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  • 1.
    Bravo, Maria J.
    et al.
    Secretaría del Plan Nacional sobre el Sida, Madrid.
    Barrio, Gregorio
    Centro Universitario de Salud Pública (CUSP), Madrid.
    de la Fuente, Luis
    Secretaría del Plan Nacional sobre el Sida, Madrid.
    Royuela, Luis
    Centro Universitario de Salud Pública (CUSP), Madrid.
    Domingo, Laura
    Proyecto Itínere, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
    Silva, Teresa
    Proyecto Itínere, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
    Reasons for selecting an initial route of heroin administration and for subsequent transitions during a severe HIV epidemic2003In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 98, no 6, p. 749-760Article in journal (Refereed)
    Abstract [en]

    Aim  To identify the most important reasons for selecting a particular route of heroin administration and for subsequent transitions during a period of epidemic HIV transmission. To study temporal trends in these reasons.

    Design  Cross-sectional survey.

    Participants  Nine hundred heroin users in three Spanish cities: 305 in Seville, 297 in Madrid and 298 in Barcelona.

    Measurements  A separate analysis was made of the reasons for five types of behaviour: (a) selecting injection as the initial usual route of heroin administration (URHA); (b) changing the URHA to injection; (c) never having injected drugs; (d) selecting the smoked or sniffed route as the initial URHA; and (e) changing the URHA to a non-injected route. Subjects were invited to evaluate the importance of each reason included in a closed list. Spontaneously self-perceived reasons were also explored in an open-ended question for each of the five types of behaviour studied.

    Findings  The primary reason selected for each type of behaviour was: (a) pressure of the social environment; (b) belief that injection is a more efficient route than smoking or sniffing heroin; (c) concern about health consequences (especially fears of HIV and overdose), and fear of blood or of sticking a needle into one's veins; (d), pressure of the social environment and (e) concern about health consequences and vein problems. For women, having a sexual partner who injected heroin played a decisive role in initiating or changing to injection. Few people spontaneously mentioned market conditions for purchasing heroin as an important reason for any behaviour, nor did many mention risk of overdose as reasons for (c) or (d).

    Conclusions  These findings should be considered when designing interventions aimed at preventing initiation of injecting or facilitating the transition to non-injected routes.

  • 2.
    Gerdner, Arne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Work.
    Diagnosinstrument för beroende och missbruk – Granskning av ADDIS validitet och interna konsistens gällande alkoholproblem2009In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 26, no 3, p. 265-276Article in journal (Refereed)
    Abstract [en]

    The Swedish National Board on Health and Welfare recommends that structured assessment instruments should be used in medical as well as in social treatment of substance misusers. These should be validated in a Swedish context. Instruments for diagnoses of dependence/abuse (DSM-IV) and dependence/harmful use (ICD-10) have been used in Sweden for many years, although not yet validated in Swedish. ADDIS, Swedish version of the American SUDDS, is used in four Nordic countries and the most often used diagnostic instrument in Sweden. This article investigates the psychometric properties of ADDIS alcohol module, including discriminant and construct validity and internal consistency. The two main constructs in DSM – dependence and abuse – as well as the seven criteria for dependence and the four criteria for abuse are studied. Further, the value of each of the 44 specific items in ADDIS for capturing these criteria is studied.

    Two samples are explored: 1) a clinical sample (n = 349; incl. 129 women) and 2) a sample of 400 men convicted for driving while intoxicated. Mean age was the same (41 ys.). Using discriminant analyses on lifetime prevalence, the items correctly classify 94 % of the cases in the two samples. Using one-factor principal component analysis to explore homogeneity of the combined samples, all 28 items on dependence and 15 of 18 items on abuse have loadings above 0,40 (R2 dependence = 0,46; abuse = 0,40). Separate analyses of the two samples, as well as on women, show similar results. Cronbach’s alpha is excellent for dependence and satisfactory for abuse in all analyses. Analyses of specific criteria show satisfactory results on dependence and acceptable on abuse. Minor revisions are proposed to make ADDIS more user-friendly and to improve some specific items. In conclusion: ADDIS has acceptable to excellent discriminant and construct validity as well as internal consistency and captures the specific criteria of DSM-IV. It has the preconditions for sensitive assessment of alcohol use disorders in men and women.

