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Background and aim: Social workers regularly encounter clients affected by substance use disorders (SUD), yet training in evidence-based assessment and interventions remains limited. In Sweden, municipal social workers have statutory responsibility for SUD assessment, intervention planning and client follow-up which underscores the need for targeted professional education. This study aimed to: (i) describe social workers’ baseline self-assessed competence in evidence-based practices for SUD and its associations with demographic and professional characteristics, and; (ii) examine knowledge gains associated with completion of an evidence-based educational intervention.

Methods: A non-randomized pre–post design included 173 municipal social workers recruited from 64 municipalities across five cohorts (2021–2023). Baseline self-assessed competence was analyzed using ordinal logistic regression, and knowledge gains were assessed using module-specific pre–post items with paired t-tests with Cohen’s d.

Results: Baseline competence was rated as low to moderate, with professional experience predicting higher perceived competence. Substantial baseline knowledge gaps were observed, particularly in evidence-based psychosocial interventions and use of digital technology in assessment and planning of treatment. Knowledge increased significantly across all modules after training completion (d = 0.26–1.41). The largest knowledge gains were for modules on use of technology in the assessment and treatment-planning, biopsychosocial interventions, research-informed use of the assessment tool Addiction Severity Index (ASI), and the professional role in assessment and care planning. Score variability decreased across several modules.

Conclusion: Completion of an immersive, online, evidence-based training was associated with meaningful improvements in social workers’ knowledge related to substance use assessment, intervention planning, and use of technology. Although causal inference is limited by the non-randomized single-group pre–post design, the findings support the potential of scalable educational interventions to address competence gaps in substance use services even in organizations with high caseloads, workforce turnover, and limited training opportunities.

Aims: This study examined the association between educational attainment and the risk of deaths of despair among individuals assessed for substance use severity at municipal social services in Sweden. It aimed to determine whether the protective association between education and despair-related mortality risk, commonly observed in broader population studies, also applies to this high-risk, treatment-seeking population.

Methods: We linked data from municipal Addiction Severity Index (ASI) assessments to various population registers. The study population included adults aged 25 years or older who were assessed for substance use severity between 1999 and 2019. Fine–Gray competing risk regression models were employed to examine the association between educational attainment and despair-related mortality, both overall and by subtype (alcohol-related, drug use-related, suicide).

Results: Tertiary education was unexpectedly associated with increased risks of overall despair-related mortality, alcohol-related and drug use-related mortality, after controlling for demographic characteristics, ASI composite scores and substance use onset age. No significant associations were found between education and suicide.

Conclusions: The counterintuitive finding that tertiary education is linked to a greater risk of despair-related mortality among social service users may be attributed to differences between the treatment-seeking population and the general population. Highly educated individuals who seek treatment from municipal social services might have severe substance use and complex psychosocial problems and/or contact social services after exhausting other treatment options. Further research is necessary to understand how educational and socioeconomic factors influence treatment pathways for individuals with severe substance use problems in Sweden and how these different pathways impact health-related outcomes.

Background: Changes in marital status are major life transitions that may affect older adults’ physical and mental health, support network, and coping behaviors such as alcohol use. This study examined the effects of baseline and longitudinal marital status on alcohol use, gender interaction, and whether depressive symptoms and loneliness mediate these associations.

Methods: Data from the GERDA study in Northern Sweden and Western Finland included 5,071 adults aged 65-85 years (53.6% women; 77.4% partnered) surveyed in 2016 and 2021. Transitions were categorized as partnered (stable/entered partnership) or unpartnered (stable/divorced/widowed). Alcohol use in 2021 was assessed using AUDIT-C (non-drinker, low-risk, and hazardous drinking and binge drinking). Multinomial and binary logistic regressions assessed associations between marital status and alcohol use, adjusting for baseline sociodemographic, psychosocial, and health factors. Gender-stratified causal mediation analyses tested indirect effects via depression and loneliness. Inverse probability weights adjusted for attrition.

Results: Being unpartnered at baseline were associated with higher odds of abstaining versus partnered (aRRR=1.39, 95%CI=1.06-1.83 and aRRR=1.47, 95%CI=1.14-1.91 respectively). No associations with hazardous or binge drinking were found. Between 2016 and 2021, unpartnered individuals had higher odds of abstaining. Partnered women were less likely than partnered men to drink at hazardous level (aRRR=0.36, 95%CI=0.28-0.47) and unpartnered women had even lower odds (interaction aRRR=0.56, 95% CI = 0.33-0.95). No significant mediation via depression or loneliness was found. Among women, being unpartnered directly predicted lower odds of hazardous and binge drinking.

Conclusions: Older unpartnered adults are more likely to abstain and no mediation via depression loneliness was found. Alcohol use in later life appears shaped more by partnership status than by psychological distress after marital loss.

Key messages:

• In later life, drinking is shaped more by social dynamics within partnerships than emotional distress after relationship loss. Prevention should target social drinking norms, especially among women.
• Future studies should improve causal inference by using repeated measures over time and address selection bias through strategies like inverse probability weighting based on baseline factors.

Background: Alcohol consumption is a leading modifiable risk factor for a range of diseases and social harms globally. Older adults are vulnerable to alcohol-related harms due to physiological changes, multimorbidity, and medication use; however, many older adults continue to drink at high-risk levels. This study examined the prevalence and gender-specific correlates of hazardous and heavy episodic drinking (HED) among Swedish and Finnish community-dwelling older adults.

Methods: Cross-sectional data from the 2021/2022 Gerontological Regional Database (GERDA) survey included 11,747 participants aged 65, 70, 75, 80, 85 and 90 years. Missing data were multiple imputed by chained equations. Hazardous drinking was defined as an AUDIT-C score of four or more, and HED was defined as consuming six or more drinks on a single occasion at least monthly. Sociodemographic, psychosocial, functional status, and health-related factors were analyzed using multinomial and logistic regression models, stratified by gender and accounting for regional differences.

