Supplement Aims and Scope
This supplement is intended to focus on harm to others from substance use and abuse.
Harm to others from alcohol, opioid, cannabis, cocaine and nicotine use and abuse
are within the supplements scope. Types of harm include violence, family deprivation,
crime, and neglect and abuse of children. Harm to others from substance use in understudied
populations is also within the scope of the supplement.
Substance Abuse: Research and Treatment aims to provide researchers working in this
complex, quickly developing field with online, open access to highly relevant scholarly
articles by leading international researchers. In a field where the literature is
ever-expanding, researchers increasingly need access to up-to-date, high quality scholarly
articles on areas of specific contemporary interest. This supplement aims to address
this by presenting high-quality articles that allow readers to distinguish the signal
from the noise. The editor in chief hopes that through this effort, practitioners
and researchers will be aided in finding answers to some of the most complex and pressing
issues of our time.
Articles should focus on the harm to others from the use and abuse of:
▪ Alcohol
▪ Opioids
▪ Cannabis
▪ Cocaine
▪ Nicotine
▪ Heroin
▪ Amphetamine
▪ Prescription drugs with abuse potential (eg, prescription opioids, benzodiazepines,
certain hypnotics and sedatives)
Types of harm may include:
▪ Violence, including interpersonal violence
▪ Harm to children, eg, neglect, abuse, or in utero exposure to different substances
▪ Passive smoking
▪ Family deprivation
▪ Crime
▪ Traffic accidents caused by intoxicated drivers
▪ Societal costs
At the discretion of the guest editors other articles on other relevant topics within
the scope of the supplement may be included.
Current Knowledge and Research Challenges
We are happy to introduce this special issue on harm to others from substance use
and abuse. This is a topic of particular interest for all guest editors involved in
the development of this edition, and one we’re excited to present for discussion.
Substance use and abuse contribute to harm in both users and third parties.1 The majority
of previous research has focused on harm to the users.2 Recently, however, there has
been increased interest in the harm experienced by people from others’ substance use
and abuse.3–10 While this increased interest has contributed new knowledge on the
topic, many questions remain unanswered. For instance, there is limited knowledge
regarding the long-term consequences from others’ substance use, and many studies
have a limited capacity for drawing causal inferences due to small samples sizes and
cross-sectional research designs. These are important challenges for this field of
research to address in future studies.
The articles in this special issue can be broadly divided into three topics, with
some articles incorporating more than one topic. The first topic addresses prenatal
substance use, the second focuses on general population surveys on harm from others’
drinking, and the third reports on innovative methodological approaches. The articles
represent a variety of study designs, including large-scale population surveys, nationwide
registry studies, and studies applying neuropsychological tests, and clinical interviews
and observations.11–19 Experts in the field have also contributed with a commentary
and an opinion article.20,21 Additionally, this special issue includes other articles
related to harm to others from substance use and abuse that are not described in detail
in this editorial.
The direct harms of substance use on the individual user are well known through previous
research, as discussed. This special issue hopes to highlight that all people affected
by substance use, including the user and third parties, require help, assistance and
often treatment when experiencing the harms associated with substance use.
Prenatal Substance Use
The section on prenatal substance use consists of articles that together provide a
snapshot of research, expert opinion and treatment initiatives regarding prenatal
substance use.
In their commentary, Terplan and colleagues explore assumptions about prenatal substance
use and maternal unfitness.21 They discuss that despite growing knowledge of addiction
as a chronic relapsing medical condition, pregnant women with substance use issues
suffer additional stigma. Their maternal fitness is questioned and punitive responses
are common. The authors argue that scientific evidence does not support linking substance
use with maternal unfitness. Such assumptions may have severe unintended consequences.
For example, it may result in pregnant women refraining from seeking both obstetric
care and treatment for their substance use, which will negatively affect the health
of both mother and child. They argue that instead of pariah status and punishment,
pregnant women who use substances should receive compassion and care.
Konijnenberg’s review addresses the effects of prenatal substance exposure on children’s
development from a methodological perspective.22 She provides a discussion of topics
including how properties of a substance, timing, dose, and duration of exposure influence
fetal development. The review also covers issues related to the assessment of developmental
outcomes and potential confounders. The author argues that systematic, large-scale,
longitudinal studies are needed to address these methodological challenges and to
develop appropriate intervention strategies to reduce and prevent developmental problems
associated with prenatal substance exposure.
