Tobias H. Elgán

Illicit drug use is common among attendees of electronic dance music (EDM) festivals, but is often significantly underreported by participants. The current study aimed to compare the prevalence and over- and under-reporting of illicit drug use among attendees at EDM festivals in two European countries with distinct drug laws and cultures. Self-reported data regarding recent drug use were collected through interviews. Participants’ blood alcohol concentrations were measured using a breathalyzer. Recent illicit drug use was assessed through sampling microparticles in the breath and consequent off-site analysis through liquid chromatography and tandem mass spectroscopy. Illicit drug use was higher in Belgium than in Sweden as indicated by self-reports (56.8 vs. 4.3%) and drug testing (37.2 vs. 12.5%). Underreporting was higher in Sweden than in Belgium; in Sweden, only 2.6% reported taking an illicit drug other than cannabis, whereas 11.6% tested positive, while the corresponding figures in Belgium were 36.5% and 36.9%. In both countries, results from self-reporting and drug testing for specific drugs matched poorly at the individual level, indicating unwitting consumption of substances. This study indicates that the drug use prevalence and the likelihood of disclosure may differ between countries or cultures, which should be considered when choosing methods to investigate drug use prevalence.

Background: The aim of this study was to explore how stakeholders perceive illicit drugs at licensed premises, existing and potential prevention interventions, and to identify facilitators and barriers to reduce illicit drugs at these locations. Methods: Semi-structured interviews with police officers, licensed premises owners, security staff and municipality officials ( n = 28) in seven counties in middle Sweden were conducted and analysed using qualitative content analysis. Results: The informants reported frequent illicit drug use and dealing at licensed premises, causing a negative influence on the restaurant environment. Efforts to prevent illicit drugs varied with respect to type and intensity but included environmental and situational changes as well as education and training, policy implementation and law enforcement. Facilitators for the reduction of illicit drugs are confidence that sufficient resources are allocated, motivated and skilled stakeholders who see benefits of prevention and collaborate closely, along with visible results. General societal prevention was also seen as important. Identified barriers were perceived drug-positive norms and high availability and use in the society, perceived lack of prioritisation and resources, difficulties to collaborate due to e.g., secrecy between organisations, lack of action among stakeholders due to financial considerations, perceived confusion about roles and mandate, and owner's and staff's fear of threats and violence from criminals or own involvement in crime. Conclusion: To maximise the potential of successful prevention, authorities should support owners of licensed premises to act firmly against illicit drugs by providing training, ensure that they apply a strict policy, work for increased stakeholder collaboration and provide appropriate police resources. Authorities should also investigate criminal activities among owners and staff as well as combat organised crime and availability of illicit drugs in the society.

Background: Children whose parents have alcohol use problems are at an increased risk of several negative consequences, such as poor school performance, an earlier onset of substance use, and poor mental health. Many would benefit from support programs, but the figures reveal that only a small proportion is reached by existing support. Digital interventions can provide readily accessible support and potentially reach a large number of children. Research on digital interventions aimed at this target group is scarce. We have developed a novel digital therapist-assisted self-management intervention targeting adolescents whose parents had alcohol use problems. This program aims to strengthen coping behaviors, improve mental health, and decrease alcohol consumption in adolescents. Objective: This study aims to examine the effectiveness of a novel web-based therapist-assisted self-management intervention for adolescents whose parents have alcohol use problems. Methods: Participants were recruited on the internet from social media and websites containing health-related information about adolescents. Possible participants were screened using the short version of the Children of Alcoholics Screening Test-6. Eligible participants were randomly allocated to either the intervention group (n=101) or the waitlist control group (n=103), and they were unblinded to the condition. The assessments, all self-assessed, consisted of a baseline and 2 follow-ups after 2 and 6 months. The primary outcome was the Coping With Parents Abuse Questionnaire (CPAQ), and secondary outcomes were the Center for Epidemiological Studies Depression Scale, Alcohol Use Disorders Identification Test (AUDIT-C), and Ladder of Life (LoL). Results: For the primary outcome, CPAQ, a small but inconclusive treatment effect was observed (Cohen d=–0.05 at both follow-up time points). The intervention group scored 38% and 46% lower than the control group on the continuous part of the AUDIT-C at the 2- and 6-month follow-up, respectively. All other between-group comparisons were inconclusive at either follow-up time point. Adherence was low, as only 24% (24/101) of the participants in the intervention group completed the intervention. Conclusions: The findings were inconclusive for the primary outcome but demonstrate that a digital therapist-assisted self-management intervention may contribute to a reduction in alcohol consumption. These results highlight the potential for digital interventions to reach a vulnerable, hard-to-reach group of adolescents but underscore the need to develop more engaging support interventions to increase adherence. Trial Registration: ISRCTN Registry ISRCTN41545712; https://www.isrctn.com/ISRCTN41545712?q=ISRCTN41545712 International Registered Report Identifier (IRRID): RR2-10.1186/1471-2458-12-35

