Substance abuse and psychiatric co-morbidity as predictors of premature mortality in Swedish drug abusers a prospective longitudinal study 1970 - 2006

<p>Abstract</p> <p>Background</p> <p>Few longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. The aim of the present study was to identify predictors of increased risk of drug related death and non drug related death in substance abusers of opiates, stimulants, cannabis, sedatives/hypnotics, hallucinogens and alcohol over several decades.</p> <p>Methods</p> <p>Follow-up study of a consecutive cohort of 561 substance abusers, admitted to a detoxification unit January 1970 to February 1978 in southern Sweden, and followed up in 2006. Demographic and clinical data, substance diagnoses and three groups of psychiatric diagnoses were identified at first admission. Causes of death were coded according to ICD-10 and classified as drug related deaths or non drug related deaths. To identify the incidence of some probable risk factors of drug related premature death, the data were subjected to a competing risks Cox regression analysis.</p> <p>Results</p> <p>Of 561 patients in the cohort, 11 individuals had either emigrated or could not be located, and 204/561 patients (36.4%) were deceased by 2006. The cumulative risk of drug related death increased more in the first 15 years and leveled out later on when non drug related causes of death had a similar incidence. In the final model, male gender, regular use of opiates or barbiturates at first admission, and neurosis were associated with an increased risk of drug related premature death, while cannabis use and psychosis were associated with a decreased risk. Neurosis, mainly depression and/or anxiety disorders, predicted drug related premature death while chronic psychosis and personality disorders did not. Chronic alcohol addiction was associated with increased risk of non drug related death.</p> <p>Conclusions</p> <p>The cohort of drug abusers had an increased risk of premature death to the age of 69. Drug related premature death was predicted by male gender, the use of opiates or barbiturates and depression and anxiety disorders at first admission. The predicted cumulative incidence of drug related death was significantly higher in opiate and barbiturate abusers over the observed period of 37 years, while stimulant abuse did not have any impact. Alcohol contributed to non drug related death.</p

Methods for analyzing decision-making : a framework approach

In political science an eternal question concerns how decisions and policies arise. Modern society, characterized by more uncertainty and complexity than before, increases the challenge of providing valid answers. However, the general lack of methodological concern in several previous studies in this area stresses the need for elaborations of more suitable approaches. In this article we add a methodological perspective that deals with this very question. By reviewing and analyzing earlier research on how decision-making is reached, the overall ambition of this article is to create a framework that can lay the methodological foundation for further studies. Such a framework, which takes into account both the complexity of modern multi-governance societies and adds methodological perspectives of macro and micro standpoints as well as of causal mechanisms, can be used in future research to achieve richer pictures of how decision-making is carried out. In addition, we show how a certain technique of analysis is highly compatible to this framework and that jointly these features provide solutions for a better understanding of the complexity of modern decision-making. All in all, applying this strategy can be used to better systematize complex causal chains that reflect different analytical levels and thereby increase leverage on how to understand and explain the process of political decisions