Stockholm Center for Dependency Disorders

Stockholm, Sweden

Stockholm Center for Dependency Disorders

Stockholm, Sweden
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Pass A.,Stockholm Center for Dependency Disorders | Kardefelt-Winther D.,Karolinska Institutet | Franck J.,Stockholm Center for Dependency Disorders | Franck J.,Karolinska Institutet
Clinical Neuropsychiatry | Year: 2017

Objective: The aim of this study was to further investigate the relationship between internet addiction and substance use disorder by exploring the prevalence of internet addiction among patients in a substance use disorder treatment clinic and to investigate the frequency with which internet addiction co-occurs with other psychiatric disorders in this population. Method: A survey, containing questions based on the nine criteria for internet gaming disorder proposed in the research appendix to DSM-5, was administered at 24 outpatient clinics for substance use disorders within the Stockholm Centre for Dependency Disorders. Data concerning additional psychiatric diagnoses was collected from patient medical records. A total of 569 patients participated, after excluding those with missing data as well as participants who primarily gambled online, the final sample size was N=462. Results: In total, 4.1% of the surveyed patients with substance use disorder met at least five out of nine internet addiction criteria at a level of "Fairly true" or higher, and reported at least "Some suffering" as a consequence of their internet use. An independent-samples t-test comparing the mean of the total internet addiction score between groups of patients with additional psychiatric diagnoses and the rest of the sample showed that participants with any one additional non-substance related psychiatric diagnose as well as those with an anxiety diagnose had significantly higher internet addiction scores than the rest of the sample. There were no significant differences in mean internet addiction scores between participants with ADHD or depression and the remaining sample. Conclusions: This study provides preliminary evidence to suggest that internet addiction does not constitute a major clinical issue for patients in treatment for substance use disorder, lending little support to the suggestion that internetrelated problem behaviours share pathophysiology with substance use disorders. Although patients with an anxiety disorder reported elevated internet addiction scores compared to the remaining sample this finding should be replicated in a population of patients who report with anxiety disorder as their primary problem. The presence of clinically relevant co-occurrence between internet addiction and substance use disorder needs to be further investigated in larger study populations, using clinical interviews to assess both diagnoses. © 2017 Giovanni Fioriti Editore s.r.l.

Sundstrom C.,Karolinska Institutet | Kraepelien M.,Karolinska Institutet | Eek N.,Gothenburg University | Fahlke C.,Gothenburg University | And 3 more authors.
BMC Psychiatry | Year: 2017

Background: A large proportion of individuals with alcohol problems do not seek psychological treatment, but access to such treatment could potentially be increased by delivering it over the Internet. Cognitive behavior therapy (CBT) is widely recognized as one of the psychological treatments for alcohol problems for which evidence is most robust. This study evaluated a new, therapist-guided internet-based CBT program (entitled ePlus) for individuals with alcohol use disorders. Methods: Participants in the study (n = 13) were recruited through an alcohol self-help web site ( and, after initial internet screening, were diagnostically assessed by telephone. Eligible participants were offered access to the therapist-guided 12-week program. The main outcomes were treatment usage data (module completion, treatment satisfaction) as well as glasses of alcohol consumed the preceding week, measured with the self-rated Timeline Followback (TLFB). Participant data were collected at screening (T0), immediately pre-treatment (T1), post-treatment (T2) and 3 months post-treatment (T3). Results: Most participants were active throughout the treatment and found it highly acceptable. Significant reductions in alcohol consumption with a large within-group effect size were found at the three-month follow-up. Secondary outcome measures of craving and self-efficacy, as well as depression and quality of life, also showed significant improvements with moderate to large within-group effect sizes. Conclusions: Therapist-guided internet-based CBT may be a feasible and effective alternative for people with alcohol use disorders. In view of the high acceptability and the large within-group effect sizes found in this small pilot, a randomized controlled trial investigating treatment efficacy is warranted. Trial registration: (NCT02384278, February 26, 2015). © The Author(s).

Jerkeman A.,Lund University | Norkrans G.,Gothenburg University | Lidman C.,Karolinska University Hospital | Westin J.,Gothenburg University | And 6 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2014

