John-Kåre Vederhus

• Birkeland, Bente; Vederhus, John-Kåre; Selbekk, Anne Schanche; Anne-Marie, Laslett,; Mary, Wilson, Ingrid & Haugland, Siri Håvås (2026). Violence exposure and quality of life among partners and parents of individuals with substance use problems. Frontiers in Public Health. 14. doi: 10.3389/fpubh.2026.1863383. Full text in Research Archive Show summary

  Background: Substance use problems (SUP) have significant adverse consequences not only for individuals with such problems, but also for their loved ones. One important concern is exposure to violence among affected family members. This study investigates whether close family members, specifically partners or parents, of individuals with SUP, including alcohol, face increased risks of physical and sexual violence and emotional abuse within the last 5 years. We also examined a hypothesized mediation model linking SUP exposure, violence, and quality of life (QoL).Methods: We conducted a cross-sectional analysis using data from 17,640 adults aged 23 years and above who participated in the Norwegian Counties Public Health Survey 2023. Multivariable logistic regressions were performed, controlling for age and socioeconomic status, and stratified by gender. Latent regression analysis was used to examine the relationship between SUP exposure and QoL.Results: Gender-specific analyses revealed that partners or parents of individuals with SUP had significantly higher odds of experiencing physical violence (women OR 4.54; men OR 4.14), sexual violence (women OR 4.31; men OR 4.80), and emotional abuse (OR 2.96 across genders). These family members also reported lower QoL. The association between family member status and lower QoL was statistically accounted for by experiences of violence. Information on the perpetrator was not available, and the source of reported violence could therefore not be determined.Conclusion: Close family members such as partners or parents of individuals with SUP face substantial risks of violence and emotional harm and report lower QoL. Support services should offer gender-sensitive, tailored assistance that addresses family members' needs as individuals, not solely as caregivers. These findings highlight the importance of recognizing affected family members as a vulnerable population within public health initiatives.

• Heimburg, Dina von; Friesinger, Jan Georg; Prilleltensky, Isaac; Ness, Ottar; Strømland, Monica & Vederhus, John-Kåre (2026). The Relational and Structural Dimensions of Wellbeing: A Population-Based Latent Model of Social Conditions, Mattering, Perceived Discrimination, and Quality of Life. Journal of Community and Applied Social Psychology. ISSN 1052-9284. 36(6). doi: 10.1002/casp.70339. Full text in Research Archive Show summary

  Mattering, the experience of feeling valued and able to contribute, is a recognised determinant of wellbeing. Perceived discrimination (PD), or unfair treatment, is socially patterned and may communicate devaluation. Anti-mattering, the subjective experience of insignificance and disregard, serves as a theoretical lens on PD, not a measured construct. Population-level studies rarely examine mattering and PD together, their socio-demographic patterning or associations with quality of life (QoL). In the 2024 Norwegian Quality of Life Survey (N = 16,396), mattering, PD, and QoL were modelled as latent constructs in a structural equation model estimating direct and indirect associations with socio-demographic predictors. Sociodemographic factors explained 11% of the variance in mattering and 31% in PD, with the largest contributions to PD observed among younger adults and those with financial difficulties, health limitations, or immigrant backgrounds. Mattering was positively associated with QoL (β = 0.55, βstd = 0.59) and PD negatively (β = −0.81, βstd = −0.29), both p < 0.001; the model explained 61% of QoL variance. The difference in explained variance suggests that PD was more strongly patterned by the socio-demographic factors included in the model than mattering. Welfare policy and practice therefore need to address mattering and discrimination relationally and structurally.

• Jobling, Nina; Mjåland, Kristian; Clausen, Thomas; Heldal, Anne Taraldsen; Thylstrup, Birgitte & Vederhus, John-Kåre (2026). Medication transitions and predictors of illicit substance use during opioid agonist treatment: a three-year follow-up study. Addiction science & clinical practice. ISSN 1940-0632. 21. doi: 10.1186/s13722-026-00711-0. Full text in Research Archive Show summary

  Background For opioid use disorder (OUD), pharmacological therapy using methadone or buprenorphine, plus psychosocial support, is the most effective opioid agonist treatment (OAT). Long-acting injectable buprenorphine (LAIB) is the newest buprenorphine formulation. This study evaluated LAIB within a naturalistic clinical setting, compared with standard OAT (sublingual buprenorphine and methadone). Methods This observational study included patients from an OAT outpatient clinic in Agder County, Norway. Data were extracted from hospital medical records in May 2022. The cohort was followed up in February 2025. Medication-group transitions and outcomes were assessed by examining switching, discontinuation, mortality, and illicit substance use over three years. Results The study included 424 patients. The LAIB group was significantly younger than the standard OAT groups. During the study period, 13.2% of patients switched medications, increasing the LAIB group from 17% to 22%. Comparable proportions of patients experienced negative outcomes: 10% discontinued treatment, and 4% died. At follow‑up, illicit substance-use problems were less frequent in the sublingual buprenorphine group than the other groups, a finding that appears to have been influenced by differential attrition. Baseline substance use was the strongest predictor of illicit substance use at follow‑up. Conclusions The LAIB group slightly increased during the study period. Transitions between medication groups appeared to yield better substance-use outcomes at follow-up in the sublingual buprenorphine group, compared to in other groups. Baseline substance use was the strongest predictor of illicit use at follow‑up, suggesting that individual clinical characteristics may contribute more to outcomes than the specific medication pathway.

• Hørte, Cathrine; Vederhus, John-Kåre; Strømland, Monica; Haugland, Siri Håvås; Birkeland, Bente & Abildsnes, Eirik (2026). Adult support and its role in the association between childhood adversity and quality of life in a population-based study. Discover Public Health. 23(1). doi: 10.1186/s12982-026-02634-2. Full text in Research Archive Show summary

  Abstract Background Childhood adversities can have long-term impacts on quality of life (QoL), health, and well-being. We surveyed an adult population to assess the prevalence of three common adverse childhood experiences (ACEs): parental alcohol problems, parental mental illness, and violence from caregivers, as well as the overlap between them. We additionally examined the prevalence of adult support across ACE exposure and how this support related to perceived childhood difficulties and adult QoL. Methods This cross-sectional study used retrospective data from the Norwegian Counties Public Health Survey in Agder 2023. Data were summarized descriptively, and a Venn diagram illustrated the overlap between ACEs. We examined associations between cumulative exposure and the presence or lack of adult support and how these factors related to perceptions of childhood difficulties and adult QoL using one-way analysis of variance. Results The most prevalent ACEs were parental mental illness and parental alcohol problems (16% and 14%, respectively), while ~ 10% reported violence from a caregiver. We observed substantial overlap amongst the three ACE categories, with 2.4% having experienced all three. Adult support was inversely associated with higher levels of ACE exposure, and analysis showed a pattern of increasing perceived childhood difficulties and decreasing QoL scores. Adult support was consistently associated with the perception of a less difficult childhood and higher QoL, among subjects with the same level of ACE exposure. Conclusions Our findings emphasize the importance of adult support within the context of ACEs, and the need for enhanced measures aimed at supporting those most affected.

• Haugjord, Kenneth; Vederhus, John-Kåre; Ness, Ottar & Sørensen, Kristine Dahl (2026). Next of kin’s experiences of healthcare encounters in the context of severe self-harm: “We know them best”. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 21(1). doi: 10.1080/17482631.2026.2712680. Full text in Research Archive Show summary

  Purpose: Policies in Norway and similar countries emphasize the inclusion of next of kin in healthcare. However, research shows that many experience limited involvement and recognition. This study explores how next of kin to individuals with severe self-harm experience and make sense of healthcare encounters in a Norwegian context. Methods: The study draws on in-depth interviews with 15 parents, partners, and siblings of individuals engaging in severe self-harm. Reflexive thematic analysis was employed, guided by a phenomenological sensibility. Results: Three interconnected themes illuminated different aspects of participants’ encounters with healthcare services. “In the hands of the system” captures experiences of navigating the healthcare system while concerned for a loved one’s wellbeing. “Who do I become when excluded” highlights participants` experiences of their experiential knowledge being marginalized and how emotional involvement appeared to undermine their credibility. “The ones who stand by” reflects concerns about their own wellbeing and that of the wider family alongside a desire for greater recognition and support. Conclusions: The results suggest that healthcare encounters involve not only support and participation but also recognition of next of kin’s experiential knowledge and needs, which appears to shape their sense of legitimacy and ability to remain involved in care.

• Grimsland, Frida; Gabrielsen, Karin Berle; Clausen, Thomas; Haugland, Siri Håvås & Vederhus, John-Kåre (2026). Child maltreatment and substance use: associations with alcohol use, nicotine use, and quality of life in a Norwegian population sample. Frontiers in Public Health. 14. doi: 10.3389/fpubh.2026.1821179. Full text in Research Archive Show summary

  Background Child maltreatment (CM) is a significant public health concern with long-term consequences for the child, including an increased likelihood of engaging in risky health behaviors, such as substance use, as well as impaired quality of life (QoL). The relationship between CM and specific substance use patterns, particularly the use of nicotine products such as Swedish snus, remains understudied. We investigated the relationship between CM and the use of nicotine and alcohol, as well as whether use of these substances mediates the association between CM and adulthood QoL. Methods This study utilized data from the Norwegian Counties Public Health Survey for Agder in 2023. Latent regression analysis was employed to examine the association between CM and QoL, as well as potential mediated associations involving substance use, while controlling for sociodemographic factors. Results Nicotine use in the past year was significantly more prevalent among individuals with a history of CM compared to the group with no history of CM (35.8% vs. 25.6%, p &lt; 0.001). Both smoking (24.3% vs. 15.6%, p &lt; 0.001) and snus use (17.6% vs. 13.3%, p &lt; 0.001) were more common in the CM group, with differences remaining significant after adjustment for sociodemographic factors. No significant differences were found in alcohol use across various measures, including frequency of use, AUDIT-C scores, and binge drinking. Latent regression analysis showed that CM had an overall negative association with QoL [β = −0.61; 95% confidence interval (CI) −0.71, −0.51; p &lt; 0.001]. A significant mediated association involving nicotine use was also observed (β = −0.12; 95% CI −0.16, −0.07; p &lt; 0.001). Conclusion CM is associated with a higher prevalence of smoking and snus use, which are negatively associated with QoL. The findings suggest that targeted efforts to support QoL among individuals with a history of CM, including attention to nicotine use, may be relevant within broader strategies addressing living conditions and psychological wellbeing.

• Romedal, Signegun; Selbekk, Anne Schanche; Haugland, Siri Håvås; Vederhus, John-Kåre & Birkeland, Bente (2026). Designing their Own Story: A Meta-Ethnography of Health Promotion Among Adolescents with Parental Substance Use Problems. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. 43(3), p. 235–260. doi: 10.1177/14550725261436976. Full text in Research Archive Show summary

  Aims Children and adolescents living with parental substance use problems (PSUP) are at potential risk of developing cognitive, behavioral, psychosocial and emotional difficulties affecting their health. However, little is known about how they themselves understand and promote their own health and well-being. This meta-ethnography aims to integrate and synthesize qualitative studies that have explored – from a salutogenic health-promoting perspective – how adolescents living with PSUP express health promotion and well-being, focusing on resources for positive health. Methods The seven iterative phases by Noblit and Hare were followed. Systematic literature searches yielded 13 articles. Results “Designing their own story” was identified as an overarching metaphor accentuated by three main themes that we named: (1) “controlling before opening up”; (2) “choosing trusted support”; and (3) “learning for life”. The overarching metaphor symbolizes how adolescents living with PSUP demonstrate agency in a stressful life situation, expressing a sense of control in everyday life and actively choosing whom to involve for support. Conclusions Supplementing protection and prevention, a different view on narrative of adolescents living with PSUP emerges in the conceptual framework of salutary health promotion. When support is offered, this can inform professionals, service providers and policymakers about the significance of acknowledging and exploring the resources within the adolescents themselves and in their environments. Further research is needed to gain a broader and deeper understanding of how to support adolescents living with PSUP in a health-promoting direction, recognizing their potential to improve their health and well-being in their stressful and challenging life situation.

