No abstract

Alcohol use during pregnancy is more extensive than has been presumed in Sweden. Simple, clinically useful screening methodology detects hazardous consumption during pregnancy in a manner which regular antenatal care does not. If this methodology can be shown to have similar sensitivity when administered under non-anonymous conditions, it should be made part of routine antenatal care.

In a previous longitudinal study of Swedish conscripts we have shown strong association between level of cannabis consumption at conscription and development of schizophrenia during 15 years of follow-up. In this study we further analysed data from a subsample of the national cohort. Case records for all conscripts residing in Stockholm County who reported consuming cannabis on more than 10 occasions and who subsequently developed schizophrenia (n = 8) were compared with case records of a sample of conscripts who also developed schizophrenia but reported no cannabis consumption at conscription (n = 13). The relative risk of schizophrenia among cannabis users in Stockholm County was 4.1 (95% confidence interval 1.8-9.3) compared with nonusers. No evidence was found of a significant role for any other narcotic drug in the emergence of schizophrenia among cannabis abusers. Further, there was no evidence of mental disorder prior to cannabis abuse, even if the role of personality traits could not be fully assessed. A different pattern of mental deterioration was found among cannabis users, with a more abrupt onset of schizophrenic symptoms than nonusers. There was no major difference between users and nonusers in heredity for schizophrenia or other mental disorder. Negative social background factors were more common among cannabis abusers. Although the number of cases in this study was small, the findings support the hypothesis that cannabis does play an aetiological role in schizophrenia.

A group of patients (N = 1630) hospitalized in Stockholm County with a diagnosis of substance abuse during 1971-1972 were followed through 1984 as regards mortality: 446 (296 males and 150 females) patients died. The excess mortality in the cohort was 5.3 (males 5.8, females 4.6) compared to the general population in Stockholm County. The highest mortality was found in opiate users, with an excess mortality of 18.3. Fifty-one percent of the causes of death belonged to ICD-8 chapter 17, injury and poisoning, and of these, 69% (155 patients) were definite or probable suicides. Since HIV entered the Stockholm drug addict population by the end of this follow-up, the excess mortality reported here can be even higher in the years to come. To follow and monitor the mortality among patients with substance abuse is an important aspect in the evaluation of programs for prevention and treatment.