Nørgaard and colleagues studied birth and neonatal outcomes from opioid medication
assisted treatment during pregnancy in all female Danish residents with a live birth
or a stillbirth from 1997 to 2011.15 Medical registers were used to identify use of
opioids and opioid medication assisted treatment, birth outcomes, and neonatal abstinence
syndrome (NAS). Of 950,172 pregnancies, 557 had been exposed to buprenorphine, methadone,
and/or heroin. Prenatal opioid use was associated with increased risk of preterm birth,
low birth-weight among infants born at term, and being small for gestational age compared
to non-opioid exposure. Congenital malformations were more common in children exposed
to opioids in utero than in those not exposed. Notably, the risk NAS was higher in
neonates exposed to methadone compared to buprenorphine.
Løhaugen and colleagues describe an initiative to establish a regional resource center
providing services for children and adolescents 2–18 years old who have been prenatally
exposed to alcohol or other substances.23 The resource center is the first of its
kind in Scandinavia. The center will provide information, education, and seminars
to health-care and child welfare personnel and special educators regarding identification,
diagnosis, and treatment of children prenatally exposed to alcohol and/or other substances.
The center will provide specialized health services to children referred from hospitals
in the region, and it will initiate multicenter studies on diagnostic processes and
intervention evaluation.
General Population Surveys on Harm from others’ Drinking
The section on general population surveys on harm from others’ drinking includes empirical
studies on harm from others’ drinking11,12,14,19 and one article that addresses methodological
issues of using population-based surveys in the study of alcohol’s’ harm to others.20
Rossow presents an opinion article addressing methodological limitations of survey
data in the study of substance use and harm’s to others.20 While acknowledging that
there are some challenges in using a cross-sectional design to study alcohol’s harm
to others, she argues that cross-sectional data based on general population samples
is an important first step in elucidating how common these problems are in populations.
Four articles using a cross sectional survey design explore harm as the result of
other people’s drinking. These articles explore a range of different types of harm
(eg, family-, financial- and psychological harms, physical injuries, and assault),
examine which correlates are associated with these harms, and describe the various
relationships of the substance user to the third party.11,12,14,19 The level of harm
in these studies differs between types of harm and different countries. However, certain
sub-groups of people are often associated with reported harm across studies, namely
women, young adults, and binge drinkers.
This result is particularly evident in the two articles with cross-country comparisons
between the six northern European countries by Moan et al, and Ramstedt et al.14,19
Both articles conclude that the proportion of people who had experienced harm from
others’ drinking differed greatly across countries. Ramstedt and colleagues further
state that country differences in harm from family and friends’ drinking is not fully
explained by variations in drinking indicators and other alcohol-related harm measures
at the country level.
Greenfield and colleagues report a significant upward trend from 2000 to 2015 in the
United States for experiencing financial troubles due to others’ drinking, whereas
no such trend was found for the other types of harms investigated, namely family and
marriage problems, assault, and vandalism.12 They further found a strong association
between having experienced harm from a partner and/or family member’s drinking with
symptoms of anxiety and depression.
Seid and colleagues studied how sociodemographic variables and drinking relate to
a four-way typology of causing harm to others and/or being harmed by others’ and one’s
own drinking.11 They found that persons with higher education more often reported
that others’ drinking had a negative effect on relationships with a partner and family,
and were at increased risk for financial problems, work problems, and injuries related
to others drinking.
In addition to arguing the utility of population-based cross-sectional surveys, Rossow
addresses some of the problems and challenges in using survey data to study alcohol’s
harm to others.20 For instance, population surveys have a limited capacity for identifying
long-term consequences from others’ drinking. Further, while alcohol’s harm to others
always include at least two parties, ie, the drinker(s) and the third party, surveys
typically reflect the perspective of only one of the parties. Harms not experienced
by individuals, for example, harm to work places in terms of lost productivity, are
typically neglected in survey studies. The harm measures used in surveys are often
unspecific and vague with regard to the nature and the severity of harm. Further,
while survey studies are well-suited to identify events, they are less well-suited
at identifying lasting states, such as mental health or financial problems resulting
from others’ drinking. The author suggests that longitudinal study designs and combinations
of population surveys and other data sources may overcome some of the problems related
to surveys on alcohol’s harm to others.