• Hørte, Cathrine; Vederhus, John-Kåre & Abildsnes, Eirik (2026). Youth Impacted by a Family Member’s Substance Use: A Qualitative Exploration of Life Course Experiences and Coping. Journal of Child and Adolescent Trauma. ISSN 1936-1521. 19, p. 1731–1742. doi: 10.1007/s40653-026-00869-4. Full text in Research Archive Show summary

  Many reports describe how children and youth are negatively impacted by substance use in their household. Less is known about how they cope. Moreover, there is a scarcity of research that analyses empirical data through a theoretical lens. The aim of the present study was two-fold: to explore the experiences and coping strategies of youth growing up impacted by a family member’s substance use, and to examine how these findings relate to pertinent theory. The participants were 17–21 years of age and had participated in a psychoeducational programme for affected family members. We conducted in-depth interviews (n = 6), applying Systematic Text Condensation in a thematic cross-case analysis. Discussions of the findings were informed by insights from the Salutogenic Model of Health. Two main themes emerged. First, growing up with substance use is a lonesome and demanding experience. Second, children and youth cope using methods that may become problematic—such as supressing emotions and trying to be self-supported—as well as strategies aimed at fostering independence and focusing on constructing a better future. By discussing our findings in the context of salutogenic theory, we gained insights into the multifaceted aspects of coping, which may inform practice and facilitate movement towards health in this population.

• Øgård-Repål, Anita; Haugland, Siri Håvås; Vederhus, John-Kåre; Robstad, Anja Nastasja & Stea, Tonje Holte (2026). Exploring sleep-related problems among concerned others of individuals with mental health problems and/or problematic substance use: a cross-sectional study. Frontiers in Public Health. 14. doi: 10.3389/fpubh.2026.1703652. Full text in Research Archive Show summary

  Background: Mental health problems and/or problematic substance use (including alcohol) affect not only the individuals directly involved but also their close family members. Being a concerned other, a partner, parent, or child of someone with mental health problems or problematic substance use can be emotionally demanding and may negatively impact sleep health. This study aimed to examine whether concerned others are at increased risk of sleep-related symptoms compared with individuals without such family-related burdens.Materials and methods: A cross-sectional study was conducted among 18,517 Norwegian adults (>18 years) by completing an online self-report questionnaire. Multivariable logistic regression models adjusted for age, economic capability (SES) and gender were used to examine whether being a partner or parent of individuals struggling with substance use or mental health problems or having experienced a parent with problematic alcohol use or mental health problems during childhood was associated with sleep-related symptoms.Results: During childhood, 15.8% and 13.9% reported having parents with mental health problems or problematic alcohol use, respectively. In adulthood, 1 in 6 individuals reported being a partner or parent to someone with mental health problems, and 1 in 10 reported being a partner or parent to someone with problematic substance use. Childhood exposure to parental mental health problems or problematic alcohol use was significantly associated with increased odds of sleep initiation difficulties, sleep maintenance problems, daytime sleepiness, and chronic sleep issues in adulthood (ORs ranging from 1.43 to 1.73). Similarly, being a concerned other to someone with mental health problems or problematic substance use in adulthood was associated with increased odds of having the same sleep-related symptoms (ORs ranging from 1.56 to 1.95).Conclusion: Concerned others of individuals with mental health problems or problematic alcohol or substance use had higher prevalence of sleep-related symptoms. Both current caregiving and childhood exposure to such experiences are linked to poor sleep and potential long-term health consequences. These findings highlight the need for targeted support and early interventions to improve sleep and overall well-being among concerned others.

• Friesinger, Jan Georg; Heimburg, Dina von; Ness, Ottar; Haugland, Siri Håvås & Vederhus, John-Kåre (2026). Discrimination experiences and their associations with sociodemographic factors, health and quality of life—a latent class analysis. Health and Quality of Life Outcomes. 24, p. 1–11. doi: 10.1186/s12955-026-02502-2. Full text in Research Archive Show summary

  Background Discrimination has adverse effects on people’s health and quality of life (QoL). This study aimed to identify distinct intersecting patterns of discrimination experiences, examine their associations with social categories and health factors, and assess the impact of perceived discrimination (PD) on health and QoL outcomes beyond specific self-reported reasons for PD. Methods We utilized data from the Norwegian Counties Public Health Survey (NCPHS) conducted in Agder County in 2023 and employed latent class analysis (LCA) to explore how patterns of discrimination reasons cluster. The selected classes were then further examined to determine how they differed by comparing each class to the reference class with no PD. Lastly, we assessed the estimated marginal means of each class on health and overall QoL using ANCOVA. Results The study identified six classes of PD: Massive PD, Gender/Age PD, No PD, Function/Illness PD, Ethnicity/Skin PD, and Political PD. ANCOVA analyses revealed significant differences across self-rated health, mental distress, and QoL. Notably, the Massive PD, Gender/Age PD, and Function/Illness PD groups reported significantly poorer self-rated health and QoL compared to the No PD group. All PD classes scored significantly higher in mental distress than the No PD group, with the Massive PD class exceeding the clinical cut-off, indicating elevated psychological distress. Conclusions Our findings reveal persistent health and QoL disparities between individuals experiencing PD and those who do not, despite a robust welfare system. Service providers must consider the interplay of factors such as age, gender, income, and health conditions with PD to ensure fair service delivery.

• Hørte, Cathrine; Vederhus, John-Kåre & Abildsnes, Eirik (2026). Problematic substance use in the family: professionals’ and adolescents’ perspectives on identification and help. A qualitative study. Scandinavian Journal of Public Health. ISSN 1403-4948. p. 1–8. doi: 10.1177/14034948251405144. Full text in Research Archive Show summary

  Aims: The aim of this study was to explore how professionals within the child health, education and welfare sectors perceive the process of identification and how they care for children and young people (CYP) living with problematic substance use (PSU) in their families. We also sought to understand the perceptions of engagements and needs of adolescents living with PSU in their families. Methods: We combine five focus group interviews with professionals and six individual interviews with adolescents. We employ systematic text condensation in a cross-case thematic analysis and discuss our findings, considering Bronfenbrenner’s bioecological model. Results: Professionals face barriers to identifying affected CYP on multiple levels and uncertainty about signs of adversities, corresponding to the experiences of adolescents who emphasise a need for vigilant adults. However, the results also suggest the school setting as an enabling arena for identification, follow-up and interdisciplinary collaboration. Both parties request a community of experience in support groups with peers for CYP and increased knowledge on how substance use affects family members. Conclusions: School can be an important arena for identifying CYP affected by PSU and interdisciplinary collaboration in the effort to attend to their needs. There is an identified need to educate professionals and CYP on living with substance use in the household and to promote peer support opportunities for CYP.

• Redondo, Christina L.; Weimand, Bente; Benth, Jurate Saltyte; Vederhus, John-Kåre; Mordal, Jon & Enger, Asle Ellingsøn [Show all 8 contributors for this article] (2025). Changes in quality of life during 52 weeks of extended-release naltrexone treatment, subsequent by a 1-year post-treatment period. Drug and Alcohol Dependence. ISSN 0376-8716. 276. doi: 10.1016/j.drugalcdep.2025.112917. Full text in Research Archive Show summary

  Background: This study investigates changes in quality of life (QoL) among individuals with opioid use disorder (OUD) undergoing extended-release naltrexone (XR-NTX) treatment for 52 weeks, subsequent by a 1-year post-treatment period. Methods: Conducted as a naturalistic, multicenter, open-label clinical trial across five urban hospitals in southern Norway, this observational study enrolled 158 participants with severe OUD. Participants received XR-NTX treatment for up to 52 weeks, with QoL assessed using the WHOQOL-BREF instrument at five time points during treatment and twice during the post-treatment period. The Addiction Severity Index, European version (EuropASI) was used to measure covariates. A linear mixed model was employed to analyze trends in QoL, adjusting for mental distress severity and substance use severity. Results: Significant improvements in QoL were observed in the physical, psychological, social and environmental domains during the XR-NTX treatment, with less pronounced changes in the environmental domain. Mental distress and substance use severity were negatively associated with QoL scores. The most substantial QoL improvements occurred within the first year of treatment, with overall perceived QoL remaining stable during the 1-year post-treatment period. Conclusions: This study highlights XR-NTX as a beneficial treatment option for enhancing QoL in individuals with OUD. The findings support the integration of XR-NTX into OUD treatment plans and emphasize the need for further research to explore long-term outcomes and the impact of external factors on QoL.

• Vederhus, John-Kåre; Timko, Christine; Haugland, Siri Håvås & Friesinger, Jan Georg (2025). Assessing Place Attachment by Immigrant Status: Validation of a Short Measure for Multidisciplinary Research. Journal of Community and Applied Social Psychology. ISSN 1052-9284. 35(3). doi: 10.1002/casp.70096. Full text in Research Archive Show summary

  Place attachment (PA) is recognised for its influence on health and well-being. We validated a brief PA measure called the PA-4, which focuses on the individual's place of residence and surrounding neighbourhood. The study included 17,487 participants from a national survey conducted in Norway in 2021. The PA-4 comprises four indicators scored on a 0–10 scale. Emotional attachment was measured through indicators of belongingness and feeling safe, while cognitive evaluation was assessed through indicators of satisfaction with housing and satisfaction with the place of residence. The analysis examined the factor structure, internal consistency, and discriminant validity of the measure using multi-group confirmatory factor analysis, comparing immigrants and native-born individuals. Convergent validity was assessed by examining the association between the PA-4 and a well-being scale through latent regression analysis. The PA-4 demonstrated good discriminant validity, as evidenced by a hypothesised difference in PA. The latent mean of the PA-4 was 0.65 (95% CI = 0.57–0.73, p < 001) lower for immigrants compared to natives. The regression analysis also supported convergent validity, as shown by PA-4's positive association with well-being. The PA-4 exhibited robust psychometric properties, indicating its suitability for use in multidisciplinary research.