Background: Research indicates that among the risks associated with young people’s alcohol and illicit drug use are sexual risks. However, insights into co-occurrence of substance use and sexual risks in adolescent samples and possible differences across countries are limited. Methods: A sample of 1449 adolescents from Belgium, Sweden, the Czech Republic, and Germany screened positive for risky alcohol/illicit drug use in a web-based intervention against alcohol and illicit drug use. They also reported incidents of sex while being drunk and/or high on drugs, condomless sex on these occasions, and sexualized touching and sexual victimization while being drunk or high on drugs. Results: In the sample, 21.5% of the participants reported sexualized touching, 9.9% being victim to sexual assault, and 49.8% having had sex while being drunk and/or high on drugs; of the latter, 48.3% had condomless sex. Reports on having had sex while being drunk and/or high on drugs were associated with higher levels of past 30-day binge drinking. Being a victim of sexual assault was associated with past 30-day binge drinking only in young men. Conclusion: When devising preventive interventions against risky substance use in adolescents, an additional focus should be set on integrating steps against sexual risks.

BACKGROUND Children whose parents have alcohol use problems are at an increased risk of several negative consequences, such as poor school performance, an earlier onset of substance use, and poor mental health. Many would benefit from support programs, but the figures reveal that only a small proportion is reached by existing support. Digital interventions can provide readily accessible support and potentially reach a large number of children. Research on digital interventions aimed at this target group is scarce. We have developed a novel digital therapist-assisted self-management intervention targeting adolescents whose parents had alcohol use problems. This program aims to strengthen coping behaviors, improve mental health, and decrease alcohol consumption in adolescents. OBJECTIVE This study aims to examine the effectiveness of a novel web-based therapist-assisted self-management intervention for adolescents whose parents have alcohol use problems. METHODS Participants were recruited on the internet from social media and websites containing health-related information about adolescents. Possible participants were screened using the short version of the Children of Alcoholics Screening Test-6. Eligible participants were randomly allocated to either the intervention group (n=101) or the waitlist control group (n=103), and they were unblinded to the condition. The assessments, all self-assessed, consisted of a baseline and 2 follow-ups after 2 and 6 months. The primary outcome was the Coping With Parents Abuse Questionnaire (CPAQ), and secondary outcomes were the Center for Epidemiological Studies Depression Scale, Alcohol Use Disorders Identification Test (AUDIT-C), and Ladder of Life (LoL). RESULTS For the primary outcome, CPAQ, a small but inconclusive treatment effect was observed (Cohen d=–0.05 at both follow-up time points). The intervention group scored 38% and 46% lower than the control group on the continuous part of the AUDIT-C at the 2- and 6-month follow-up, respectively. All other between-group comparisons were inconclusive at either follow-up time point. Adherence was low, as only 24% (24/101) of the participants in the intervention group completed the intervention. CONCLUSIONS The findings were inconclusive for the primary outcome but demonstrate that a digital therapist-assisted self-management intervention may contribute to a reduction in alcohol consumption. These results highlight the potential for digital interventions to reach a vulnerable, hard-to-reach group of adolescents but underscore the need to develop more engaging support interventions to increase adherence. CLINICALTRIAL ISRCTN Registry ISRCTN41545712; https://www.isrctn.com/ISRCTN41545712?q=ISRCTN41545712 INTERNATIONAL REGISTERED REPORT RR2-10.1186/1471-2458-12-35