Innovative Methodological Approaches can Provide New Insight
The articles in this section describe innovative methodological approaches to study
harm to others from substance use. The first article describes the great potential
in using nationwide registries, either alone or in combination with surveys, to study
harm to others from substance use.18 The next two articles describe the background
and design of cohort studies that combine registry and survey data.16,17
Lund and Bukten note that nation-wide registers are rarely used to study harm to others
from substance use.18 Their paper provides an introduction to how registers can be
applied to study harm to children or partners from parental or partner substance use,
respectively. Advantages include the long-term follow-up of entire or large subsets
of a population with minimal attrition. The personal identification numbers and family
numbers included in most registers in the Nordic countries allow for the linkage of
information from several registers both at the individual and family level. The authors
discuss how registry data can be combined with survey data to maximize the benefits
from both approaches. Finally, they address methodological and ethical considerations
associated with the use of registry data for research purposes.
Lund and colleagues describe the background and study design of a cohort study on
long-term adverse effects of parental drinking.16 They argue that while many studies
have addressed adverse outcomes in children of parents with alcohol use issues, less
is known about possible long-term effects of more common parental alcohol consumption,
such as low consumption and episodic heavy drinking. The extent of harm from parental
drinking may therefore be underestimated. Further, due to methodological limitations
in most previous studies on parental drinking and negative long-term outcomes in children,
they have limited capacity for drawing causal inferences from associations between
exposure and outcomes. Using a large general population cohort where both survey data
on exposure to parental drinking and registry data on child outcomes are available,
the projects’ main objective is to study possible long-term effects of parental drinking
on children’s mental health, substance use, and unemployment as they age. The authors
argue that a better understanding of the extent of parental drinking and potential
adverse consequences for children can serve as a strong argument for effective strategies
to prevent harmful drinking in parents.
Bukten and colleagues describe the background, design, and implementation of a large-scale
longitudinal cohort study that combines national survey and registry data to study
mental health, substance use, and criminal activity before, during, and after custody
among prisoners in Norway.17 The unique combination of research methods allow for
addressing questions that will provide new knowledge that may help reduce relapse
rates and prevent overdoses among prisoners. This will likely reduce societal harm
in that fewer relapses would mean lower costs associated with treatment after relapse,
and fewer crimes to finance substance use after release from prison.
Conclusions
This special issue contributes to the advancement of the field of harm to others from
substance use by discussing important issues relating to prenatal substance use, harm
from others’ drinking, and by highlighting innovative methodological approaches that
can be useful for future investigations. Besides discussing novel findings relating
to the types, prevalence, and correlates of harm to others, many of the articles contribute
to the research field by addressing knowledge gaps that need to be further explored.
Several contributions also addressed common methodological limitations in the literature
and suggestions to avoid some of these frequently occurring limitations. Moreover,
this issue includes a thought-provoking opinion piece regarding the stigma of substance
use among pregnant women. Studies on harms from others substance use and abuse has
the potential to influence alcohol and drug policies through increased societal understanding
of the negative consequences of substance use and abuse. We hope this special issue
spurs discussions and inspires ideas for future work to address the identified gaps
in knowledge and methodological challenges facing this important field of research
in an effort to reduce substance use related harm.
Lead Guest Editor Dr Ingunn Olea Lund
Dr Ingunn Olea Lund is a research scientist at the Department of Alcohol, Drug and
Tobacco Research at the Norwegian Institute of Public Health. Her main research interests
are harm to children from parental drinking, and maternal and neonatal outcomes from
opioid maintenance treatment during pregnancy. Dr Lund completed her PhD at the Norwegian
Center for Addiction Research, University of Oslo, and was a visiting Fulbright scholar
at Johns Hopkins Medicine and RTI International. Dr Lund is the author of 22 peer-reviewed
papers, she has presented at 16 scientific conferences and provided peer review for
10 journals. She also lectures at the University of Oslo, and has contributed to the
development of the WHO guidelines for the identification and management of substance
use and substance use disorders in pregnancy.