• Friesinger, Jan Georg; Haugland, Siri Håvås; Heimburg, Dina von; Ness, Ottar & Vederhus, John-Kåre (2025). Associations between perceived discrimination and health: a cross-sectional public health study. BMC Public Health. 25. doi: 10.1186/s12889-025-23888-6. Full text in Research Archive Show summary

  Background Many people experience discrimination based on factors such as age, gender, illness, disability, ethnicity, skin color, religion, beliefs or sexuality. Discrimination can lead to marginalization and be linked to poor health. As a result, there is a growing interest in exploring the underlying causes of discrimination and its cumulative consequences. The aim of the present study was to explore the prevalence of perceived discrimination (PD) in a large cross-sectional public health study and its association with self-rated health and mental distress. Methods The study was based on data from 18,517 participants in the 2023 Norwegian Counties Public Health Survey (NCPHS) in Agder County. The participants were asked if they had experienced discrimination in the past 12 months and could specify different reasons. Furthermore, they were asked about their self-rated health, mental distress, and sociodemographic factors. In the analysis of the responses, PD was categorized based on the number of reasons, ranging from no PD to one, two, or three or more reasons. Results Among the participants, 17.8% reported experiencing discrimination for at least one reason. Compared with those who experienced no discrimination, participants reporting discrimination for one reason were twice as likely to report poor self-rated health or mental distress. The odds increased to a range between two and a half to three times for those facing discrimination on two grounds. For individuals experiencing discrimination for three or more reasons, the likelihood rose substantially: Four times higher for poor self-rated health and approximately three times higher for mental distress. Conclusions There is a clear association between multiple reasons for PD and low scores in mental and/or physical health, suggesting a cumulative influence. To address this issue effectively, prevention efforts should be implemented at both the national level and within local public health strategies.

• Haugland, Siri Håvås; Gallefoss, Lisbeth; Hals-Lydersen, Aleksander & Vederhus, John-Kåre (2025). Parental Alcohol Problems and Lack of Adult Support During Childhood—Consequences for Subjective and Objective Social Connection in Adulthood. Drug and Alcohol Review. ISSN 0959-5236. 44(5), p. 1459–1467. doi: 10.1111/dar.14070. Full text in Research Archive Show summary

  Introduction: Parental alcohol problems may cause immediate and long-term harm in children. This study investigated the relationship between parental alcohol problems and adult social connection, and whether the absence of adult support during childhood compounded these relationships. Methods: We used cross-sectional data from 23,714 adults (> 18 years) who participated in the 2019 Norwegian Counties Public Health Survey. Parental alcohol problems were assessed using CAST-6. Social connection was measured using objective (participation in social activities) and subjective indicators (missing someone to be with, feeling excluded, isolated or lack of support). Multivariable logistic regression analysis was used to analyse associations between parental alcohol problems (with or without adult support) and adult social connection, adjusted for sex, age and socioeconomic status. Results: Individuals reporting parental alcohol problems had higher odds of poor social connection across all indicators compared to those without these experiences (odds ratios [OR] and 95% confidence intervals [CI] ranged from OR 1.14; CI 1.01–1.29 to OR 1.49; CI 1.26–1.76). These associations were notably stronger for those who also lacked adult support during childhood, particularly in subjective indicators of social connection, with OR ranging from 1.50; CI 1.36–1.67 to OR 4.02; CI 3.49–4.64. Discussion and Conclusions: Findings revealed associations between parental alcohol problems and lack of social connection in adulthood. The negative impact was amplified when adult support during childhood was lacking, particularly affecting the subjective measures of social connection. These findings highlight the long-term consequences of parental alcohol problems and underscore the potential protective role of adult support.

• Vederhus, John-Kåre & Haugland, Siri Håvås (2025). Vanskelige barndomsopplevelser setter spor. In Andersen, Anders Johan W. & Haugland, Siri Håvås (Ed.), Perspektiver på psykososial helse. Fagbokforlaget. ISSN 9788245053180. p. 107–124. doi: 10.55669/oa550206. Full text in Research Archive Show summary

  Vanskelige barndomsopplevelser kan sette negative spor i folks helse helt inn i voksen alder. Dette har fått stor oppmerksomhet i forskningslitteraturen de siste 20 årene (Bellis et al., 2019; Hughes et al., 2017). I dette kapittelet ønsker vi å se om internasjonale funn fra dette forskningsfeltet bekreftes i en norsk folkehelseundersøkelse. Spesifikt vil vi undersøke i hvilken grad vanskelig-heter i barndommen er relatert til psykososiale konsekvenser (sosiale forhold, økonomisk situasjon og psykisk helse) i voksen alder.Internasjonalt blir temaet omtalt som «Adverse Childhood Experiences» (ACE), etter navnet på en større amerikansk studie om fenomenet fra midten av 90-tallet (Felitti, 2019). Bakgrunnen for studien var at klinikere i en helse-forebyggende poliklinikk oppdaget hvor vanskelig det var for pasienter i et behandlingsprogram for fedme å gjøre livsstilsendringer for å gå ned i vekt og å holde vekten nede (Felitti et al., 2010; Olsen, 2020). Når de utforsket dette nærmere, oppdaget de at spisevanene kunne være en måte å håndtere under-liggende emosjonelle problemer forårsaket av seksuelle overgrep i barndom-men. Oppdagelsen førte til at de begynte å spørre alle pasienter med fedme om barndomstraumer, og de ble overveldet over hvor mange som hadde slike negative barndomsopplevelser. I en pilotstudie oppdaget de at så mange som 55 % av pasientene hadde opplevd seksuelle overgrep i barndommen (Felitti, 2019). Forskerne ble rådet til å gjøre en større epidemiologisk studie for å undersøke forekomsten blant sykehuspasienter generelt, og ACE-studien ble igangsatt i 1995 blant medlemmer i et større privat sykehusforetak i USA, Kaiser Permanente i San Diego. Internasjonalt har vanskelige barndoms-opplevelser blitt målt på ulike måter, alt fra enkeltspørsmål til større spørre-skjemaer – men mest kjent er nok fremdeles de ti spørsmålene fra ACE-studie som blant annet inneholdt spørsmål om emosjonelt eller seksuelt misbruk, omsorgssvikt, foreldres rusbruk og skilsmisse.

• Schrøder, Siv & Vederhus, John-Kåre (2025). Balansekunst - når brukerkunnskap er en del av undervisningen. In Andersen, Anders Johan W. & Haugland, Siri Håvås (Ed.), Perspektiver på psykososial helse. Fagbokforlaget. ISSN 9788245053180. p. 289–304. doi: 10.55669/oa550217. Full text in Research Archive
• Mordal, Jon; Juya, Farid; Holtan, Line; Vederhus, John-Kåre; Opheim, Arild & Brenna, Ida Halvorsen [Show all 10 contributors for this article] (2025). High induction rate onto extended-release naltrexone for people with opioid use disorder: experiences from a Norwegian naturalistic study. Addiction science & clinical practice. ISSN 1940-0632. 20(1). doi: 10.1186/s13722-025-00576-9. Full text in Research Archive Show summary

  Background For people with opioid use disorder (OUD), extended-release naltrexone (XR-NTX) is an effective antagonist treatment option. However, successful opioid tapering and abstinence is a prerequisite for XR-NTX induction and has repeatedly been reported as a major barrier to effective treatment. The aims of this study were to describe XR-NTX induction rates, reasons for incomplete induction, and extraordinary complications reported during the induction phase. We also compared sociodemographic and clinical variables among those who did and did not complete induction onto XR-NTX. Methods This naturalistic, multicenter, and open-label Norwegian study of XR-NTX included men and women aged 18–65 who had severe OUD. Most participants were referred to inpatient medically managed opioid withdrawal and received individualized pharmacological and psychosocial treatment according to clinical assessment and national guidelines. After opioid withdrawal, the participants underwent a minimum of three opioid-free days prior to XR-NTX induction. Variables were collected through baseline assessments and a retrospective patient chart review. XR-NTX induction completers and non-completers were compared via bivariate and logistic regression analyses. Results Of 129 participants with recent opioid use at inclusion, 106 (82%) completed XR-NTX induction. Induction was initiated in an inpatient setting for 116 participants (90%) and extraordinary complications were noted for 19 (15%) patients. Withdrawal symptoms and ambivalence were the most common reasons for non-completion, each noted in 75% of the cases. As compared with those who successfully completed induction, non-completers more often reported lifetime hepatitis (78% vs. 52%, p = 0.017), had a longer period of current substance use (mean 119 vs. 54 months, p = 0.001), and more frequently used methadone prior to study inclusion (43% vs. 8%, p < 001). In logistic regression analyses, methadone use was the only significant factor and was negatively associated with completion (odds ratio 0.20, 95% confidence interval = 0.05–0.72, p = 0.014). Conclusion The results demonstrate the safety, efficacy and tolerability of a Norwegian opioid withdrawal and XR-NTX induction procedure. Although the present induction rate was high, our findings indicate that methadone users need special attention and tailored interventions regarding opioid withdrawal management and XR-NTX induction. Trial registration The study is registered at clinicaltrials.gov (NCT03647774).

• Bjørnestad, Endre Dahlen; Vederhus, John-Kåre & Clausen, Thomas (2024). Change in substance use among patients in opioid maintenance treatment: baseline to 1-year follow-up. Harm Reduction Journal. 21(1), p. 101–101. doi: 10.1186/s12954-024-01005-x. Full text in Research Archive Show summary

  Background Individuals with opioid use disorder (OUD) often have concurrent use of non-opioid substances. When patients enter opioid maintenance treatment (OMT), less is known about outcomes regarding the use of other types of drugs. Here we aimed to investigate changes in substance use among patients entering outpatient OMT, from treatment initiation to 1-year follow-up. Methods We used data from the prospective Norwegian Cohort of Patient in OMT and Other Drug Treatment Study (NorComt). Among 283 patients who entered OMT at participating facilities across Norway, 179 were assessed at follow-up. Of these patients, 131 were in a non-controlled environment, and were included in the present analysis. The main outcome was change in substance use. Logistic regression analysis was applied to identify factors associated with abstinence from all substances (other than agonist medication) at follow-up. Results Along with opioid use, most patients reported polysubstance use prior to entering treatment. No significant differences were found in baseline characteristics between the included and non-included groups when examining attrition. At the 1-year follow-up, reduced substance use was reported. While in treatment, around two-thirds of patients continued using other drugs to varying degrees. At follow-up, about one-third of patients reported abstinence from all drugs, apart from the agonist medication. Factors related to abstinence included a goal of abstinence at baseline (OR = 5.26; 95% CI 1.14–19.55; p = 0.013) and increasing age (OR = 1.05; 95% CI 1.00–1.09; p = 0.034). Conclusions The majority of patients entering OMT used other substances in addition to opioids. About one-third of patients reported abstinence at the 1-year follow up. Although the majority of patients continued co-use of other drugs while in treatment, for most substances, less than 10% reported daily use at follow-up, with the exception of cannabis which was used daily/almost daily by about 2 in 10. Higher age and treatment goal at the start of OMT were important factors related to reducing concomitant substance use during treatment. These findings suggest that many patients entering OMT are in need of treatment and support related to the use of other substances, to further improve prognosis. Clinical trial registration Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).

• Gabrielsen, Karin Berle; Clausen, Thomas; Haugland, Siri Håvås & Vederhus, John-Kåre (2024). Gradual improvement in functioning and mental distress during long-term outpatient SUD treatment – A prospective pre-post study. Addictive Behaviors Reports. ISSN 2352-8532. 19, p. 1–8. doi: 10.1016/j.abrep.2024.100525. Full text in Research Archive Show summary

  Background Globally, outpatient programs for substance use disorder (SUD) treatment have gained prominence. To assess the broader clinical implications of this trend we investigated shifts in functioning experienced by outpatients undergoing treatment. Methods We describe the clinical characteristics of a cohort of 93 SUD patients in a Norwegian outpatient treatment clinic. Using paired-samples t-tests, we examined changes in perceived functioning, mental distress, and other clinically relevant outcome variables in a 5-month time interval during the treatment course. Results We obtained follow-up data for 67 (72%) of the included patients, with no significant difference in patient-related factors between those who completed the treatment course and those who were not assessed at follow-up. Perceived functioning increased significantly from study inclusion (Time 0) (mean 19.8, standard deviation ± 8.8) to its conclusion (Time 1) (24.3, ±9.3; t (66) = 4.5, (95% CI: 2.5–6.5, p < 0.001). We also identified significant improvement in most other measured variables, including mental distress, self-reported sleep quality, restlessness, and obsessive thinking. Substance use–related variables showed a modest, non-significant improvement at T1. Conclusion During a 5-month course of outpatient treatment, patients’ subjective experience of functioning improved significantly. Those with the lowest functioning levels at T0 improved the most. Structured monitoring may be a valuable clinical tool for personalizing intervention, enhancing treatment outcomes, and supporting the clinical decision-making process.

