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Among all Swedish residents aged\u2009older than 10\u2009years and BZDR-na\u00efve by 2007, 960,430 BZDR-recipients with incident dispensation in 2007\u20132019 and without any recorded pre-existing substance-related conditions were identified and matched (1:1) to non-recipients from the general population. Twin BZDR-recipients (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200912,048) were linked to 12,579 unexposed co-twins. Outcomes included alcohol and drug use disorders, poisoning, deaths, and related suspected criminal offences. Flexible parametric survival models estimated outcome risks across up to 14\u2009years of follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In the demographically matched cohort (60% women, median age at BZDR initiation 51\u2009years), incidence rates in BZDR-recipients and non-recipients (per 1000\u2009person-years) were 5.60 versus 2.79 for alcohol-related and 4.15 versus 1.23 for drug-related problems, respectively. In fully adjusted models, relative risks were increased for alcohol- and drug-related problems (adjusted hazard ratio (95% confidence interval): 1.56 (1.53\u20131.59) and 2.11 (2.05\u20132.17), respectively). The risks persisted within the co-twin comparison, different follow-ups, and all additional sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>BZDR initiation was associated with a small but robust increase in absolute and relative risks of developing alcohol- and drug-related problems. The findings contribute to evidence base for making decisions on BZDR treatment initiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02698811251373069","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T05:55:16Z","timestamp":1759384516000},"page":"305-315","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Incident benzodiazepine and Z-drug use and subsequent risk of alcohol- and drug-related problems: A nationwide matched cohort study with co-twin comparison"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6218-5950","authenticated-orcid":false,"given":"Xinchen","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, 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