IngunnOlea.Lund@fhi.no
Guest Editors
ERICA SUNDIN
Ms. Erica Sundin is a PhD student at the Department of Clinical Neuroscience at Karolinska
Institutet and is a research analyst at the Swedish Council for Information on Alcohol
and Other Drugs (CAN). She graduated in 2010 with a Bachelor of Medical Science with
a major in Public Health Science at the Karolinska Institutet and she has since then
been working in the area of alcohol research. Within her PhD education, she was recently
a visiting research fellow at the Centre for Alcohol Policy Research at La Trobe University.
Her thesis focus is the epidemiology and the longitudinal patterns of alcohol’s harm
to others in the Swedish general population. Ms Sundin has been in the program committee
for two international alcohol conferences, one of which was a thematic conference
with focus on alcohol’s harm to others. She is the co-author of six peer-reviewed
published papers and has presented at four scientific conferences.
erica.sundin@can.se
CAROLIEN KONIJNENBERG
Dr Carolien Konijnenberg is a Postdoctoral Research Fellow at the Cognitive Developmental
Research Unit of the Department of Psychology at the University of Oslo. She completed
her PhD at the Norwegian Center for Addiction Research at the University of Oslo and
holds an M.Phil. in cognitive neuropsychology. Her research interests include the
development of children at risk from prenatal drug exposure, and early socio-emotional
and cognitive development. She teaches a variety of courses at the University of Oslo
in the field of developmental psychology. Dr. Konijnenberg is the author or co-author
of 7 peer-reviewed published papers and has presented at 8 conferences.
caroliko@psykologi.uio.no
http://www.sv.uio.no/psi/english/people/aca/caroliko/index.html
KAMILLA ROGNMO
Dr Kamilla Rognmo is an associate professor at the Department of Psychology at the
University of Tromsø–The Arctic University of Norway. She completed her PhD at the
Department of Mental Health at the Norwegian Institute of Public Health and the University
of Oslo in 2013. In the Ph.D, Dr Rognmo studied the mental health of family members
of alcohol abusers. Dr. Rognmo is the author or co-author of 8 peer reviewed published
papers. Besides her research focus on the mental health of family members of alcohol
abusers, her research interests include the relationship between sleep problems and
alcohol use, sleep problems and weight gain and physical activity and mental health
among adolescents. Dr. Rognmo is a reviewer for four scientific journals.
Kamilla.rognmo@uit.no
PRISCILLA MARTINEZ
Dr Priscilla Martinez is a Postdoctoral Fellow and Associate Scientist at the Alcohol
Research Group, University of California, Berkeley. She also has a lecturer appointment
at the Department of Community Health and Human Development at the UC Berkeley School
of Public Health. She completed her PhD at the Norwegian Center for Addiction Research
at the University of Oslo. She has 10 peer-reviewed publications and is an NIAAA LRP
award recipient. Her research interests include alcohol use in low and middle income
countries, and the role of biological mechanisms in alcohol-related racial/ethnic
health disparities in the U.S.
pmartinez@arg.org
http://www.phi.org/people/?name=priscilla-martinez
ANDREA FIELDER
Dr Andrea Fielder is a pharmacologist specializing in the area of substance use and
pregnancy, with particular interests in opioid maintenance pharmacotherapies. She
received her PhD from the University of Adelaide investigating the use of buprenorphine
and methadone in pregnancy and their effects on the mother, fetus and neonate. In
2014 she undertook her Fulbright Scholarship at the University of North Carolina Horizons
Program in Chapel Hill North Carolina, where she was able to observe the logistics
of a comprehensive treatment program to improve outcomes for substance using pregnant
and parenting women and their families. She has published extensively including 29
peer reviewed publications, 11 international and national conferences and has provided
peer review for 12 journals. Dr Fielder has also significantly contributed to clinical
guidelines in the area of substance use and mental health in pregnant and non-pregnant
populations, including guidelines for the World Health Organization, the Colombo Plan
and the United States International Narcotics and Law Enforcement.
Andrea.Fielder@unisa.edu.au