  • 3.
    Gerdner, Arne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Work.
    Framgångsfaktorer i vården vid tungt missbruk. : Inviterad presentation vid konferensen På jakt efter den kraft som utvecklar - FSS studiedagar i Åre 27-29 september. Föreningen Sveriges Socialchefer (FSS)2006Conference paper (Other scientific)
  • 4.
    Gerdner, Arne
    Mid Sweden University, Faculty of Human Sciences, Department of Social Work.
    Perspektiv på tvångsvård för alkohol- och drogproblem. : Inviterad föreläsning vid konferensen Tvangsinleggelser i Rusbehandling erfaringer, dilemmaer og muligheter, i arrangemang av Borgestadklinikken, Helse Sør og RESA (Regional for samordning og anal2007Conference paper (Other scientific)
  • 5.
    Gerdner, Arne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Work.
    Andersson, J
    Mid Sweden University, Faculty of Human Sciences, Department of Social Work.
    Specific types of childhood maltreatment predict different forms of psychosocial problems in adultsManuscript (Other academic)
  • 6.
    Gerdner, Arne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Work.
    Berglund, Mats
    Lunds Universitet, Avd för klinisk alkohol- och drogforskning.
    Översikt om tvångsvård vid missbruk – effekt och kvalitet.2009Report (Other academic)
    Abstract [sv]

    Tvångslagstiftning som möjliggör vård av vuxna personer med tungt missbruk är vanligt internationellt. I en studie av 24 europeiska länder hade 21 en sådan lagstiftning år 1999 och 19 år 2009. En begränsad litteratur finns internationellt och nationellt vad gäller randomiserat kontrollerade studier och kvasiexperimentella studier om effekt av socialt tvång. Dessutom finns ett antal förloppsstudier. Baserat på dessa studier är det möjligt att dra följande slutsatser.

    Tvångsvård där samtycke om frivillig vård ej finns ökar förutsättningarna för att vård skall komma till stånd och förbättrar fullföljandet av vården. Tvångsföreskrift kan också öka fullföljande av eftervård. Utfall av vård och eftervård som ges med tvångsföreskrift är lika bra eller bättre än utfall av motsvarande frivillig vård för motsvarande patientgrupper. Personernas problemnivå samt vårdens och eftervårdens innehåll och omfattning är avgörande för resultaten i tvångsvård, precis som i frivillig vård.

    Strukturerade behandlingsmetoder som i frivillig vård visat sig ge vara effektiva, kan användas även inom tvångsvården. Initiativ till utbildningar har tagits under senare år och det är viktigt att studera implementeringen av dem. Vårdens kvalitet är också av stor betydelse för att minska de negativa upplevelserna av tvånget som förekommer hos de flesta intagna. Denna upplevelse kan vara starkare och mer långvarig än hos dem som vårdas enligt psykiatrisk tvångslag.

    Flera stora projekt har de senaste åren inriktats på en förbättrad integrering av initial institutionsvård och strukturerad eftervård. Resultaten är lovande men ännu ej konklusiva. Studierna visar positiva behandlingsresultat. ESS-projektet är en randomiserad studie vilket ökar möjligheterna till slutsatser. Vårdkedjeprojektet och Ett kontrakt för livet är andra omfattande men ej randomiserade projekt med betoning på eftervården

  • 7.
    Gerdner, Arne
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Social Work.
    Fridell, Mats
    Effects of psychologists assessments of patients within compulsory care: A matched-control trial2007In: Proccedings. 50th International ICAA Conference on Dependencies, Stockholm, June 2007, 2007Conference paper (Refereed)
    Abstract [en]

