Bet questionnaire. The study sample (n = 257) consisted of the respondents screening positive on Lie/Bet and completing a postal questionnaire about gambling and motives for gambling (measured with the NODS-PERC and the RGQ respectively). When considering the level of risk gambling, motives for gambling were not associated with gender, whereas younger persons gambled for the challenge more often than did older participants. Card/Casino and Sport gamblers played to a greater extent for social and challenge reasons then did Lotto/Bingo-gamblers. EGM-gamblers played more for coping reasons than did Lotto/Bingo gamblers. However, this association turned non-significant when considering the level of risk gambling. Moderate risk gamblers played for the challenge and coping reasons to a greater extent than low risk gamblers motives for gambling differ across subgroups of preferred game and between gamblers with low and moderate risk. The level of risk gambling is intertwined with motives for gambling and should be considered when examining gambling reasons.

Psychometric properties of the Affect Phobia Test.

The aim of this study was to make the first evaluation of the psychometric properties of the Affect Phobia Test, using the Swedish translation - a test developed to screen the ability to experience, express and regulate emotions. Data was collected from a clinical sample (N = 82) of patients with depression and/or anxiety participating in randomized controlled trial of Internet-based affect-focused treatment, and a university student sample (N = 197). The internal consistency for the total score was satisfactory (Clinical sample α = 0.88/Student sample α = 0.84) as well as for all the affective domains, except Anger/Assertion (α = 0.44/0.36), Sadness/Grief (α = 0.24/0.46) and Attachment/Closeness (α = 0.67/0.69). Test retest reliability was satisfactory (ICC > 0.77) for the total score and for all the affective domains except for Sadness/Grief (ICC = 0.04). The exploratory factor analysis resulted in a six-factor solution and did only moderately match the test's original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. As expected, the Affect Phobia test showed negative significant correlations in the clinical group with measures on depression (rxy  = -0.229; p < 0.01) and anxiety (rxy  = -0.315; p < 0.05). The conclusion is that the psychometric properties are satisfactory for the total score of the Affect Phobia Test but not for some of the test's affective domains. Consequently the domains should not be used as subscales. The test can discriminate between individuals who seek help for psychological problems and those who do not.

Risk Gambling and Personality: Results from a Representative Swedish Sample.

The association between personality and gambling has been explored previously. However, few studies are based on representative populations. This study aimed at examining the association between risk gambling and personality in a representative Swedish population. A random Swedish sample (N = 19,530) was screened for risk gambling using the Lie/Bet questionnaire. The study sample (N = 257) consisted of those screening positive on Lie/Bet and completing a postal questionnaire about gambling and personality (measured with the NODS-PERC and the HP5i respectively). Risk gambling was positively correlated with Negative Affectivity (a facet of Neuroticism) and Impulsivity (an inversely related facet of Conscientiousness), but all associations were weak. When taking age and gender into account, there were no differences in personality across game preference groups, though preferred game correlated with level of risk gambling. Risk gamblers scored lower than the population norm data with respect to Negative Affectivity, but risk gambling men scored higher on Impulsivity. The association between risk gambling and personality found in previous studies was corroborated in this study using a representative sample. We conclude that risk and problem gamblers should not be treated as a homogeneous group, and prevention and treatment interventions should be adapted according to differences in personality, preferred type of game and the risk potential of the games.

Estimating the size of hidden populations from register data.

BACKGROUND: Prevalence estimates of drug use, or of its consequences, are considered important in many contexts and may have substantial influence over public policy. However, it is rarely possible to simply count the relevant individuals, in particular when the defining characteristics might be illegal, as in the drug use case. Consequently methods are needed to estimate the size of such partly 'hidden' populations, and many such methods have been developed and used within epidemiology including studies of alcohol and drug use. Here we introduce a method appropriate for estimating the size of human populations given a single source of data, for example entries in a health-care registry. METHODS: The setup is the following: during a fixed time-period, e.g. a year, individuals belonging to the target population have a non-zero probability of being "registered". Each individual might be registered multiple times and the time-points of the registrations are recorded. Assuming that the population is closed and that the probability of being registered at least once is constant, we derive a family of maximum likelihood (ML) estimators of total population size. We study the ML estimator using Monte Carlo simulations and delimit the range of cases where it is useful. In particular we investigate the effect of making the population heterogeneous with respect to probability of being registered. RESULTS: The new estimator is asymptotically unbiased and we show that high precision estimates can be obtained for samples covering as little as 25% of the total population size. However, if the total population size is small (say in the order of 500) a larger fraction needs to be sampled to achieve reliable estimates. Further we show that the estimator give reliable estimates even when individuals differ in the probability of being registered. We also compare the ML estimator to an estimator known as Chao's estimator and show that the latter can have a substantial bias when applied to epidemiological data. CONCLUSIONS: The population size estimator suggested herein complements existing methods and is less sensitive to certain types of dependencies typical in epidemiological data.

The psychometric properties of the AUDIT: a survey from a random sample of elderly Swedish adults.

