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Rose Boyle, PhD-student in the PriSUD-project, has published a new paper: «Operating between recovery and desistance: Researching substance use treatment in Norwegian prisons». This short article, published in the Nordic Journal of Criminal Science's special issue, discusses drug treatment methods in Norwegian prisons in the context of the ongoing debate on the criminalization and punishment of drug offenses, and trends toward harm reduction in Nordic drug policy. Many countries have moved in the direction of harm reduction and questions are being asked about the effects of criminalization and punishment of people with substance abuse disorders and the so-called "zero tolerance" drug policy. Norway has historically had a tendency towards strict drug legislation, as well as a high incidence of drug disorders and overdose deaths among both the prison population and recent releases, and this is discussed as part of the ongoing debate about the possible consequences of a drug reform. The article discusses methods for drug treatment in Norwegian prisons and the implications of these for both rehabilitation from drug disorders and distance from crime, seen in the light of the larger discourse on drug use, attitudes in society, criminal policy, and public health. The article is published in a special issue of the criminological journal 'Nordisk Tidsskrift for Kriminalvitenskab' and can be read here.

Pape, Hilde, Rossow, Ingeborg, and Bukten, Anne. "Are Short Audit Screeners Effective in Identifying Unhealthy Drinking of Varying Severity? A Prison Population Study." Drug and Alcohol Dependence 229, B (2021). https://doi.org/10.1016/j.drugalcdep.2021.109153. Background Whether brief versions of the Alcohol Use Disorder Identification Test (AUDIT) can be used as graded severity measures is largely unknown. We examined the performance of eight such brief screeners in a prison population, and compared their effectiveness in detecting hazardous drinking, harmful drinking, and possible alcohol dependence as classified by the full ten-item AUDIT. Methods The study sample included pre-prison drinkers who participated in the Norwegian Offender Mental Health and Addiction (NorMA) study (n = 758). We conducted receiver operating characteristic curve (ROC) analyses and estimated the area under the curve (AUROC) to assess the performance of AUDIT-C (three consumption items) and four-item versions that consisted of AUDIT-C and one additional item. Results AUDIT-C performed very well in detecting unhealthy drinking of varying severity (AUROCs of 0.933 or 0.935). Four-item versions performed even better. Of these, the well-established AUDIT-4 was superior in identifying harmful drinking (AUROC=0.969) and possible alcohol dependence (AUROC=0.976). For AUDIT-C, the optimal cut-points in terms of the highest combined sensitivity and specificity were ≥ 6 (hazardous drinking), ≥ 8 (harmful drinking) and ≥ 8 or ≥ 9 (possible dependence). The corresponding cut-points on AUDIT-4 were ≥ 6, ≥ 9 and ≥ 10. The highest cut-point whereby all cases of possible dependence were identified was ≥ 6 on AUDIT-C and ≥ 8 on AUDIT-4. At these cut-points, almost all individuals with harmful drinking were also detected. Conclusions AUDIT-C and AUDIT-4 were both highly effective in detecting hazardous drinking, harmful drinking and possible alcohol dependence. AUDIT-4 was superior, notably as a graded severity measure.

The NorMA cohort is a national cohort of inmates in Norwegian prisons that has formed the basis for a number of reports and scientific articles. But to what extent is the NorMA cohort representative of the Norwegian prison population? This question has been answered by a PhD candidate in the PriSUD project, Nicoline Toresen Lokdam, in a brand new article. In the PriSUD project, we work with several types of data and data sources. One of the basic cohorts in the project is the one we call the NorMA cohort. An important question to ask when working with data from cohorts is how well the cohort represents the population one wants to investigate. In this new article, we have therefore investigated how well the NorMA cohort reflects the general Norwegian prison population The article is based on questionnaire data from the NorMA study, combined with register data from the prison register (KOMPIS). The article has a methodological perspective that describes how data from registers can generally be used to assess whether data you work with is representative of the group you want to investigate. The article uses the NorMA cohort as an example, and thus also helps to shed light on how well the NorMA cohort represents the Norwegian prison population. The study compared the NorMA cohort's 733 participants, who served all over the Norway in 2013-2014, with an average of the entire Norwegian prison population on a single day during the same period. "We can see that the NorMA cohort is largely representative of the part of the Norwegian prison population that we would normally investigate with register data, namely those that have a valid Norwegian person number. The groups are similar in relation to prison history, prison time, convictions and drug-related sentences (such as "use and possession"). On the other hand, part of the NorMA study consists of persons who did not have a valid Norwegian person number and who we cannot follow through studies on the NorMA cohort», says Nicoline. «One of the strengths of the study is that we both have answers from the questionnaire survey of those who for various reasons did not provide a social security number, but also the prison's registrations of those without a social security number. Therefore, we have the opportunity to say something about how it affects our results if these people are not included. It is a great strength for further research on the NorMA cohort that one has knowledge of how the cohort represents the Norwegian prison population »says Nicoline. The article is published in the medical methodological journal Research Methods in Medicine and Health Science and can be read here.