    Introduction. Psychological assessment is usually not provided as routine within care for substance use disorders (SUD) in Sweden. A number of studies has shown that about 70-80 percent of compulsory care patients for substance use disorders suffer from additional axis-1 disorder and about 50-75 percent meet the criteria of a personality disorder (axis-2). A synthesized review with meta-regression on 32 outcome studies of compulsory care of SUD patients showed that structured psychiatric or psychological assessment was related to higher rate of total abstainers as well as the rate of improved, when patient profile and study methology was controlled for. This study explores the effect of a psychologist�s assessment in compulsory care of SUD patients for planning and implementation of after-care as well as for outcome. Methods. The study was conducted at three compulsory care institutions. The intervention group of 115 patients who were assessed by a licensed psychologist were matched with 115 who were not assessed in that way (control group). Matching criteria were age, gender, psychiatric status at intake, type of drug use, institution. Patients were interviewed 1-2 years post discharge and social workers replied to a questionnaire, using the same items. Interviews and questionnaires explored the content of after-care planning, the actual aftercare, and the outcome on substance misuse, health and social conditions. Results: Data collection was completed in the beginning of April, 2007, with at least one reply on more than 90 percent in the intervention group as well as in the control group. At the time of call for abstracts, these data were not yet analysed. At the conference, comparisons will be provided. Discussion: The findings may help us to understand the usage of psychologists´ assessment for care and after-care planning as well as for the outcomes in terms of misuse, health and social integration

  • 8.
    González-Saiz, Francisco
    et al.
    Fundaci ́ on Andaluza para la Atenci ́ on a las Drogodependencias, Sevilla, Spain.
    Lozano, M. Oscar
    Fundaci ́ on Andaluza para la Atenci ́ on a las Drogodependencias, Sevilla, Spain.
    Ballesta, Rosario
    Fundaci ́ on Andaluza para la Atenci ́ on a las Drogodependencias, Sevilla, Spain.
    Silva, Teresa
    Centro Nacional de Epidemiolog ́ ıa, Instituto de Salud Carlos III, Madrid, Spain.
    Brugal, Maria Teresa
    Agencia de Salut Publica, Barcelona, Spain.
    Bilbao, Izaskun
    Fundaci ́ on Andaluza para la Atenci ́ on a las Drogodependencias, Sevilla, Spain.
    Barrio, Gregorio
    Universidad Complutense de Madrid, Madrid, Spain.
    Domingo-Salvany, Antonia
    Unidad de Investigaci ́ on en Servicios Sanitarios, Institut Municipal.
    de la Fuente, Luis
    Centro Nacional de Epidemiolog ́ ıa, Instituto de Salud Carlos III, Madrid, Spain.
    Validity of the Severity of Dependence Scale (SDS) construct applying the Item Response Theory to a non-clinical sample of heroin users2008In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 43, no 7, p. 919-935Article in journal (Refereed)
    Abstract [en]

    Aims: The purpose of this work is to study the validity of the Severity of Dependence Scale (SDS) construct by applying Rasch models to a non-clinical sample of heroin abusers. Subjects: 982 (73% men) young people 30 years old or under (mean age 25.9 years) participated. All of them were captured from the community in the metropolitan areas of Madrid, Barcelona and Seville, between April 2002 and December 2003. Analysis: Dimensionality of the scale and calibration of items were studied using the Rating Scale model, which is a Rasch-type model. A factorial analysis was also performed to check the dimensionality of the scale. Results: The analysis of fit shows that all the items have infit and outfit values between ± 2 logits, indicating that the data fit the model and that it may be assumed to be unidimensional. The principal components analysis also showed the existence of a principal factor that explains 52.5% of the variance observed. Item calibration found that they are between +0.89 and −1.04 logits on the scale. Conclusion: The results show unidimensional structure of the SDS scale. Item calibration shows they are distributed along the continuum, which must be taken into account when calculating total scores. The study's limitations are noted.