• Ordahl, Monica Øvensen; Vederhus, John-Kåre & Birkeland, Bente (2024). Utforskning av mentorordningen ved et kommunalt, langtids rehabiliteringstilbud for mennesker med rusmiddelavhengighet – en kvalitativ studie. Nordisk tidsskrift for livskvalitet og bærekraftig velferdsutvikling. 3(3), p. 179–194. doi: 10.18261/njwel.3.3.5. Full text in Research Archive Show summary

  I denne studien undersøkte vi erfaringer med en mentorordning blant beboere i rehabilitering for rusmiddelavhengighet i en kommunal kontekst, med et spesielt fokus på betydningen av det å være mentor for egen bedringsprosess. Vi utforsket også eventuelle utfordringer knyttet til mentorordningen. Datamaterialet er basert på kvalitativ metode, og vi gjennomførte tematisk analyse av syv semistrukturerte intervjuer fra beboere som hadde vært på Jegersberg gård (JG) i omtrent ett år. Funnene beskriver mulighetene og utfordringene ved mentorordningen. De ble oppsummert i temaene: 1) ansvar for andres ve og vel, 2) formidlere av håp, 3) fra byrde til ressurs, 4) «Er det noe som dukker opp, venter vi ikke til de ansatte kommer», og 5) når forventningene ikke ble innfridd. Deltakerne hadde en sterk oppfatning av at mentorfunksjonen var en viktig og nyttig ordning for fellesskapet og driften av et slikt rehabiliterende bofellesskap i kommunal regi. Mentorordningen ble fremhevet som et viktig redskap i den enkeltes bedringsprosess, både for beboerne og mentorene selv. Noen aktuelle utfordringer ved mentorrollen nevnes. En mentorordning synes å være et svært aktuelt og nyttig tiltak i kommunal rehabilitering av mennesker med rusmiddelavhengighet.

• Bjørnestad, Endre Dahlen; Vederhus, John-Kåre & Clausen, Thomas (2024). Change in self-reported somatic symptoms among patients in opioid maintenance treatment from baseline to 1-year follow-up. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-05590-w. Full text in Research Archive Show summary

  Background High somatic comorbidity is common among patients in treatment for opioid use disorder (OUD). The present study aims to investigate changes in self-reported somatic health conditions and somatic symptoms among patients entering opioid maintenance treatment (OMT) programs. Methods We used data from the Norwegian Cohort of Patients in OMT and Other Drug Treatment (NorComt) study. Of 283 patients who entered OMT, 176 were included for analysis at a 1-year follow-up. Participants provided self-reported data during structured interviews on somatic conditions, somatic symptoms, substance use severity measures, and mental distress. A multivariable linear regression analysis identified factors associated with changes in the burden of somatic symptoms. Results Patients entering OMT reported a high prevalence of somatic conditions at the beginning of treatment, with 3 of 5 patients reporting at least one. The most prevalent condition was hepatitis C, followed by asthma and high blood pressure. Patients reported experiencing a high number of somatic symptoms. The intensity of these symptoms varied across a wide spectrum, with oral health complaints and reduced memory perceived as the most problematic. Overall, for the entire sample, there was no significant change in somatic symptoms from baseline to 1 year. Further analysis indicated that those who reported a higher burden of somatic symptoms at baseline had the greatest improvement at the 1-year follow-up. A higher number of somatic conditions and higher mental distress at baseline was associated with improvements in somatic symptoms burden at follow-up. Conclusions Patients in OMT report a range of somatic conditions and somatic symptoms. Given the wide range of symptoms reported by patients in OMT, including some at high intensity levels, healthcare providers should take into consideration the somatic healthcare needs of individuals in OMT populations. Clinical trial registration Clinicaltrials.gov no. NCT05182918. Registered 10/01/2022 (the study was retrospectively registered).

• Vederhus, John-Kåre; Timko, Christine; Birkeland, Bente; Haugland, Siri Håvås & Gabrielsen, Karin Berle (2024). Validation of an ultra-short global quality of life scale in a large population-based health survey. PLOS ONE. 19(8). doi: 10.1371/journal.pone.0307539. Full text in Research Archive Show summary

  Introduction Quality of life (QoL) assessment is essential in health-related research and clinical settings, offering insights into individuals’ well-being and functioning. This study validated the Essential QoL-3 (EQoL-3), an ultra-short scale assessing essential dimensions of QoL, for use in epidemiological research and clinical settings. Methods Data from a 2021 national survey in Norway (N = 17,487) were used. Three items on the EQoL-3 assess life satisfaction, happiness, and meaningfulness on a 0–10 scale. Discriminant validity was assessed by comparing the EQoL-3 with the Satisfaction with Life Scale (SWLS) and by examining latent mean differences between individuals with adverse life experiences (ALE+) and those without such experiences (ALE-). Convergent validity was evaluated through latent regression analyses comparing the EQoL-3 with a perceived mastery scale and a mental distress scale. Results The discriminant validity of the EQoL-3 was less than optimal when compared with the SWLS. Nonetheless, a multigroup confirmatory factor analysis revealed that the EQoL-3 score was 1.42 (95% CI = 1.33–1.50, p

• Weimand, Bente Margrethe; Karlsson, Ann Tarja; Solli, Kristin Klemmetsby; Vederhus, John-Kåre; Mordal, Jon & Digranes, Linn Camilla Wergeland [Show all 7 contributors for this article] (2023). Characteristics of opioid-dependent patients choosing antagonist treatment with extended-release naltrexone compared with patients in opioid maintenance treatment in Norway. Heroin Addiction and Related Clinical Problems. ISSN 1592-1638. 25(4), p. 5–14. Full text in Research Archive Show summary

  Background: Opioid dependency is a risk factor for several negative life events and conditions. The opioid receptor inhibitor extended-release naltrexone (XR-NTX) is safe and effective in reducing illicit substance use. Here, we report results of a naturalistic, multicentre, open-label trial of XR-NTX for 24 weeks, with an optional 28-week treatment extension (NaltRec study). Aims: The study aims were to compare sociodemographic and clinical variables between patients choosing XR-NTX (n=162) and those in opioid agonist treatment (OAT) (n= 155), and to compare these variables in the XR-NTX group between patients who were (n= 103) and were not (n= 59) in OAT before study inclusion. Methods: To measure objective-related factors, we used a structured interview at inclusion. Results: The XR-NTX group had fewer women, was younger and reported poorer living and social conditions than the OAT group. Both groups had serious health conditions. Across groups, 40% percent reported lifetime suicide attempts, and 60% reported abusive experiences, with 47% women and 17% men reporting sexual abuse. Age at onset of polydrug use was 20 years. Patients preferring XR-NTX to OAT reported poorer social conditions compared with those choosing OAT. Conclusions: Women and patients who are not stabilized before enrolment need specific attention to tailored supportive measures during treatment with extended-release naltrexone.

• Karlsson, Ann Tarja; Vederhus, John-Kåre; Clausen, Thomas; Weimand, Bente Margrethe; Solli, Kristin Klemmetsby & Tanum, Lars Håkon Reiestad (2022). Impact of Impulsivity, Hyperactivity, and Inattention on Discontinuation Rate among Opioid-Dependent Patients Treated with Extended-Release Naltrexone. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(18), p. 1–8. doi: 10.3390/ijerph191811435. Full text in Research Archive Show summary

  Previous studies have indicated elevated levels of impulsivity, hyperactivity, and inattention (IHI) among opioid-dependent patients seeking outpatient treatment with extended-release naltrexone (XR-NTX). This led us to hypothesize that IHI may be associated with a higher discontinuation rate for XR-NTX treatment. In a group of 162 patients with opioid dependence, discontinuation prior to the full 24 weeks of the study period (six injections and attending the study visit at 24 weeks) occurred in 49% of the patients, primarily in the early stage of treatment. IHI above the clinical cut-off on the adult ADHD self-report scale (ASRS) was not associated with a risk of premature discontinuation. This finding was not altered when controlling for socio-demographics, substance, use and mental health severity. Conclusively, high levels of IHI per se is not contradictive for XR-NTX treatment in regard to concern for premature discontinuation.

• Gabrielsen, Karin Berle; Clausen, Thomas; Haugland, Siri Håvås; Hollup, Stig Arvid & Vederhus, John-Kåre (2022). Infralow neurofeedback in the treatment of substance use disorders: a randomized controlled trial. Journal of Psychiatry & Neuroscience. ISSN 1180-4882. 47(3), p. 222–229. doi: 10.1503/jpn.210202. Full text in Research Archive Show summary

  Background Infralow neurofeedback (ILF-NF) was recently developed as a subtype of traditional, frequency-based neurofeedback that targets cerebral rhythmic activity below 0.5 Hz and improves brain self-regulation. The efficacy of ILF-NF in the treatment of substance use disorder has not yet been evaluated, but clinical evidence suggests that it may prevent relapse by improving functioning in various life domains. The current study aimed to fill this research gap and extend empirical evidence related to this issue. Methods Ninety-three patients with substance use disorders at an outpatient unit in Norway were randomized to receive 20 sessions (30 minutes each) of ILF-NF training combined with treatment as usual (TAU), or TAU alone. The primary outcome was quality of life post-treatment as an overall measure of functioning. We analyzed between-group differences using Student t tests. Results We found no significant differences in quality of life between groups. We found similar nonsignificant results for most of the secondary outcome measures, including drug use, sleep, anxiety and depression. Compared to TAU, the ILF-NF + TAU group reported significantly lower restlessness scores post-treatment (mean difference −1.8, 95 % confidence interval −3.1 to −0.5; p = 0.006). Limitations: This study was limited by broad inclusion criteria and a lack of placebo control (sham neurofeedback treatment). Conclusion ILF-NF offered limited additional benefit when combined with TAU, except in the area of restlessness. Future studies could further investigate the relationship between ILF-NF, restlessness and substance use in targeted subpopulations to illuminate relapse mechanisms.

