Substance Use in Swedish Adolescents : The Importance of Co-occurring Psychiatric Symptoms and  Psychosocial Risk

Aims: Study I: Identify substance use disorders (SUDs), psychiatric disorders, and psychosocial risk (PSR) in adolescence, to predict SUD after 5 years in 147 adolescents who sought treatment at a misuse-clinic. Study II: Identify alcohol risk use (ARU) and its association with psychiatric symptoms and PSR in 960 adolescents who sought treatment in general psychiatric care. Study III: Examine the effect of antisocial behavior (ASB) on the association between inattention, hyperactivity, impulsivity, and alcohol use in 3,864 adolescent students. Study IV: Examine the veracity of drug use reports comparing responses in questionnaires, in-depth interview, and hair analysis in 200 adolescent students. Results: Study I: SUDs in adolescence persisted into early adulthood. Predictors for SUD: girls who had mothers with alcohol use disorder, victimization, criminality, SUD, or SUD treatment. Study II: Prevalence of ARU was 20%. ARU increased with the number of psychiatric symptom domains. Probability of psychiatric symptoms increased with ARU. Most ARU was found in: ASB and sexual abuse. Most common in ARU: symptoms of ADHD, depression, and anxiety. Study III: ASB reduced association between inattention, hyperactivity, impulsivity, and alcohol use for boys, and hyperactivity and impulsivity for girls. Girls’ inattention continued to affect alcohol use despite the presence of ASB. Study IV: Twice as many participants reported drug use in interviews compared to questionnaires. Questionnaires and hair-analysis showed low sensitivity and high specificity. Responses from participants in less privileged socioeconomic circumstances were less reliable. Conclusions: Study I: Treatment-as-usual experienced difficulties preventing the persistence of SUD. Participants’ comorbidity and PSR must be attended to. Study II: ARU in general psychiatric care is prevalent and associated with other psychiatric symptoms, and all symptoms must be attended to simultaneously. Study III: ASB should be screened for when symptoms of ADHD are present. Inattention in girls might require special attention to prevent alcohol use. Study IV: Interviews might be an alternative to questionnaires. Hair analysis was less useful in this population, but a physical measure might function as a pipeline procedure. Responses from participants in less privileged circumstances might be interpreted with caution