Mental health and substance use-related problems tend to gather and become part of
greater problem nexuses. Researchers of different traditions have tried to devise
ways to capture this circumstance. In comorbidity networks, human diseases are mapped
broadly in entire populations (e.g., Chmiel, Klimek, & Thurner, 2014), while social
epidemiology, for example, attempts to identify structural circumstances by formulating
indicators and determinants. An attempt to grasp problems as intertwined is that undertaken
by the European PARADISE consortium, which has launched a medical “horizontal epidemiology”
(PARADISE, 2010). It challenges previous approaches that look for separate disease
trajectories. Instead, horizontal epidemiology is meant to capture the fact that psychosocial
difficulties, such as sleep disturbances, emotional instability and difficulties in
personal interactions, and their environmental determinants are often related and
share commonalities in the brain (Cieza et al., 2015). For people suffering from addiction,
this may help to frame their problems as entangled – even if only in the diagnostic
and medical sense.
In grasping interconnected factors in the social seating of problems, Meier, Warde,
and Holmes (2018) argue for a social practice theory that sees the social meaning,
settings, and the nature of health-related activities as integrated in people’s daily
lives. When practices are conceptualised as routine types of human activity that are
made up of, and can be recognised by “the coming together of several interwoven elements”
(Meier et al., 2018, p. 206), the authors see that alcohol research can shift its
attention away from individuals and recognise contexts that have been neglected, especially
in quantitative research.
Within its social scientific scope, Nordic Studies on Alcohol and Drugs has sought
to keep up to date with the multi-problems framing. In December 2018, we published
a thematic issue on polydrug use, in which the guest editors Kataja, Tigerstedt, and
Hakkarainen (2018) point out that, while the volume of publications dealing with the
theme has certainly increased, a great gap remains in understanding such mixed use
as a social question. With contributions from Sweden, Norway, and Finland, the present
issue can be seen as following up on the poly-use and multi-problems theme. The articles
discuss concurrent substance use, experience of different kinds of use by others,
and risky habits of pre-loading, sexual behaviour, and driving.
Use of different substances
The fact that problems accumulate and gather, propelling heavy users into the risk
zone of comorbidities and marginalisation is unfolded by the Swedish alcohol researcher
Mats Ramstedt (2019). He has studied the concurrent use of addictive substances –
tobacco, illicit drugs, and non-prescribed use of analgesics and sedatives – among
different kinds of alcohol drinkers in the Swedish general population. The study is
able to show that those who drink the most are more likely to use other addictive
substances than are non-drinkers, and that such concurrent use becomes more common
the more alcohol is consumed. Ramstedt’s conclusion is that the screening for concurrent
use of different kinds of addictive substances is important for healthcare providers
to identify the nature of the patient’s problem picture.
A population survey among 16–64-year-olds serves as the data for perceptions of others’
use of alcohol, cigarettes, and illegal drugs in a Norwegian study by Moan, Bye, Storvoll,
and Lund (2019). It appears that the closer you are to the person the more harm you
are likely to experience. This likelihood also increases if you are a user yourself.
Women and younger persons were more likely to report harm from others’ alcohol and
cigarette use.
Intoxication and risk
The ways in which we combine habits as suggested in social practice theory could also
serve for figuring out (changing) youth consumption and use patterns. Swedish university
students’ alcohol intoxication and hazardous alcohol use is studied by Elgàn, Durbeej,
and Gripenberg (2019) in the setting of eight student parties. Breath alcohol concentration,
background data, and responses to the AUDIT-C were gathered, implicating that drinking
at pre-parties is likely to lead to a pattern of heavier intoxication. This is not
a marginal question, since a great majority of the students (91% among the respondents)
drink before arriving to university parties.
If the pre-loading study by Elgan and colleagues maps youngsters’ risky intoxication
habits at the beginning of party nights, the study by Strandberg and colleagues (2019)
could in a sense be seen as looking at the results. Among visitors at youth health
clinics in Stockholm county, risky alcohol consumption is associated with risky sexual
behaviour outcomes.
In the study on driving fitness among patients with alcohol problems in hospitals
in Finland, authors Kalsi, Tervo, and Tervo (2019) point out the worrying circumstance
that the evaluation of the heavy alcohol users’ driving fitness is often neglected.
The study shows that their driving fitness was significantly reduced, and the health
requirements of the driving licence were not met. Still, heavy alcohol users’ capability
to drive is seldom tested (only in 24% of the cases).
Last but certainly not least
In order to really acquire insights into the complex and unique events that may lead
to a life spent with addiction, I recommend to readers Willy Pedersen’s account of
an in-depth interview with a woman born in the early 1920s, who developed a heavy
morphine addiction (Pedersen, 2019). In the course of the interview, she gradually
reveals the ways in which her husband and physicians played key roles in the development
of her addiction over time. Pedersen points out that this story serves not only as
an interesting illustration of how women from the upper strata of society with close
links to male physicians may have been at particular risk of opioid misuse in the
period before 1960, but also as a parallel to the recent prescription opioid drug
crisis in the United States. Prescription drug use can develop in intimate and psychologically
complicated relationships with physicians. The story can also be read as educative
for understanding what is hidden behind the statistics in our research. No indicator
list is long enough and no social epidemiologist is skilful enough to account for
the story of this fatal attraction-based opioid addiction.
In the summer of 2019, our impact factor has increased to 0.875. Although this measurement
has significant flaws for arguing a journal’s quality, we still welcome this news,
since we work hard to maintain a high standard. At the editorial office, we hope that
the journal’s accessibility, quality, and range of topics will appeal to and be useful
for as many readers as possible.