• Vederhus, John-Kåre; Rørendal, Malin; Skårdal, Madelene; Næss, Marianne Otterstad; Clausen, Thomas & Kristensen, Øistein (2022). Successful outcomes with low–threshold intervention for cannabis use disorders in Norway - an observational study. PLOS ONE. 17(6), p. 1–12. doi: 10.1371/journal.pone.0269988. Full text in Research Archive Show summary

  Aims Cannabis is the most commonly used regulated drug by European youths. Yet, few cannabis-specific interventions have been examined in Europe. The Cannabis Cessation Program (CCP) was developed in Sweden in the 1990s and has been implemented in some Norwegian municipalities. The present study aimed to examine outcomes of this intervention in the Norwegian setting. Method The respondents (N = 102) were recruited in four community-based CCPs in Norway. We examined their changes in cannabis use, other substance use, mental distress, well-being, sense of coherence (SoC), and social networks, from baseline (T0) to post-treatment (T1) and up to a 3-month follow-up period (T2). Changes were evaluated with pair-wise t-tests. Result Seventy-six participants (75%) completed the 8-week program, according to plan. All participants reported a significant reduction in cannabis use at T1 (average reduction ~16 days per month) and at T2 (N = 59; ~13 days per month). Among those that completed the program, 67% was abstinent from cannabis at T1 and 37% was abstinent at T2. An intention-to-treat analysis showed that 50% (51/102) and 22% (22/102) were abstinent from cannabis use at T1 and T2, respectively. In parallel to abstinence, we observed a substantial reduction in mental distress and an increase in well-being and SoC. Respondents socialized with fewer friends with current substance use, but drug-free social networks were not expanded. Conclusion Our findings suggested that the CCP was a valuable, low-threshold manual-based intervention for cannabis use disorders. It showed considerable potential for reducing individuals’ cannabis use. Clinical trial registration Clinicaltrials.gov no. NCT04989205. Registered 12 July 2021, i.e., the study was retrospectively registered.

• Friesinger, Jan Georg; Haugland, Siri Håvås & Vederhus, John-Kåre (2022). The significance of the social and material environment to place attachment and quality of life: findings from a large population-based health survey. Health and Quality of Life Outcomes. 20(135). doi: 10.1186/s12955-022-02045-2. Full text in Research Archive Show summary

  Background: There is an international public health interest in sustainable environments that promote human wellbeing. An individual’s bond to places, understood as place attachment (PA), is an important factor for quality of life (QoL). The material environment, such as access to nature (AtN), access to amenities (AtA), or noise, and the social environment, such as social support or loneliness, has the potential to infuence PA. The aim of the present study was to explore the relationship between these factors and QoL. Methods: The study relied on data from 28,047 adults from 30 municipalities in Southern Norway obtained from the Norwegian Counties Public Health Surveys in 2019. Latent regression analyses were used to examine the relationship between the material and social environmental factors and QoL, mediated by PA. Results: We found a relationship between social and material environmental factors and PA. Higher AtN and AtA scores were related to an increase in PA, whereas higher perception of noise problems was related to decreased PA scores. When social environment factors were added to the model, they were even stronger predictors of PA and, in turn, QoL through mediated efects. We also found a strong positive association between PA and QoL (unstandard‑ ized β=0.88, 95% CI=0.87–0.90, p<0.001). The whole model explained 83% of the variance in PA and 65% of the variance in QoL. Conclusions: Taken together, the fndings suggest the relevance of material and social environmental factors for PA and QoL. Therefore, research on public health and QoL should include place-sensitive variables.

• Vederhus, John-Kåre; Haugland, Siri Håvås & Timko, Christine (2022). A mediational analysis of adverse experiences in childhood and quality of life in adulthood. International Journal of Methods in Psychiatric Research. ISSN 1049-8931. 31(1). doi: 10.1002/mpr.1904. Full text in Research Archive Show summary

  Objectives: This study examined associations of three prevalent adverse childhood experiences (ACEs) - parents' problematic alcohol use (PPAU), parental separation/divorce, and lack of support from a trusted adult-with adult quality of life (QoL), and potential mediators of associations. Methods: Data were from a representative survey (N = 28,047) in Norway that assessed ACEs, QoL, and potential mediators: enduring perceptions of childhood hardships (Difficult Childhood Questionnaire; DCQ), current mental distress, and current social isolation. Latent regression analyses examined potential mediators. Results: Each ACE was positively associated with perceptions of childhood as difficult (higher DCQ scores). In turn, ACEs were negatively associated with adult QoL through indirect effects. Lack of support from a trusted adult had the strongest negative association with adult QoL, compared to PPAU and parental separation/divorce. The association between the ACEs and QoL was explained through the mediators of mental distress and social isolation. Conclusions: Of the examined ACEs, lack of support from a trusted adult had the strongest negative impact on adult QoL. Adult support to vulnerable children could potentially ameliorate adult consequences of ACEs. In addition, adults reporting difficulties due to childhood adversities may benefit from therapeutic interventions that address both psychological distress and isolation.

• Bjørnestad, Endre Dahlen; Vederhus, John-Kåre & Clausen, Thomas (2022). High smoking and low cessation rates among patients in treatment for opioid and other substance use disorders. BMC Psychiatry. 22(1), p. 1–8. doi: 10.1186/s12888-022-04283-6. Full text in Research Archive Show summary

  Background: Smoking is a well-documented cause of health problems among individuals with substance use disorders. For patients in opioid maintenance treatment (OMT), the risk for somatic health problems, including preventable diseases associated with tobacco smoking, increases with age. Our aim was to describe smoking among patients entering substance use disorder (SUD) treatment, investigate changes in smoking from the start of treatment to 1-year follow-up, and explore factors related to smoking cessation. Methods: We employed data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). Participants were 335 patients entering SUD treatment at 21 participating facilities across Norway. They were interviewed at the start of treatment and at 1-year follow-up. The main outcomes were smoking and smoking cessation by treatment modality. A logistic regression identified factors associated with smoking cessation. Results: High levels of smoking were reported at the start of treatment in both OMT (94%) and other SUD inpatient treatment patients (93%). At 1-year follow-up most patients in OMT were still smoking (87%), and the majority of the inpatients were still smoking (69%). Treatment as an inpatient was positively associated and higher age was negatively associated with smoking cessation. Most patients who quit smoking transitioned to smokeless tobacco or kept their existing smokeless habit. Conclusion: As illustrated by the high smoking prevalence and relatively low cessation levels in our sample, an increased focus on smoking cessation for patients currently in OMT and other SUD treatment is warranted. Harm-reduction oriented smoking interventions may be relevant.

• Gallefoss, Lisbeth; Gabrielsen, Karin Berle; Haugland, Siri Håvås; Clausen, Thomas & Vederhus, John-Kåre (2022). Effects of a brief pre‑admission telephone reminder on no‑show and dropout rates in substance use disorder treatment: a quasi‑experimental study. Substance Abuse Treatment, Prevention, and Policy. 17(1). doi: 10.1186/s13011-022-00489-9. Full text in Research Archive Show summary

  Background Appointment no-show and early dropout from treatment represent major challenges in outpatient substance use disorder treatment, adversely affecting clinical outcomes and health care productivity. In this quasi-experimental study, we examined how a brief reminder intervention for new patients before their first appointment affected treatment participation and retention. No-shows (not attending any sessions) and dropouts (discontinuation of initiated treatment because of three consecutively missed appointments) were compared between a period with pre-admission telephone calls (intervention) and a period without such reminders (non-intervention). Methods Participants were all eligible patients (N = 262) admitted to a Norwegian specialist clinic for substance use disorder treatment. We used the Chi-square test for the no-show analysis. Of the eligible patients, 147 were included in a subsequent dropout analysis. We used the number of visits up to 10 appointments as a measure for time to event. Group differences were analyzed using a Kaplan–Meier plot and the log-rank test. To control for relevant sociodemographic variables, as well as substance use and mental distress severity, we used Cox regression. Results No-show rates did not differ between the two periods (12% for non-intervention vs. 14% for intervention; χ2 = 0.20, p = 0.653). Of those consenting to participate in the dropout analysis (n = 147), 28 (19%) discontinued treatment within the time frame of 10 appointments, with no differences between the two periods (log-rank test = 0.328, p = 0.567). Controlling for baseline characteristics did not alter this finding. In fact, of the registered covariates at baseline, only higher education level was associated with attrition, linked to a reduced risk for dropout (hazard ratio = 0.85, 95% CI = 0.74–0.98, p = 0.025). Conclusion These findings do not provide support for the systematic use of a brief pre-admission telephone reminder in the current treatment setting. Trial registration The study was retrospectively registered 13 Jan 2021 at ClinicalTrials.gov, NCT04707599.

• Karlsson, Ann Tarja; Vederhus, John-Kåre; Clausen, Thomas; Weimand, Bente; Solli, Kristin Klemmetsby & Tanum, Lars Håkon Reiestad (2021). Levels of impulsivity, hyperactivity, and inattention and the association with mental health and substance use severity in opioid-dependent patients seeking treatment with extended-release naltrexone. Journal of Clinical Medicine. 10(19), p. 1–9. doi: 10.3390/jcm10194558. Full text in Research Archive Show summary

  The level of impulsivity, hyperactivity, and inattention (IHI) is higher among patients with substance use disorder (SUD) than in the general population. However, the prevalence of such symptoms in patients seeking treatment with an opioid antagonist, such as extended-release naltrexone (XR-NTX), is unknown. We screened 162 patients with opioid use disorder (OUD) seeking treatment with XR-NTX in Norway using the Adult ADHD Self-Report Scale (ASRS) to estimate the prevalence of IHI alongside an assessment of mental and physical health and substance use. Sixty-six patients scored above the clinical cut-off on the ASRS. Higher levels of IHI were significantly associated with a longer history of frequent amphetamine use, current alcohol use, and greater mental distress. Mental distress was the strongest factor associated with higher levels of IHI. The introduction of screening for IHI and mental distress in opioid maintenance treatment and XR-NTX would likely improve the quality of care and enable clinicians to tailor interventions to the needs of patients with high levels of IHI to prevent treatment discontinuation

• Vederhus, John-Kåre; Timko, Christine & Haugland, Siri Håvås (2021). Adverse childhood experiences and impact on quality of life in adulthood: development and validation of a short difficult childhood questionnaire in a large population-based health survey. Quality of Life Research. ISSN 0962-9343. 30, p. 1769–1778. doi: 10.1007/s11136-021-02761-0. Full text in Research Archive
• Haugland, Siri Håvås; Carvalho, Barbara Olivieira Vieira de; Stea, Tonje Holte; Strandheim, Arve & Vederhus, John-Kåre (2021). Associations between parental alcohol problems in childhood and adversities during childhood and later adulthood: a cross-sectional study of 28047 adults from the general population. Substance Abuse Treatment, Prevention, and Policy. 16. doi: 10.1186/s13011-021-00384-9. Full text in Research Archive Show summary

  Background Adverse childhood experiences (ACE) are related to adverse physical and mental health outcomes. However, few larger studies based on a general population sample with age groups ranging from young adults to elderly have investigated whether parental alcohol problems increase the risk of offspring subjective reports of ACE both during childhood and current adult adversities. The purpose of this study was to examine the associations between parental alcohol problems and adversities during childhood and later in adulthood. Methods The 28,047 respondents were adults (> 18 years old) from the general population who participated in the Norwegian Counties Public Health Survey. The study had a cross-sectional design and included respondents’ evaluations of childhood experiences and current adult adversities. The short version of the Children of Alcoholics Screening Test (CAST-6, cut-off ≥3) measured parental alcohol problems. Multivariable logistic regression was adjusted for gender, age, and education. Results Growing up with parental alcohol problems strongly increased the risk of experiencing a dysfunctional family environment during childhood (odds ratio [OR] 6.84; 95% confidence interval [CI] 6.36–7.36), perceiving childhood as difficult (OR 5.01; 95% CI 4.58–5.49), and reporting a lack of support from a trusted adult (OR 3.07; 95% CI 2.86–3.29). Parental alcohol problems were associated with a modestly increased risk of harmful alcohol use (OR 1.38; 95% CI 1.29–1.48), but the association with struggling with bad memories was strong (OR 4.56; 95% CI 4.17–4.98). Conclusions Parental alcohol problems increased the risk of offspring experiencing adversities during both childhood and adulthood. Providing supportive services to these children and their families and addressing this issue as part of treatment is important to prevent alcohol related harm.