BACKGROUND: Increasing alcohol consumption and related harms have been reported among the elderly population of Europe. Consequently, it is important to monitor patterns of alcohol use, and to use a valid and reliable tool when screening for risky consumption in this age group. The aim was to evaluate the internal consistency reliability and construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in elderly Swedish adults, and to compare the results with the general Swedish population. Another aim was to calculate the level of alcohol consumption (AUDIT-C) to be used for comparison in future studies. METHODS: The questionnaire was sent to 1459 Swedish adults aged 79-80 years with a response rate of 73.3%. Internal consistency reliability, were assessed using Cronbach alpha, and confirmatory factor analysis assessed construct validity of the Alcohol Use Disorders Identification Test (AUDIT) in elderly population as compared to a Swedish general population sample. RESULTS: The results showed that AUDIT was more reliable and valid among the Swedish general population sample than among the elderly and that Item 1 and 4 in AUDIT was less reliable and valid among the elderly. CONCLUSIONS: While the AUDIT showed acceptable psychometric properties in the general population sample, it's performance was of less quality among the elderly respondents. Further psychometric assessments of the AUDIT in elderly populations are required before it is implemented more widely.

Stability and change in alcohol habits of different socio-demographic subgroups--a cohort study.

BACKGROUND: Stability in alcohol habits varies over time and in subgroups, but there are few longitudinal studies assessing stability in alcohol habits by socio-demographic subgroups and potential predictors of stability and change. The aim was to study stability and change in alcohol habits by sex, age, and socio-economic position (SEP). METHODS: Data derived from two longitudinal population based studies in Sweden; the PART study comprising 19 457 individuals aged 20-64 years in 1998-2000, and the Stockholm Public Health Cohort (SPHC) with 50 067 individuals aged 18-84 years in 2002. Both cohorts were followed-up twice; PART 2000-2003 and 2010, and SPHC 2007 and 2010. Alcohol habits were measured with the Alcohol Use Disorders Identification Test (AUDIT), and with normal weekly alcohol consumption (NWAC). Stability in alcohol habits was measured with intraclass correlation. Odds ratios were estimated in multinomial logistic regression analysis to predict stability in alcohol habits. RESULTS: For the two drinking measures there were no consistent patterns of stability in alcohol habits by sex or educational level. The stability was higher for older age groups and self-employed women. To be a man aged 30-39 at baseline predicted both increase and decrease in alcohol habits. CONCLUSIONS: The findings illustrate higher stability in alcohol habits with increasing age and among self-employed women with risky alcohol habits. To be a man and the age 30-39 predicted change in alcohol habits. No conclusive pattern of socio-economic position as predictor of change in alcohol habits was found and other studies of potential predictors seem warranted.

Targeting individuals with problematic alcohol use via Web-based cognitive-behavioral self-help modules, personalized screening feedback or assessment only: a randomized controlled trial.

BACKGROUND/AIMS: Most problematic alcohol users never seek professional help to reduce their use, and Web-based interventions might fulfill users' unmet needs for professional support. METHODS: This randomized controlled trial compared two open Web-based interventions, one extended self-help program and one brief screening and feedback intervention, with an assessment-only control group. Participants were 633 Internet help seekers with at least hazardous alcohol use (Alcohol Use Disorders Identification Test, AUDIT ≥6 for women and ≥8 for men). RESULTS: All groups reduced their alcohol use at 3-month follow-up (p < 0.001), remaining stable at the 6- and 12-month follow-ups (n.s.) according to AUDIT-C and AUDIT scores (intention-to-treat, ITT, analysis). Per protocol (PP) analysis, including only participants who accessed the interventions and also reported accessing additional outside interventions during the trial, showed that about 75% of extended self-help participants moved from probable dependence, harmful or hazardous use to lower alcohol use levels at 3- and 6- and 12-month follow-ups, compared to about 40-60% of brief intervention users and controls who accessed extra help (p < 0.05). CONCLUSION: ITT analysis suggested parity over time for all interventions, including assessment only, in reducing problematic alcohol use. In contrast, PP analysis suggested that cognitive-behavioral extended self-help in combination with other interventions was more effective in changing alcohol use than brief intervention or assessment only.

The AVI-R2: an inventory for a differentiated diagnosis of alcohol problems.

Often in clinical practice, a diagnosis of alcohol dependence or abuse does not provide enough information to establish an adequate treatment plan. Hence, multidimensional instruments have been constructed better to describe the extent and character of a patient's alcohol problem. The purpose of the current article is to present the AVI-R2, a self-report test that provides a standardized and differentiated description of an ongoing drinking problem. The instrument includes 81 items categorized into 16 primary scales that were further summarized into four secondary scales: alcohol dependence, psychological benefits, relational complications and multiple dependence. The article provides reference values and psychometric properties of the Swedish version of the test. Data were based on 270 alcoholic patients recruited from the Centre for Dependency Disorders in Stockholm. Except for one primary scale (social complications due to drinking), the psychometric properties of the test were satisfactory. Recommendations on when and how the test can be used were also provided.