Women's alcohol and drug use. Risk indicators from everyday life

Abstract: Aims: The overall aim of this thesis was to explore how various aspects of everyday life, measured using self-reported experiences from childhood, adolescence and adulthood were associated with alcohol and drug use in a population-based sample of Swedish women. Methods: The thesis is based on data from the “Women and Alcohol in Gothenburg” project, a Swedish three-wave longitudinal, population-based, multi-purpose study. Three of the studies included women 20 and 25 years old when interviewed; and the sample sizes were 946 and 760, respectively. The fourth study included 851 women 20-55 years old. Studies I and II focused on the associations between the independent variables early risk indicators, socio-demographic factors, alcohol use, smoking, psychiatric illness and the dependent variables illicit and licit drug use. In Studies III and IV cluster analysis was used to identify clusters based on variables measuring patterns of drinking context and patterns of everyday occupations. The patterns of everyday occupations were defined as employment status, household work, leisure activities, time for free disposal and satisfaction with each domain. Drinking context was operationalised with questions on where and with whom the drinking occurred, together with questions on self-reported effects of drinking. Further, the associations between identified clusters and problematic alcohol consumption were analyzed. All four studies were based on cross-sectional analyses. Results: Significant associations regarding early risk indicators and drug use were found; to some extent these were different for occasional use and more frequent use. Early alcohol debut and behavioral factors were related to all three drug use patterns, whereas family factors were associated with occasional use and with more frequent use of illicit and licit drugs. Frequent use of both illicit and licit drugs was also associated with a history of eating problems. Problematic alcohol consumption, smoking and psychiatric illness were significantly associated with illicit and licit drug use; with the strongest associations found for illicit drug use among the 20-year-old women. Cluster analysis identified distinct groups with respect to the investigated patterns. Concerning drinking context patterns, the cluster characterized with coping effects of drinking, frequent drinking in different settings but also solitary drinking, was significantly associated with alcohol use disorder and high alcohol consumption. High episodic drinking was more common in the cluster reporting frequent drinking together with social effects such as becoming less shy or having more fun. Problematic alcohol consumption was more common in clusters characterized with varied or low engagement in leisure activities in combination with a large amount of spare time. Conclusions: The strong associations between illicit and licit drug use, alcohol consumption, smoking, and psychiatric illness point to a higher risk for developing any or several of these problems once one of these habits has been established. The results also underline the importance of identifying groups of individuals with different drinking patterns and with different patterns of everyday occupations. As a complement to variable analysis, investigating such patterns may provide new options for preventive actions as opposed to focusing on specific risk factors.