• Birkeland, Bente; Weimand, Bente; Ruud, Torleif; Maybery, Darryl & Vederhus, John-Kåre (2021). Perceived family cohesion, social support, and quality of life in patients undergoing treatment for substance use disorders compared with patients with mental and physical disorders. Addiction science & clinical practice. ISSN 1940-0632. 16(1), p. 1–9. doi: 10.1186/s13722-021-00252-8. Full text in Research Archive Show summary

  Purpose: Support from family and other social network elements can be important in helping patients to cope with practical and emotional consequences of diseases. The aim of the study was to examine perception of family and social support and quality of life (QoL) in patients undergoing treatment for substance use disorders (SUDs). We compared them with patients in treatment for mental disorders (MDs) and physical disorders (PDs). Methods: We used data from a national multicenter study that recruited patients (N  =  518) from three treatment domains; SUD treatment units, MD treatment units, and PD treatment units (severe neurological conditions or cancer). Data on family cohesion, social support, and QoL were compared across patient groups. In addition, data on health variables was collected. We used a multiple linear regression procedure to examine how health and support variables were associated with QoL. Results: Family cohesion and social support in the SUD and MD groups were rated at similarly low levels, substantially lower than in the PD group. The SUD group exhibited a somewhat lower QoL than did the PD group, but their QoL was still in the near-to-normal range. In contrast, the MD group had markedly low QoL. When examining factors associated with QoL, we found that greater family cohesion and social support were positively associated with QoL. Mental distress was the strongest factor, and was negatively associated with QoL (beta − 0.15, 95% CI  =  − 0.17/− 0.14, p  <  0.001). Conclusion: Service providers need to be aware of the weaker networks and less regulatory family and/or social support available to patients with SUDs. Providers should focus consistently on the social networks of patients and include patients’ families in treatment processes.

• Drivenes, Karin; Vederhus, John-Kåre; Haaland, Vegard Øksendal; Ruud, Torleif; Hauge, Yina Luk & Regevik, Hilde [Show all 8 contributors for this article] (2020). Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport. Medicine. ISSN 0025-7974. 99(1), p. 1–8. doi: 10.1097/MD.0000000000018635. Full text in Research Archive Show summary

  This cross sectional study examined patients’ perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting. The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics. A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5=strongly agree), and the Beliefs about Medicines Questionnaire. Diagnosis and treatment information were obtained at the clinical visits and from patient records. Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study. The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86–89) and a convergent validity toward the available variables. The MedSupport mean score was 3.8 (standard deviation.9, median 3.8). Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support. Patients diagnosed with behavioral and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders. The MedSupport inventory was suitable for assessing the patients’ perceived support from health care service regarding their medication. Awareness of differences in patients’ perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.

• Vederhus, John-Kåre; Høie, Magnhild & Birkeland, Bente (2020). One size doesn't fit all: A thematic analysis of interviews with people who have stopped participating in Narcotics Anonymous in Norway. Addiction science & clinical practice. ISSN 1940-0632. 15(18). doi: 10.1186/s13722-020-00191-w. Full text in Research Archive
• Vederhus, John-Kåre; Rørendal, Malin; Bjelland, Cathrine; Skar, Anja Kristin Solheim & Kristensen, Øistein (2020). Can a Smartphone App for Cannabis Cessation Gain a Broader User Group than Traditional Treatment Services? Substance Abuse: Research and Treatment. 14, p. 1–9. doi: 10.1177/1178221820902237. Full text in Research Archive
• Drivenes, Karin; Haaland, Vegard Øksendal; Hauge, Yina Luk; Vederhus, John-Kåre; Irgens, Audun Campbell & Solli, Kristin Klemmetsby [Show all 9 contributors for this article] (2020). Discrepancy in ratings of shared decision making between patients and health professionals: A cross sectional study in mental health care. Frontiers in Psychology. 11:443, p. 1–10. doi: 10.3389/fpsyg.2020.00443. Full text in Research Archive Show summary

  Background: A defined goal in mental health care is to increase the opportunities for patients to more actively participate in their treatment. This goal includes integrating aspects of user empowerment and shared decision-making (SDM) into treatment courses. To achieve this goal, more knowledge is needed about how patients and therapists perceive this integration. Objective: To explore patient experiences of SDM, to describe differences between patient and therapist experiences, and to identify patient factors that might reduce SDM experiences for patients compared to the experiences of their therapists. Methods: This cross-sectional study included 992 patients that had appointments with 267 therapists at Sørlandet Hospital, Division of Mental Health during a 1-week period. Both patients and therapists completed the CollaboRATE questionnaire, which was used to rate SDM experiences. Patients reported demographic and treatment-related information. Therapists provided clinical information. Results: The analysis included 953 patient-therapist responder pairs that completed the CollaboRATE questionnaire. The mean SDM score was 80.7 (SD 20.8) among patients, and 86.6 (SD 12.1) among therapists. Females and patients that did not use medication for mental health disorders reported higher SDM scores than males and patients that used psychiatric medications (83.3 vs. 77.7; p < 0.001 and 82.6 vs. 79.8; p = 0.03, respectively). Patients with diagnoses involving psychotic symptoms reported lower SDM scores than all the other patients (66.8 vs. 82.3; p < 0.001). The probability that a patient would report lower SDM scores than their therapist was highest among patients that received involuntary treatment (OR 3.2, p = 0.02), patients with treatment durations longer than 2.2 years (OR 1.9, p = 0.001), and patients that required day care or in-patient care (OR 3.2, p = 0.01 and OR 3.2, p < 0.001, respectively). Conclusion: We showed that both therapists and patients reported good SDM experiences in decisional situations, which indicated that SDM was implemented well. However, the SDM scores reported by in-patients and patients with prolonged or involuntary treatments were significantly lower than scores reported by their therapists. Our findings suggested that it remains a struggle in mental health care to establish a common understanding between patients and therapists in decisional processes regarding treatments for some patient groups

• Vederhus, John-Kåre; Kristensen, Øistein & Timko, Christine (2019). How do psychological characteristics of family members affected by substance use influence quality of life? Quality of Life Research. ISSN 0962-9343. 28(8), p. 2161–2170. doi: 10.1007/s11136-019-02169-x. Full text in Research Archive
• Årseth, Anne Lene; Johannessen, Berit & Vederhus, John-Kåre (2018). No increase in in-patient detoxification completion rates following pre-hospital telephone intervention. Sykepleien Forskning. ISSN 1890-2936. p. 1–16. doi: 10.4220/Sykepleienf.2018.73348. Full text in Research Archive
• Heldal, Anne Taraldsen; Skurtveit, Svetlana; Lobmaier, Philipp Paul K.; Vederhus, John-Kåre & Bramness, Jørgen Gustav (2018). Bruk av medikamenter for alkoholbrukslidelser i Norge 2004–16. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(18). doi: 10.4045/tidsskr.18.0383. Full text in Research Archive Show summary

  <p><i>Background - </i>Alcohol use disorder can lead to serious illness and early death. The lifetime prevalence rate among the Norwegian population is estimated at 7–10 %. Many patients are never admitted to any kind of treatment programme, and it is assumed that few of those who are treated receive medicinal treatment. There are a variety of drugs on the market that can help reduce alcohol consumption and maintain abstinence. We wanted to gain an insight into the prescription prevalence rate and practice for these drugs. <p><i>Material and method - </i>We obtained encrypted data from the Norwegian Prescription Database of everyone who received drugs for alcohol use disorder in the period 2004–2016. The drugs included were disulfiram, acamprosate, naltrexone 50 mg and nalmefene. <p><i>Results - </i>The annual prescription prevalence rate increased from 0.85 to 1.13 per 1000 during the observation period. Half of all patients only received prescribed drugs once, and Disulfiram was the most commonly prescribed drug. There was a slight increase in the prevalence rate in age groups up to and including 55 years, and a significant increase for the over-55s. <p><i>Conclusion - </i>There was a slight increase in the prescription prevalence rate during the observation period. Disulfiram was the most commonly prescribed drug. The prescription increase was greatest among women and in the group of over-55s.

• Vederhus, John-Kåre & Høie, Magnhild (2018). The Pragmatic Believer – Faith Development and Personal Experiences of a ‘Higher Power’ in Seasoned Members of Narcotics Anonymous. Research in the Social Scientific Study of Religion. ISSN 1046-8064. 29, p. 123–144. doi: 10.1163/9789004382640_008. Full text in Research Archive
• Pasareanu, Adrian Razvan; Vederhus, John-Kåre; Opsal, Anne; Kristensen, Øistein & Clausen, Thomas (2017). Mental distress following inpatient substance use treatment, modified by substance use; comparing voluntary and compulsory admissions. BMC Health Services Research. 17:5, p. 1–9. doi: 10.1186/s12913-016-1936-y. Full text in Research Archive Show summary

  Background Treatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based. The Norwegian Municipal Health Care Act (NMHCA) calls for compulsory treatment for persons with “severe and life-threatening substance use disorder” if these individuals are not otherwise willing to be voluntarily treated and consequently risk their lives over drug use. Mental distress is known to be high among SUD patients admitted to inpatient treatment. The purpose of this study is to describe changes in mental distress from admission to a 6-month follow-up in patients with SUDs, which underwent either voluntary or compulsory treatment. Method This prospective study followed 202 hospitalized patients with SUDs who were admitted voluntarily (VA; n = 137) or compulsorily (CA; n = 65). Levels of mental distress were assessed with SCL-90-R. Of 123 patients followed-up at 6 months, 97 (62 VA and 35 CA) had rated their mental distress at admission, discharge and follow-up. Sociodemographics and substance use severity were recorded with the use of The European Addiction Severity Index (EuropASI). We performed a regression analysis to examine factors associated with changes in psychiatric distress at the 6-month follow-up. Results The VA group exhibited higher mental distress than the CA group at admission, but both groups improved significantly during treatment. At the 6-month follow-up, the VA group continued to show reduced distress, but the CA group showed increases in mental distress to the levels observed before treatment. The deterioration appeared to be associated with higher scores that reflected paranoid ideas, somatization, obsessive-compulsive symptoms, interpersonal sensitivity, and depression. Active substance use during follow-up was significantly associated with increased mental distress. Conclusion In-patient treatment reduces mental distress for both CA and VA patients. The time after discharge seems critical especially for CA patients regarding active substance use and severe mental distress. A greater focus on continuing care initiatives to assist the CA patients after discharge is needed to maintain the reduction in mental distress during treatment. Continuing-care initiatives after discharge should be intensified to assist patients in maintaining the reduced mental distress achieved with treatment.