  • 9.
    Larm, Peter
    et al.
    Maria Ungdom Research Centre, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden.
    Silva, Teresa C
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Hodgins, Sheilagh
    Maria Ungdom Research Centre, Karolinska Institutet, Stockholm County Council, Stockholm, Sweden.
    Adolescent substance misusers with and without delinquency: Death, mental and physical disorders, and criminal convictions from age 21 to 452015In: Journal of Substance Abuse Treatment, ISSN 0740-5472, E-ISSN 1873-6483, Vol. 59, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Little is known about adult outcomes of males who as adolescents sought treatment for alcohol misuse or drug use, and who additionally were engaging or not engaging in other forms of delinquency. Since the rates of negative outcomes vary in the general population, the study determined whether the sub-groups of clinic attendees fared differently as compared to males of the same age who had not sought treatment for substance misuse from age 21 to 45. Adolescent males who consulted the only substance misuse clinic in a Swedish city between 1968 and1971 were divided into four groups: ALCOHOL no drug use, no criminal offending (n = 52); ALCOHOL + D no drug use, plus criminal offending (n = 105); DRUG use, no criminal offending (n = 92); and DRUG + D plus criminal offending (n = 474). These four groups were compared to a general population sample (GP) of males matched on age and birthplace, who did not seek treatment for SM in adolescence. National Swedish registers provided data on death, hospitalizations for substance misuse (SM), mental and physical disorders, and criminal convictions. Compared to the GP, and after controlling for co-occurring adult outcomes, ALCOHOL showed elevated risks for SM hospitalization and convictions for violent crimes, and DRUG showed elevated risks for SM hospitalization, convictions for non-violent crimes, and hospitalization for psychosis. ALCOHOL + D and DRUG + D showed increased risk for SM hospitalization, violent and non-violent convictions, and DRUG + D additionally, for death, and hospitalizations for psychosis and physical illness. Misuse of alcohol without drug use or other delinquency in adolescence was associated with increased risk for convictions for violent crimes during the subsequent 25 years, in addition to SM, while adolescent drug use without other forms of delinquency was associated with increased risks for convictions for non-violent crimes, hospitalizations for SM, and non-affective psychosis. Cannabis use, with and without delinquency, was associated with subsequent hospitalization for non-affective psychosis. Consistent with contemporary studies, most adolescents treated for SM from 1968–1971 presented delinquency that was associated with an increase in risk of all adverse outcomes to age 45.

  • 10.
    Rodriguez-Llera, MC
    et al.
    Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM), Dr. Aiguader 80, E-08003 Barcelona, Spain.
    Domingo-Salvany, Antònia
    Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM), Dr. Aiguader 80, E-08003 Barcelona, Spain.
    Brugal, M.T.
    Public Health Agency (ASPB), Pl Lesseps 1, E-08023 Barcelona, Spain.
    Silva, Teresa
    Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
    Sanchez-Nubió, A
    Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM), Dr. Aiguader 80, E-08003 Barcelona, Spain.
    Torrens, M
    Psychiatry Research Unit, IMIM, Dr. Aiguader 80, E-08003 Barcelona, Spain.
    Psychiatric comorbidity in young heroin users2006In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 84, no 1, p. 48-55Article in journal (Refereed)
    Abstract [en]

    In order to determine the prevalence of psychiatric comorbidity in a population of young heroin users recruited from outside of the healthcare context, a sample was assembled by targeted sampling and nomination techniques; it was comprised of regular current users of heroin aged between 18 and 30 years and resident in Barcelona, Spain. Psychiatric evaluation was done with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) semi-structured interview. Of 149 individuals evaluated, 33% were women, whose mean age was 25.1 years; 93% received a diagnosis of heroin dependence and 71% of cocaine dependence. Thirty-two percent of the subjects had never been treated for substance use. Around two-thirds (67.1%, 95% CI: 59.6-74.7%) of the sample had lifetime psychiatric comorbidity, with antisocial personality and mood disorders being the most frequent conditions (33% and 26%, respectively). Mood, anxiety and eating disorders were more common among women than men. There were no differences in ever having been in treatment for drug use according to the presence of psychiatric comorbidity, although comorbidity was lower among those currently in treatment. Young heroin users recruited on the street presented a high prevalence of psychiatric comorbidity which was unrelated to past treatment history.

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