To control adherence to age limits regarding sales of tobacco products, Swedish authorities can conduct compliance checks. Compliance checks involve prior information to all retailers, mystery shopping, and subsequent feedback to the retailers. This study investigated whether compliance checks can decrease the rates of cigarette sales to underaged adolescents. Test purchases of cigarettes were conducted using pseudo-underaged mystery shoppers, i.e., 18-year-old adolescents with a younger appearance not carrying ID, to measure the refusal rate and rate of ID checks. Test purchases were conducted at 257 retail outlets in 13 municipalities in Stockholm County at baseline 2017 and follow-up 2019, respectively. In between the measurements, six municipalities (intervention area) conducted compliance checks, and seven municipalities were used as a comparison. Comparing baseline and follow-up, rates of refusal (70.4 to 95.8%) and ID checks (80.3 to 95.8%) improved in the intervention area. In the comparison area, refusal rates increased (80.9 to 85.2%), and ID check rates remained stable (at 86.1%). Significant group × time interaction effects reveal that the rates of refusal and ID checks differently changed in the study areas over time. These results indicate that compliance checks are an effective method to decrease cigarette sales to underaged adolescents.

Background: Monitoring emerging trends in the increasingly dynamic European drug market is vital; however, information on change at the individual level is scarce. In the current study, we investigated changes in drug use over 12 months in European nightlife attendees. Method: In this longitudinal online survey, changes in substances used, use frequency in continued users, and relative initiation of use at follow-up were assessed for 20 different substances. To take part, participants had to be aged 18–34 years; be from Belgium, Italy, the Netherlands, Sweden, or the UK; and have attended at least 6 electronic music events in the past 12 months at baseline. Of 8,045 volunteers at baseline, 2,897 completed the survey at both time points (36% follow-up rate), in 2017 and 2018. Results: The number of people using ketamine increased by 21% (p < 0.001), and logarithmized frequency of use in those continuing use increased by 15% (p < 0.001; 95% CI: 0.07–0.23). 4-Fluoroamphetamine use decreased by 27% (p < 0.001), and logarithmized frequency of use in continuing users decreased by 15% (p < 0.001, 95% CI: −0.48 to −0.23). The drugs with the greatest proportion of relative initiation at follow-up were synthetic cannabinoids (73%, N = 30), mephedrone (44%, N = 18), alkyl nitrites (42%, N = 147), synthetic dissociatives (41%, N = 15), and prescription opioids (40%, N = 48). Conclusions: In this European nightlife sample, ketamine was found to have the biggest increase in the past 12 months, which occurred alongside an increase in frequency of use in continuing users. The patterns of uptake and discontinuation of alkyl nitrates, novel psychoactive substances, and prescription opioids provide new information that has not been captured by existing cross-sectional surveys. These findings demonstrate the importance of longitudinal assessments of drug use and highlight the dynamic nature of the European drug landscape.

The aim of the study presented here was to estimate the prevalence of parental alcohol problems during childhood in a general population of Norwegian adults, and to investigate associations between parental alcohol problems during childhood and lower socioeconomic status in adulthood. This cross-sectional study recruited 28,047 adults (≥18 years) to an online health survey (Norwegian Counties Public Health Surveys). We evaluated demographic and socioeconomic measures and responses to a shortened version of the Children of Alcoholics Screening Test (CAST-6) scale to assess whether respondents perceived parental alcohol consumption during childhood as problematic. Respondents reported parental alcohol problems at a rate of 15.6%, but the experience was more prevalent among adults with a low education (20.0%), compared to those with intermediate (16.4%) or high educations (13.8%, χ²(2) = 87.486, p < 0.001), and it was more common among respondents with low economic capabilities (21.1%) compared to those with middle/high capabilities (14.2%, χ²(1) = 162.089, p < 0.001). Parental alcohol problems were most prevalent among respondents that received welfare benefits (24.5%). Multivariable logistic regression analyses revealed associations between parental alcohol problems and low socioeconomic status in adulthood; odds ratios (95% confidence intervals) ranged from 1.33 (1.25–1.42) to 1.89 (1.72–2.06). From a public health perspective, children who grow up with parental alcohol problems should be reached through both universal and selective interventions.