Objectives: Opiate substitution treatment (OST) programs could provide opportunities for management of comorbidities, such as hepatitis C virus (HCV) infection, in people who inject drugs. We aimed to prospectively evaluate the real-life feasibility of interferon/ribavirin-based HCV treatment in OST recipients, with a special focus on psychiatric status and health-related quality of life. Methods: Patients from a cohort of OST recipients from three cities in Sweden were selected for HCV treatment on the basis of structured investigation for HCV-related liver disease. Therapy was delivered in collaboration between infectious disease and OST clinics, with monitoring for completion and adherence, treatment response, adverse events, health-related quality of life (HRQoL) (SF-36) and signs of depression (MADRS-S), or relapse into drug abuse. The primary endpoint was completion of prescribed treatment; the secondary endpoints were sustained virological response (SVR), adherence, and incidence of depression. Results: Among 69 patients with an indication for antiviral therapy, 41 initiated treatment; 34/41 (83%) completed treatment and 19/41 (46%) achieved SVR. Adequate adherence was observed in 29/41 patients (71%). Two serious adverse events occurred, including one death because of liver failure. Baseline scores for self-assessed health were low, with a significant reduction during treatment. Seventy-one percent of patients (29/41) fulfilled the criteria for clinically significant depression at some time point during treatment. Baseline scores for HRQoL/MADRS-S were associated with treatment completion, SVR, and depression during treatment. Conclusion: Despite the low HRQoL and the high occurrence of depression, HCV treatment was feasible and showed satisfactory rates of completion in this cohort of unselected OST recipients. © Lippincott Williams and Wilkins.

Sinadinovic K.,Karolinska Institutet | Sinadinovic K.,Stockholm Center for Dependency Disorders | Wennberg P.,Stockholm Center for Dependency Disorders | Wennberg P.,University of Stockholm | And 3 more authors.
Drug and Alcohol Dependence | Year: 2012

Background: The aim of this study is to investigate the effects of an Internet-based screening and brief intervention (SBI) site for problematic alcohol and drug use among illicit drug users. Method: Individuals searching for information about alcohol or drugs online who scored over 0 on the Drug Use Disorders Identification Test (DUDIT) and were 15 years or older were recruited for this trial and randomized into one group receiving Internet-based screening and brief intervention via (n= 101) or one assessment-only control group (n= 101). Both groups were screened at baseline and followed up at 3 and 6 months. The primary outcome measure was the DUDIT-C score and secondary outcome measures were DUDIT, AUDIT-C (Alcohol Use Disorders Identification Test-C) and AUDIT scores. Additional outcomes included the proportion of drug abstainers and those who made a clinically significant change in their alcohol and drug use. Four statistical models of analysis were used to conservatively assess results. Results: A significant decrease in DUDIT-C scores at the 3-month follow-up occurred in both groups. Three out of four statistical models showed a larger decrease in the DUDIT score in the intervention group than in the control group (p= 0.006; p= 0.046; p= 0.001). Two models showed a continued decrease in AUDIT-C and AUDIT scores also at the 6-month follow-up in the intervention group but not in the control group. No additional differences occurred. Conclusions: The results are inconclusive but provide some evidence that SBI sites such as could be effective for short-term reductions of problematic substance use. © 2012 Elsevier Ireland Ltd.

Sinadinovic K.,Karolinska Institutet | Sinadinovic K.,Stockholm Center for Dependency Disorders | Wennberg P.,Stockholm Center for Dependency Disorders | Wennberg P.,University of Stockholm | And 3 more authors.
Drug and Alcohol Dependence | Year: 2011

Background: The wide accessibility of computer-based technologies like the Internet and Interactive Voice Response (IVR) systems raises the question of whether population survey data could be collected more easily and cheaply compared to using paper questionnaires. In the area of possibly stigmatized behaviors such as problematic alcohol and drug use, the question extends to whether the prevalence of such behaviors in the general population could be surveyed without compromising the quality of the data. Aims: This study compares Internet and IVR versions of the AUDIT and DUDIT with respect to: (1) response rate, (2) problematic alcohol and drug use and (3) reliability. Method: 5000 individuals, randomly selected from the Swedish general population, were contacted via postal mail and invited to complete the AUDIT and DUDIT questionnaires via Internet or IVR. In total, 1861 (37.8%) participated in the study, 1089 via Internet and 772 via IVR. Results: The Internet administration mode yielded a higher response rate (38.1%) compared to the IVR mode (33.9%). When respondents were given a choice between Internet and IVR, a higher response rate resulted (43.2-46.6%). Problematic alcohol and drug use occurred among 21.1% and 2.8% of the sample, respectively, with no significant differences by administration mode. Both the AUDIT and DUDIT exhibited satisfactory reliability across administration modes, Cronbach's α 0.76/0.86. Conclusions: Data quality does not deteriorate with computerized administration methods for the AUDIT and DUDIT in population studies but paper questionnaires should also be made available to respondents in order to maximize response rates. © 2010 Elsevier Ireland Ltd.

Sinadinovic K.,Karolinska Institutet | Sinadinovic K.,Stockholm Center for Dependency Disorders | Wennberg P.,Karolinska Institutet | Wennberg P.,University of Stockholm | And 3 more authors.
European Addiction Research | Year: 2014

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. © 2014 S. Karger AG, Basel.