Toresen Lokdam, Nicoline, Riksheim Stavseth, Marianne, and Bukten, Anne. "Exploring the External Validity of Survey Data with Triangulation: A Case Study from the Norwegian Offender Mental Health and Addiction (Norma) Study." Research Methods in Medicine & Health Sciences 2, no. 4 (2021): 140-47. https://doi.org/10.1177/26320843211061298. Objectives This paper demonstrates how to investigate the external validity of a study sample by triangulating survey and registry data, using data from the Norwegian Offender Mental Health and Addiction (NorMA) Study as a case. Methods We use survey data from the NorMA study (n = 1495), including the NorMA cohort (n = 733), and data from the Norwegian Prison Registry on all people imprisoned on 1 September 2013 (n = 3386). Triangulation was performed by (1) comparing the NorMA cohort to those lost to follow-up (n = 762), using survey data from the NorMA study. Secondly, we compared the NorMA cohort to the one-day population, using data from the Norwegian Prison Registry. We also stratified the one-day sample by possession of a Norwegian personal identification number (PIN). Results We found differences in birthplace, imprisonment and drug use between the NorMA cohort, lost to follow-up and the one-day population. Twenty-three percent of the one-day population did not have a Norwegian PIN. The NorMA cohort was more similar to those with a Norwegian PIN in the one-day population. Our triangulation demonstrates that 56–62% of the Norwegian prison population had an indication of drug use before imprisonment. Conclusions The NorMA cohort was overall representative of the one-day prison population holding a Norwegian PIN and less representative of prisoners without a Norwegian PIN. Using this method provides tangible inputs on the strengths and limitations of a study sample and can be a feasible method to investigate the external validity of survey data.

Welcome to our two new colleagues on the PriSUD project: Vegard Svendsen and Torill Tverborgvik! Vegard will work as a Ph.D. research fellow and will work with nPRIS data, including the use of social security data. Torill has started working in a postdoc position and will focus on Nordic cooperation in the PriSUD project. We are very happy to have even more talented people on board and very much looking forward to working with both!

Lindstad M, Skurtveit S, Bukten A. "Too much or too little medication? A national study of prescribed psychotropic drugs among inmates in Norwegian prisons." Norsk Epidemiologi 2021; 29 (1-2): 85-95. https://doi.org/10.5324/nje.v29i1-2.4049. Background: Prescription drug use in the Norwegian population is increasing. Knowledge of who the users areand usage patterns is a prerequisite for optimizing prescription drug use in all groups of the population. There are no updated studies describing prescription drug use among prisoners in Norway. The purpose of this study is to describe the use of prescribed psychotropic drugs among inmates in prison before and during imprisonment and to investigate factors associated with prescription drug use while in prison. Material and method: The study is based on self-reported data from "The Norwegian Offender Mental Health and Addiction Study" (NorMA) which was conducted in the period 2013-2014 at 57 prison units in Norway. A total of 1495 inmates (96 women) responded to the questionnaire. We investigated self-reported use of psychotropic drugs related to: hypnotics, anxiolytics, antidepressants, OMT-medications, pain medication and ADHD-medications. We used logistic regression models to investigate relationships between different background factors and the use of prescribed drugs during imprisonment. Results: Hypnotics were most commonly used, both before and during imprisonment. Twenty percent of inmates had used hypnotics daily during imprisonment. Inmates used more psychotropic drugs than the general population, with the exception of pain medications. During imprisonment, usage of most psychotropic drugs imprisonment were associated with symptoms of mental illness, harmful drug use before imprisonment, having received social benefits and to have had an upbringing marked by drug use and mental problems. Conclusion: Our findings show that prisoners' mental health and substance use situation should have a high priority during imprisonment. It is expected that inmates use more prescribed psychotropic drugs than the general population. The fact that the general population uses more pain medication than inmates should therefore be investigated further.