A 30-year follow-up of substance misusers in Sweden – differences in predictors of mortality between women and men

Background: Differing results on gender specific factors related to mortality risks among substance misusers highlights the need for further research. The present article is based on a 30-year follow-up study on substance misusers treated in residential care for drug problems in Sweden in 1982-1983 aiming to identify and compare gender differences in predictors of mortality.

Method: Original data consists of personal interviews with 1163 substance misusers treated in inpatient units in Sweden during 1982-1983. The outcome variable is death retrieved from the National Cause of Death Register held by the National Board of Health and Welfare. Gender differences and similarities regarding predictors of mortality was estimated in univariate and multivariate models, using Cox proportional hazards models.

Results: School failure, imprisonment and being a parent without custody of the child seem to constitute risk factors for mortality among women, but not among men. A social network of friends seemed to be more important for men. Treatment-dropout was a significant risk factor for premature death among men, but not among women. Both gender reporting alcohol as their self-reported most dominant substance misuse showed higher mortality risks compared with those with stimulants as dominant substance misuse.

Conclusions: Imprisonment was highly predictive of mortality for the women, suggesting that this group is important to pay particular attention to. Suggested differences in the importance of social factors need to be investigated more thoroughly. The substantial hazard revealed for women with polydrug misuse including alcohol calls for attention to this in treatment for substance misuse.     

ADHD,stimulant treatment in childhood and subsequent substance abuse in adulthood — A naturalistic long-term follow-up study

The purpose of the study was to estimate the risk of substance use disorder (SUD) and alcohol abuse in adulthood among children and adolescents with attention-deficit hyperactivity disorder (ADHD) compared to the background population. Furthermore, to examine whether the age at initiation and duration of stimulant treatment in childhood predicts SUD and alcohol abuse in adulthood. 208 youths with ADHD (183 boys; 25 girls) were followed prospectively. Diagnoses of SUD and alcohol abuse were obtained from The Danish Psychiatric Central Register. The relative risk (RR) of SUD and alcohol abuse for cases with ADHD, compared to the background population was 7.7 (4.3–13.9) and 5.2 (2.9–9.4), respectively. Female gender, conduct disorder in childhood and older age at initiation of stimulant treatment increased the risk of later SUD and alcohol abuse. Our results warrant increased focus on the possibly increased risk of substance abuse in females with ADHD compared to males with ADHD.