• Birkeland, Bente; Weimand, Bente; Ruud, Torleif; Høie, Magnhild & Vederhus, John-Kåre (2017). Perceived quality of life in partners of patients undergoing treatment in somatic health, mental health, or substance use disorder units: A cross-sectional study. Health and Quality of Life Outcomes. 15(1). doi: 10.1186/s12955-017-0750-5. Full text in Research Archive Show summary

  Background: This study explores (1) differences in socio-demographic, social/familial, and health variables and perceived quality of life (QoL) among partners of patients with somatic illness, mental illness, or substance use disorder (SUD); and (2) identifies factors associated with QoL. Methods: Participants (N = 213) in this cross-sectional study were recruited from inpatient or outpatient services in five hospitals in Norway, 2013-2014. QoL was measured by the QoL-5, a generic five-item questionnaire. Differences between groups were examined using Chi-square for categorical variables and Kruskal-Wallis for contiuous variables. Multiple linear regression analyses were used to examine factors associated with QoL. Results: The mean QoL score was similar to that of a general population sample, and 13% of the sample had a markedly low QoL. Partners in the SUD group experienced worse socio-demographic conditions in terms of occupation and income, but QoL did not differ significantly among the three groups. In a regression model, perceived family cohesion was positively associated with QoL while psychological distress (Symptom Checklist-10) was negatively related to it. The model explained 56% of the variance in QoL. Conclusions: When patients are ill, clinicians should consider the partners' QoL, and brief QoL tools can be used to identify those who are struggling most. Reduced QoL is associated with higher psychological distress and lower family cohesion. Treatment initiatives focusing on these themes may serve as preventive measures to help the most vulnerable families cope with their difficult life situation.

• Dunsæd, Frode; Kristensen, Øistein; Vederhus, John-Kåre; Clausen, Thomas & Høie, Magnhild (2016). Standardisert avrusning ved blandingsmisbruk. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(19), p. 1639–1642. doi: 10.4045/tidsskr.16.0308. Full text in Research Archive
• Vederhus, John-Kåre; Birkeland, Bente & Clausen, Thomas (2016). Perceived quality of life, 6 months after detoxification: Is abstinence a modifying factor? Quality of Life Research. ISSN 0962-9343. 25(9), p. 2315–2322. doi: 10.1007/s11136-016-1272-z. Full text in Research Archive
• Vederhus, John-Kåre; Clausen, Thomas & Humphreys, Keith (2016). Assessing understandings of substance use disorders among Norwegian treatment professionals, patients and the general public. BMC Health Services Research. 16(1). doi: 10.1186/s12913-016-1306-9. Full text in Research Archive Show summary

  Background Beliefs about substance use disorder (SUD) shape how patients, treatment professionals and the general public view addiction and its treatment. A U.S. developed scale exists to assess such beliefs, but it has never been tested in Norway nor normed on any general population sample. Methods The Short Understanding of Substance Abuse Scale (SUSS) was translated from English to Norwegian and used to assess beliefs about the nature of addiction among addiction treatment professionals (N = 291), patients with SUDs (N = 133) and respondents from the general public (N = 216). The disease and psychosocial model subscales of the SUSS were examined with a multigroup factor analysis to confirm that the constructs were invariant across the studied groups. We also controlled for demographic covariates in a multiple indicator multiple cause model. Results The multigroup confirmatory factor analysis of the SUSS yielded a partial scalar invariant model and thus, we were able to compare latent means between groups. In unadjusted comparisons, patients and the general public reported significantly higher endorsement of disease model beliefs than did professionals. However, the difference between professionals and the general public disappeared when the comparison was adjusted for covariates (i.e., age, gender, education). In both unadjusted and adjusted analyses, the general public group but not the patient group scored significantly lower than professionals on the psychosocial belief scale. Conclusion The SUSS is useable with slight adaptations in Norwegian samples. Norwegian treatment professionals have different views of substance use disorder than do patients and the general public. This may create opportunities for dialogue and mutual learning, but also presents risk of miscommunication and distrust.

• Vederhus, John-Kåre; Pripp, Are Hugo & Clausen, Thomas (2016). Quality of Life in Patients with Substance Use Disorders Admitted to Detoxification Compared with Those Admitted to Hospitals for Medical Disorders: Follow-Up Results. Substance Abuse: Research and Treatment. 10, p. 31–37. doi: 10.4137/SART.S39192. Full text in Research Archive
• Opsal, Anne; Kristensen, Øistein; Vederhus, John-Kåre & Clausen, Thomas (2016). Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders. BMC Health Services Research. 16(1), p. 1–10. doi: 10.1186/s12913-016-1906-4. Full text in Research Archive Show summary

  Background Perceived coercion is a sense of pressure related to the experience of being referred to treatment. The sense of pressure arises from the patient’s internal perception of coercion. The sources of coercion may be the legal system, the family, the health system, or self-criticism (internal sources). Here, we studied patients diagnosed with substance use disorders that were involuntarily admitted to hospital, pursuant to a social services act. We sought to determine whether these patients perceived coercion differently than patients that were admitted voluntarily. Methods This study included patients admitted to combined substance use disorder and psychiatry wards in three publicly funded treatment centres in Norway in the period 2009–2011. Participants included 63 patients that were admitted involuntarily, pursuant to the Norwegian Public Health Act, and 129 patients that were admitted voluntarily. All participants completed the Perceived Coercion Questionnaire. Sociodemographic variables were determined with the European Addiction Severity Index. The range of psychopathological symptoms was evaluated with the Symptom Checklist-90-R. Independent sample t-tests, the chi-squared test, and Fisher’s exact test were used to detect statistically significant differences between groups. Results Scores on the Perceived Coercion Questionnaire showed that patients admitted voluntarily and those admitted involuntarily experienced similar levels of perceived coercion. Those admitted voluntarily reported higher levels of perceived coercion from internal sources, and those admitted involuntarily perceived significantly higher coercion from legal sources. No differences between groups were found with the other tests. Conclusions Our results suggested that assumptions about involuntary admissions should be evaluated carefully to determine how best to alleviate counterproductive feelings of coercion when a coerced admission is planned. Informing and collaborating with the patient will most likely facilitate a better experience during admission and treatment. Moreover, the patient is more likely to experience a better recovery process.

• Pasareanu, Adrian Razvan; Vederhus, John-Kåre; Opsal, Anne; Kristensen, Øistein & Clausen, Thomas (2016). Improved drug-use patterns at 6 months post-discharge from inpatient substance use disorder treatment: Results from compulsorily and voluntarily admitted patients. BMC Health Services Research. 16:291. doi: 10.1186/s12913-016-1548-6. Full text in Research Archive Show summary

  Background Treatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based. The Norwegian Municipal Health Care Act calls for mandated treatment for persons with “severe and life-threatening substance use disorder” if these individuals are not otherwise willing to be voluntarily treated and consequently risk their lives over drug use. This study aims to examine substance use–related outcomes at 6 months following inpatient treatment and to analyse factors associated with improved outcomes and abstinence. Method This prospective study followed 202 hospitalized patients with SUD who were admitted voluntarily (VA; n = 137) or compulsorily (CA; n = 65). The European Addiction Severity Index was used at baseline and at follow-up to assess socio-demographic and substance use variables. Regression analysis was conducted to investigate factors associated with abstinence at 6 months of follow-up. Results The frequency of use of a preferred substance showed marked improvement for both VA and CA patients (61 and 37 %, respectively) at follow-up. Seventy-five percent of VA patients using amphetamine reported improvement compared to 53 % of CA patients. At follow-up, the CA group continued to have a higher rate of injection use. The CA group had experienced higher rates of overdose in the past 6 months and lower abstinence rates (24 % versus 50 %) at follow-up. A lower severity of drug use at intake (non–injection drug use), voluntary treatment modality, and higher treatment involvement during follow-up all were significant factors associated with abstinence at 6 months after treatment. Conclusion Voluntary treatment for SUD generally yielded better outcomes; nevertheless, we also found improved outcomes for CA patients. It is important to keep in mind that in reality, the alternative to CA treatment is no treatment at all and instead a continuation of life-threatening drug use behaviours. Our observed outcomes for CA patients support the continuation of CA treatment.

• Solhaug, Pål; Høie, Magnhild & Vederhus, John-Kåre (2015). Endring i psykisk velvære etter gjennomført 12-trinnsbasert rusbehandling - En sammenligning av dag- og døgnbehandling. Tidsskrift for psykisk helsearbeid. ISSN 1503-6707. 12(1), p. 28–38. Full text in Research Archive
• Pasareanu, Adrian Razvan; Opsal, Anne; Vederhus, John-Kåre; Kristensen, Øistein & Clausen, Thomas (2015). Quality of life improved following in-patient substance use disorder treatment. Health and Quality of Life Outcomes. 13. doi: 10.1186/s12955-015-0231-7. Full text in Research Archive
• Vederhus, John-Kåre; Zemore, Sarah E.; Rise, Jostein; Clausen, Thomas & Høie, Magnhild (2015). Predicting patient post-detoxification engagement in 12-step groups with an extended version of the theory of planned behavior. Addiction science & clinical practice. ISSN 1940-0632. 10. doi: 10.1186/s13722-015-0036-3. Full text in Research Archive Show summary

  Introduction Individuals with substance use disorders can receive important abstinence-specific support in 12-step groups (TSGs). However, our understanding of key factors that influence TSG participation remains limited. This study used an extended version of the theory of planned behavior (TPB) to enhance the understanding of TSG affiliation. Methods Data were retrieved from a controlled trial of a 12-step facilitation intervention conducted on an inpatient detoxification ward in Norway (N = 140). Surveys at baseline included a TPB questionnaire. The behavioral target was to attend at least two TSG meetings per month in the 6-month follow-up period. Structural equation modeling was used to analyze the predictors of behavior at follow-up. Results We found that attitudes, the moral norm, and perceived behavior control accounted for 81 % of the variance in the intention to participate regularly in TSGs after treatment. Subjective norms did not significantly influence the intention to participate. Moreover, the intention to participate significantly predicted behavior (β = 0.42, p < 0.001). In contrast to theory, there was a substantial, model-independent pathway from past to later behavior (β = 0.22, p = 0.047). The model explained 46 % (p < 0.001) of the variance in behavior. Attending ≥ 12 TSG meetings in the follow-up period was associated with a high percentage of abstinent days at follow-up (β = 0.38, p = 0.023). Conclusions The present TPB questionnaire worked well for assessing patient intentions to attend a TSG. Treatment providers should encourage patient intentions to participate in TSGs post-detoxification.