Berman A.H.,Karolinska Institutet | Berman A.H.,Stockholm Center for Dependency Disorders | Forsberg L.,Karolinska Institutet | Durbeej N.,Karolinska Institutet | And 2 more authors.
Substance Use and Misuse | Year: 2010

Thirty-five inpatients at a Stockholm hospital drug user detoxification unit received single-session Motivational Interviewing (MI) between 2006 and 2008. At baseline and after 3months, they were compared to a semirandomized control group of 52 patients with treatment as usual. In the MI group, self-efficacy increased regarding abstention in connection with positive feelings, appreciation of positive drug effects increased, and participants tended to transition toward preparation/action stages of change. Despite implementation challenges, the study demonstrates the feasibility and effectiveness of single-session MI delivery in the inpatient drug detoxification setting and suggests paths for future research on delivery of single-session MI. Copyright © 2010 Informa Healthcare USA, Inc.

Sinadinovic K.,Karolinska Institutet | Sinadinovic K.,Stockholm Center for Dependency Disorders | Berman A.H.,Karolinska Institutet | Berman A.H.,Stockholm Center for Dependency Disorders | And 5 more authors.
Addictive Behaviors | Year: 2010

A Swedish web-based service ( offers self-assessment and self-monitoring of alcohol and drug use via on-line screening with the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT) as well as in-depth risk assessment using extended versions of both tests (Alcohol-E and DUDIT-E). Users receive individualized feedback concerning their alcohol and drug consumption and can follow their alcohol and drug use over time in personal diagrams and by writing in an electronic diary. This study describes user characteristics, service utilization patterns, and psychometric test properties for 2361 individuals who created a valid account over 20 months starting in February 2007. Problematic alcohol use according to AUDIT criteria was indicated for 67.4%, while 46.0% met DUDIT criteria for problematic drug use. Men and women accessed the service equally, with a mean age of 23 years. Internal consistency reliability figures were 0.90 for 1846 first-time AUDIT users and 0.97 for 1211 first-time DUDIT users; among 213 second-time AUDIT users reliability was 0.93, and 0.96 for 97 second-time DUDIT users. Internet-based alcohol and drug monitoring could function as a self-help tool or as a complement to substance abuse treatment. © 2009 Elsevier Ltd. All rights reserved.

Sinadinovic K.,Karolinska Institutet | Sinadinovic K.,Stockholm Center for Dependency Disorders | Wennberg P.,University of Stockholm | Wennberg P.,Karolinska Institutet | And 2 more authors.
Journal of Studies on Alcohol and Drugs | Year: 2014

This trial investigated the effects of access to an Internet-based screening and brief intervention site for illicit drug users. This article adds to previously published results from the 3- and 6-month follow-ups by extending the follow-up period to 12 months and reporting changes in substance use between the 6- and 12-month follow-ups. Method: In total, 202 Internet help-seekers with illicit drug use, 15-70 years old, were randomly assigned to either an intervention group that received Internet-based screening and brief intervention via or to an assessment-only control group. The primary outcome measure was the Drug Use Disorders Identification Test consumption questions (DUDIT-C) score, and secondary outcome measures were the DUDIT, Alcohol Use Disorders Identification Test consumption questions (AUDIT-C), and AUDIT scores, as well as the proportion of drug abstainers and participants making a clinically significant change in their alcohol and other drug use. Results: DUDIT-C, DUDIT, AUDIT-C, and AUDIT scores remained stable between the 6- and 12-month follow-ups. However, 12 months after recruitment, 34.3% of those who used had changed their alcohol use to a clinically lower level compared with the 21.8% of the controls. Also, none of the users increased their level of alcohol use during this 12-month period, whereas 5.0% in the control group did so. Conclusions: Despite no changes in illicit drug use from the 6- to 12-month follow-up for both the intervention and control group, seems to be more effective than assessment only for reducing alcohol use among illicit drug users over a 12-month period.

PubMed | Karolinska Institutet, Uppsala University Hospital and Stockholm Center for Dependency Disorders
Type: | Journal: Journal of interpersonal violence | Year: 2015

The aims of this study were to investigate the type and extent to which women with substance abuse problems have been exposed to male violence during their lifetime, and to examine possible differences between women with a residence (WR) and homeless women (HW). The total sample included 79 women (WR, n = 35; HW, n = 44; M age = 47.8 years). Of the total sample, 72 women (91%) had experienced different kinds of male violence, 88% from former partners, and 26% from male friends or acquaintances. Of the 72 women, 71% further reported Countless occasions of violent events, and 36% had been forced to commit criminal acts. Abused women who had been forced to commit criminal acts were significantly more frequently found to be homeless, have reported parental alcohol and/or drug problems, have witnessed domestic violence in childhood, have been victims of sexual violence, have used illicit drugs as a dominant preparation, and have injected illicit drugs. Almost half of the abused women (46%) met criteria for posttraumatic stress disorder (PTSD), where HW showed an almost 4-time higher risk (RR 3.78) than WR. In conclusion there is a particular vulnerability in women with substance abuse to male violence, which has an important impact on their health status. Thus, from a public health perspective, it is suggested that for those women who have experienced male violence, treatment protocols need to include both assessing and addressing the impact of such experience in relation to substance abuse as well as concomitant health concerns.

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