Results: Overall, 30.2% (95% CI, 29.0–31.4) of men and 9.8% (95% CI, 9.1–10.6) of women were classified as hazardous drinkers. HED prevalence was 13.0% (95% CI, 12.1–13.9) in men and 2.9% (95% CI, 2.5–3.3) in women. Hazardous drinking and HED in women were associated with higher socioeconomic status and psychosocial stressors, such as depression and bereavement, while functional and health-related factors were significant predictors of problematic alcohol use in men. Across both genders, religious participation was a protective factor, while self-reported cardiovascular disease was associated with increased risk of hazardous drinking.

Conclusions: Hazardous and HED are prevalent among older adults in Sweden and Finland with some regional differences, and notable gender differences in associated risk factors. There is a need for interventions that focus on strengthening resilience to psychosocial stressors and provide older adults with clear, consistent health communication about alcohol's harmful effects on cardiovascular and overall health.

Background: Eliciting and understanding older persons’ descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing.

Methods: Eight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews.

Results: Three themes were identified: “Tipping the balance”, “Staying behind a veil” and “Lifting the vail”. First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery.

Conclusions: Older persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons’ desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.

Background and Objectives: With an ageing population, the number of older persons with substance use problems, particularly problematic alcohol use, is increasing. Despite grow­ing recognition of the negative consequences of problematic alcohol use on older persons, there is a dearth of knowledge about the alcohol use profiles and the dimensionality of alcohol problems in older people. Moreover, little is known about older persons’ experi­ences and perspectives on alcohol use in relation to their ageing and their personal goals regarding treatment and recovery. This thesis aimed to (i) describe the characteristics of older persons who accessed municipal substance use treatment and care services (addic­tion services) and to investigate their future hospitalization; (ii) examine the heterogeneity and multidimensionality of problematic alcohol use among older persons; and (iii) to shed light on the experiences and perspectives of older persons regarding ageing, alcohol prob­lems and recovery.

Methods: For studies I-III, municipal Addiction Severity Index (ASI) assessment data (between 2003 and 2017) from adults aged 50 years and older were used to select the study samples. Generalized linear regression models investigated hospitalization related out­comes among 3624 older persons in Study-I. In Study-II, a latent class analysis was applied on ASI data from 1747 individuals with alcohol problems. Study-III linked the ASI data from Study-II to hospital discharge and mortality data forming time-to-repeated-event dataset; Andersen-Gill regression model with a robust variance estimator was used for the analysis. Study-IV applied qualitative content analysis on interview data from ten older persons re­cruited from a specialist outpatient clinic for alcohol treatment. 

Results: Nearly three-fourth of older persons assessed for substance use severity at municipal addiction services were later hospitalized (Study-I). Individuals diagnosed with substance use disorders, psychiatric or dual diagnoses had more cumulative hospitalized days, higher rates of hospital readmissions, and shorter time to first admission following an initial ASI assessment at municipal addiction services (Study-I). Five distinct groups of older persons with comparable alcohol problem severity but with variation in onset age, psychiatric comorbidities, polysubstance use, social support and gender composition were identified (Study-II). The five groups varied in risks of repeated hospitalizations due to substance use and psychiatric disorders (Study-III). Older persons experienced their ageing and alcohol use having a dynamic interplay (Study-IV). They needed to constantly negotiate with their environment to maintain a positive ageing trajectory. They perceived moderate alcohol use fosters healthy ageing, but over time, experienced their alcohol use as unsustainable and a threat to their pursuit of healthy ageing. Stigma and ambivalence delayed treatment seeking (Study-IV). They accessed treatment programs which re­spected their preferences and autonomy, engaged them in goal setting and strengthened their agency. After reducing their alcohol use, positive changes in their biopsychosocial functioning encouraged them to continue their recovery journey even in the presence of setbacks (Study-IV).

Conclusion: Most older persons who access municipal addiction services are hospitalized repeatedly. Many older persons with alcohol problems live with medical and psychiatric comorbidities suggesting multiple care needs from health and social care services. Incor­porating older persons’ desire for healthy ageing into alcohol treatment plan can facilitate treatment engagement and recovery. Many older persons aim to moderate their alcohol consumption. Clinicians can deliver person-centered care for older persons, by consider­ing their heterogeneity in treatment goals, biopsychosocial functioning, and available re­sources. A multidimensional identification of alcohol use profiles could improve treatment by establishing the variation in alcohol problems among older treatment seekers. Older persons stay engaged in alcohol treatment programs which value their experiences and expertise, incorporate their personal treatment and life goals, respect their autonomy and agency, and involve them as active participants. Sensitizing service providers on old age substance use problems could provide multiple points of contact for screening of older persons and earlier referral to treatment. A streamlined data sharing within and between health and social care services fosters timely and equitable care and facilitates an inte­grated and person-centered care across the continuum. 

Unit of analysis: Individual

Population: Older people aged between 61 and 73 years who have sought treatment for alcohol at a specialist outpatient clinic in a metropolitan city in Sweden.

Time Method: Cross-section

Sampling procedure: Non-probability: Purposive

The study participants were purposefully recruited from a specialist outpatient alcohol treatment clinic located in a Swedish metropolitan city. To be eligible for the study, participants had to be 55 years or older, had to self-report a history of problematic alcohol use and treatment for alcohol use after the age of 50. Individuals who were unable or unwilling to provide informed consent or participate in the interview via Zoom, Skype, or telephone were excluded from the study.

Time period(s) investigated: 2021-12 – 2022-04

Number of individuals/objects: 10

Data format / data structure: Text