• Vederhus, John-Kåre; Rysstad, Ole; Gallefoss, Frode; Clausen, Thomas & Kristensen, Øistein (2015). Kartlegging av alkoholbruk og røyking hos pasienter innlagt i medisinsk avdeling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(14), p. 1251–1255. doi: 10.4045/tidsskr.14.0848. Full text in Research Archive
• Vederhus, John-Kåre; Timko, Christine; Kristensen, Øistein; Hjemdal, Bente & Clausen, Thomas (2014). Motivational intervention to enhance post-detoxification 12-Step group affiliation: A randomized controlled trial. Addiction. ISSN 0965-2140. 109(5), p. 766–773. doi: 10.1111/add.12471. Full text in Research Archive
• Vederhus, John-Kåre (2013). Tvangsinnleggelse av rusmiddelavhengige - noen etiske aspekter. In Mesel, Terje & Leer-Salvesen, Paul (Ed.), Makt og avmakt. Etiske perspektiver på feltet psykisk helse. Portal forlag. ISSN 9788292712740. p. 242–260. Full text in Research Archive
• Vederhus, John-Kåre; Kristensen, Øistein; Clausen, Thomas & Gossop, Michael (2012). Turn something bad into something good. British Journal of General Practice. ISSN 0960-1643. 62(594), p. 32–32. doi: 10.3399/bjgp12X616382. Full text in Research Archive
• Vederhus, John-Kåre; Hjerkinn, Bjørg & Kristensen, Øistein (2011). Selvhjelpsgrupper for rusmiddelavhengige. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 131(12), p. 1204–1206. doi: 10.4045/tidsskr.11.0068. Full text in Research Archive
• Vederhus, John-Kåre; Timko, Christine; Kristensen, Øistein & Clausen, Thomas (2011). The courage to change: Patient perceptions of 12-Step fellowships. BMC Health Services Research. 11. doi: 10.1186/1472-6963-11-339. Full text in Research Archive
• Kunøe, Nikolaj; Lobmaier, Phillip; Vederhus, John-Kåre; Hjerkinn, Bjørg L; Hegstad, Solfrid & Gossop, Michael [Show all 8 contributors for this article] (2010). Retention in naltrexone implant treatment for opioid dependence. Drug and Alcohol Dependence. ISSN 0376-8716. 111(1-2), p. 166–169. doi: 10.1016/j.drugalcdep.2010.03.021. Full text in Research Archive
• Vederhus, John-Kåre; Laudet, Alexandre; Kristensen, Øistein & Clausen, Thomas (2010). Obstacles to 12-step group participation as seen by addiction professionals: Comparing Norway to the United States. Journal of Substance Abuse Treatment. ISSN 0740-5472. 39(3), p. 210–217. doi: 10.1016/j.jsat.2010.06.001. Full text in Research Archive
• Kunøe, Nikolaj; Lobmaier, Phillip; John-Kåre, Vederhus; Hjerkinn, Bjørg; Gossop, Michael & Hegstad, Solfrid [Show all 8 contributors for this article] (2010). Challenges to antagonist blockade during sustained-release naltrexone treatment. Addiction. ISSN 0965-2140. 105(9), p. 1633–1639. doi: 10.1111/j.1360-0443.2010.03031.x. Full text in Research Archive
• Kunøe, Nikolaj; Lobmaier, Phillip; Vederhus, John Kåre; Hjerkinn, Bjørg; Hegstad, Solfrid & Gossop, Michael [Show all 8 contributors for this article] (2009). Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial. British Journal of Psychiatry. ISSN 0007-1250. 194(6), p. 541–546. doi: 10.1192/bjp.bp.108.055319. Full text in Research Archive
• Kunøe, Nikolaj; Lobmaier, Philipp Paul; Vederhus, John Kåre; Hjerkinn, Bjørg; Hegstad, Solfrid & Gossop, Michael [Show all 8 contributors for this article] (2009). Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial. British Journal of Psychiatry. ISSN 0007-1250. 194, p. 541–546. doi: 10.1192/bjp.bp.108.055319. Full text in Research Archive
• Vederhus, John-Kåre; Kristensen, Øistein; Laudet, Alexandre & Clausen, Thomas (2009). Attitudes towards 12-step groups and referral practices in a treatment culture unfamiliar to 12-step ideology; a survey study. BMC Health Services Research. 9(147). Full text in Research Archive
• Vederhus, John-Kåre; Kristensen, Øistein; Laudet, Alexandre & Clausen, Thomas (2009). Attitudes towards 12-step groups and referral practices in a 12-step naive treatment culture; a survey of addiction professionals in Norway. BMC Health Services Research. 9. doi: 10.1186/1472-6963-9-147. Full text in Research Archive Show summary

  Background Addressing substance use disorders effectively requires a long-term approach. Substance abuse treatment is typically of short duration; referring patients to Twelve Step based self-help groups (TSGs) – e.g. Narcotics Anonymous, represents a promising complementary recovery resource. Clinicians' attitudes and referral practices towards the TSGs have mainly been studied in countries with high integration of the 12-step philosophy in their substance abuse services and where the TSGs are widely available, such as the US. In Norway, there are currently 294 weekly TSG meetings (6 per 100,000 inhabitants). This study describes clinicians' attitudes and referral practices to TSGs in Norway where health authorities seek to promote self-help participation, but where the treatment culture is unfamiliar with 12-step fellowships. Methods Data collected by a self-administered questionnaire, adapted from established US and UK instruments. Information covered the attitudes, knowledge and referral practices towards TSGs among addiction treatment professionals in Norway in mid 2008. Results The return rate was 79.7% (n = 291). Participants had moderately positive attitude scores towards TSGs, but referral to these groups among Norwegian addiction professionals was low, as was the level of knowledge about TSGs. More than six out of ten did not refer any patients to TSGs in the previous week. Local variation with more referrals to TSGs in the county with the one established 12-step treatment facility was observed. Respondents' integration of the 12-steps in their own treatment work, higher self-efficacy for making a successful referral, and greater TSG knowledge were associated with referring patients. Conclusion Low referral rates to TSGs point to the need for education and training to raise the awareness and knowledge about it among addiction professionals unfamiliar with these 12-step fellowships. Training should focus on the usefulness of these groups for all types of treatment models regardless of therapeutic orientation. Increased knowledge is expected to lead to higher referral rates, which in turn would maximize the likelihood of positive long-term patient outcomes.

• Vederhus, John-Kåre; Kristensen, Øistein; Laudet, Alexandre & Clausen, Thomas (2009). Attitudes towards 12-step groups and referral practices in a 12-step naive treatment culture; a survey of addiction professionals in Norway. BMC Health Services Research. 9. doi: 10.1186/1472-6963-9-147. Full text in Research Archive
• Vederhus, John-Kåre; Kristensen, Øistein; Tveit, Helga & Clausen, Thomas (2008). Tolvtrinnsbaserte selvhjelpsgrupper en ressurs i rehabiliteringen av rusmiddelavhengige. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 45(10), p. 1268–1275. Full text in Research Archive
• Kristensen, Øistein; Lølandsmo, Terje; Isaksen, Åse; Vederhus, John-Kåre & Clausen, Thomas (2006). Treatment of polydrug-using opiate dependents during withdrawal: towards a standardisation of treatment. BMC Psychiatry. doi: 10.1186/1471-244X-6-54. Full text in Research Archive Show summary

  Background The growing tendency among opioid addicts to misuse multiple other drugs should lead clinicians and researchers to search for new pharmacological strategies in order to prevent life-threatening complications and minimize withdrawal symptoms during polydrug detoxification. Methods A non-randomised, open-label in-patient detoxification study was used to compare the short-time efficacy of a standardised regimen comprising 6 days Buprenorphine and 10 days Valproate (BPN/VPA) (n = 12) to a control group (n = 50) who took a 10-day traditional Clonidine/Carbamazepine (CLN/CBZ) regimen. Sixty-two dependent subjects admitted to a detoxification unit were included, all dependent on at least opioids and benzodiazepines. Other dependencies were not excluded. Results In the BPN/VPA group, 8 out of 12 patients (67%) completed treatment compared with 25 of 50 patients (50%) in the CLN/CBZ group; this difference between the groups was non-significant (p = 0.15). Withdrawal symptoms were reduced in both groups, but only the BPN/VPA group achieved a reduction in withdrawal symptoms from day one. The difference between the two groups was significantly in favour of the BPN/VPA group for days 2 (p < 0.001), 3 (p < 0.05), 4 (p < 0.001), 5 (p < 0.01), 7 (p < 0.01) and 8 (p < 0.05). The BPN/VPA combination did not affect blood pressure, pulse or liver function, and the total burden of side-effects was experienced as modest. There appeared to be no pharmacological interactions of clinical concern, based on measurement of Buprenorphine and Valproate serum levels. Both the patients and the staff were satisfied with the standardised treatment combination. Conclusion Overall, the combination of Buprenorphine and Valproate seems to be a safe and promising method for treating multiple drug withdrawal symptoms. The results of this study suggest that the BPN/VPA combination is potentially a better detoxification treatment for polydrug withdrawal than the traditional treatment with Clonidine and Carbamazepine. However, a randomised, double-blind study with a larger sample size to confirm our results is recommended. Trial registration Clinical Trials.gov: NCT00367874

• Vederhus, John-Kåre & Kristensen, Øistein (2006). High effectiveness of self-help programs after drug addiction therapy. BMC Psychiatry. 6. doi: 10.1186/1471-244X-6-35. Full text in Research Archive
• Kristensen, Øistein & Vederhus, John-Kåre (2005). Selvhjelpsgrupper i rusbehandling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. p. 2798–2801. Full text in Research Archive

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• Øgård-Repål, Anita; Haugland, Siri Håvås; Vederhus, John-Kåre; Robstad, Anja Nastasja & Stea, Tonje Holte (2024). What about the family? Sleep problems among close family members of people with mental health- or substance use problems. Full text in Research Archive
• Bjørnestad, Endre Dahlen; Vederhus, John-Kåre & Clausen, Thomas (2022). High smoking and low cessation rates among patients in treatment for opioid and other substance use disorders. Full text in Research Archive
• Vederhus, John-Kåre; Årseth, Anne Lene & Gallefoss, Lisbeth (2017). Kan telefonkontakt før behandling øke oppmøte og redusere frafall i rusbehandling? Erfaringer fra poliklinikk og avgiftningspost ved Sørlandet Sykehus. Full text in Research Archive
• Kristensen, Øistein & Vederhus, John-Kåre (2015). Alkoholforbruk – en naturlig del av anamnesen. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 135(14), p. 1240–1241. doi: 10.4045/tidsskr.15.0365. Full text in Research Archive
• Vederhus, John-Kåre (2012). Patient education to enhance 12-step involvement among patients undergoing detoxification. Full text in Research Archive
• Vederhus, John-Kåre (2012). Selvhjelpsgrupper - å vende problemet til en ressurs. Mot rusgift. ISSN 0806-9107. p. 10–13. Full text in Research Archive
• Vederhus, John-Kåre (2012). – Jeg sier «Jeg er Rita og jeg er rusavhengig» og så svarer de i kor. [Internet]. NRK Rogaland. Full text in Research Archive
• Vederhus, John-Kåre (2012). – Jeg sier «Jeg er Rita og jeg er rusavhengig» og så svarer de i kor. [Radio]. NRK Rogaland. Full text in Research Archive
• John-Kåre, Vederhus (2011). National differences in acceptance by treatment professionals of Twelve-Step recovery and spirituality. Full text in Research Archive
• John-Kåre, Vederhus (2011). Pasienters oppfatning av 12-trinnsgrupper. Full text in Research Archive
• Hjemdahl, Bente; John-Kåre, Vederhus & Clausen, Thomas (2011). Quality of Life (QoL) - Perceived QoL among Patients Admitted to Detox. Full text in Research Archive
• John-Kåre, Vederhus (2011). Selvhjelpsgrupper i rusfeltet – virksomme mekanismer og resultater. Full text in Research Archive
• John-Kåre, Vederhus (2011). Towards a greater involvement with peer-based resources: addiction-focused self-help groups. Full text in Research Archive
• Kristensen, Øistein; Sundøy, Anders; Skeie, Karin; Vederhus, John-Kåre; Øye, Ingebjørg & Opsal, Anne [Show all 8 contributors for this article] (2009). Short-term treatment of Hepatitis C in heroin-dependent patients. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 129(16), p. 1639–1642. Full text in Research Archive
• Vederhus, John-Kåre; Kristensen, Øistein; Laudet, Alexandre & Clausen, Thomas (2009). Attitudes toward 12-step groups and referral practices in a culture naive to 12-step ideology. Full text in Research Archive
• John-Kåre, Vederhus & Clausen, Thomas (2012). Addiction professionals’ and substance abuse patients’ attitudes towards and usage of 12-step-based self-help groups. Universitetet i Oslo. ISSN 9788282642590. Full text in Research Archive

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