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Aims: This study examined the association between educational attainment and the risk of deaths of despair among individuals assessed for substance use severity at municipal social services in Sweden. It aimed to determine whether the protective association between education and despair-related mortality risk, commonly observed in broader population studies, also applies to this high-risk, treatment-seeking population.

Methods: We linked data from municipal Addiction Severity Index (ASI) assessments to various population registers. The study population included adults aged 25 years or older who were assessed for substance use severity between 1999 and 2019. Fine–Gray competing risk regression models were employed to examine the association between educational attainment and despair-related mortality, both overall and by subtype (alcohol-related, drug use-related, suicide).

Results: Tertiary education was unexpectedly associated with increased risks of overall despair-related mortality, alcohol-related and drug use-related mortality, after controlling for demographic characteristics, ASI composite scores and substance use onset age. No significant associations were found between education and suicide.

Conclusions: The counterintuitive finding that tertiary education is linked to a greater risk of despair-related mortality among social service users may be attributed to differences between the treatment-seeking population and the general population. Highly educated individuals who seek treatment from municipal social services might have severe substance use and complex psychosocial problems and/or contact social services after exhausting other treatment options. Further research is necessary to understand how educational and socioeconomic factors influence treatment pathways for individuals with severe substance use problems in Sweden and how these different pathways impact health-related outcomes.

Background: The Addiction Severity Index (ASI) assesses respondents' biopsychosocial problems in seven addiction-related domains (mental health, family and social relations, employment, alcohol use, drug use, physical health, and legal problems). This study examined the association between the seven ASI composite scores and re-employment in a sample of Swedish adults screened for risky alcohol and drug use who were without employment at assessment.

Methods: We conducted a retrospective cohort analysis of employment outcomes among 6502 unemployed adults living in Sweden who completed an ASI assessment for risky alcohol and drug use. The study linked ASI scores to annual tax register data. The primary outcome was employment, defined as having earnings above an administrative threshold. We used Cox proportional hazard models to estimate the association between time to re-employment and ASI composite scores, controlling for demographic characteristics.

Results: Approximately three in ten individuals in the sample regained employment within five years. ASI composite scores suggested widespread biopsychosocial problems. Re-employment was associated with lower ASI composite scores for mental health (estimate: 0.775, 95 % confidence interval: 0.629–0.956), employment (estimate: 0.669, confidence interval: 0.532–0.841), drug use (estimate: 0.628, confidence interval: 0.428–0.924), and health (estimate: 0.798, confidence interval: 0.699–0.912).

Conclusions: This study suggests that several ASI domains may provide information on the complex factors (i.e., mental health, health, drug use) associated with long-term unemployment for people with risky substance use.

Background: In Sweden, as in other countries, individuals with immigrant backgrounds are disproportionately represented within the incarcerated population. This study examined the association between immigrant background and future incarceration for individuals assessed for illicit substance use severity, while considering their prior incarceration history.

Methods: Using data from Swedish Addiction Severity Index (ASI) assessments linked to register data from Statistics Sweden, we employed Zero-Inflated Negative Binomial (ZINB) regression models to analyse differences in incarceration histories within five years before and after ASI assessments based on immigrant backgrounds. Additionally, Cox proportional-hazard models were used to assess the likelihood of post-assessment incarceration among these groups.

Results: Immigrant background was positively associated with pre- and post-assessment incarceration. First- and second-generation immigrants from the Global South had longer periods of incarceration in the five years before assessments compared to native Swedes. Post-assessment, first-generation immigrants showed longer periods of incarceration. Survival analyses supported these findings, indicating a higher risk of prolonged post-assessment incarceration among all immigrant groups, particularly first-generation immigrants from the Global South.

Conclusion: Among individuals assessed for illicit drug use within Swedish municipalities, those with immigrant backgrounds faced higher incarceration risks, even after controlling for substance use severity and prior incarceration. Tailored interventions and support systems are vital to prevent re-entry into the criminal justice system. Timely actions can break re-offending cycles, redirecting paths away from reoffending and towards legal reintegration, thereby reducing incarceration and recidivism rates.

Aim: This study used 17 year of Swedish registry data (2003–2019) for 25,125 adults assessed for their severity of substance use to identify the baseline factors predicting the risk of being court-ordered into compulsory care and examine the association between admission to compulsory care and mortality risks due to alcohol- or drug-related causes.

Methods and materials: Addiction Severity Index (ASI) assessment data were linked to register data on demographic characteristics, compulsory care, and alcohol- and drug-related mortality. Cox regression models were used to identify baseline factors predictive of post-assessment admission to compulsory care in the 5 years post-substance use assessment. Discrete-time random-effect logistic regression models were used to examine the association between compulsory care duration and alcohol or drug-related mortality risks. Propensity score matching was used for validation.

Results: The first models identified that younger age, female gender, and ASI composite scores for drug use, mental health and employment were significantly associated with the risk of placement in compulsory care for drugs other than alcohol. Female gender and ASI composite scores for alcohol, drug use and employment were significantly associated with compulsory care treatment for alcohol use. The second models showed that older individuals and men were more likely to die due to alcohol-related causes, while younger individuals and men were more likely to die due to drug-related causes. Length of stay in compulsory care institutions significantly increased the likelihood of dying due to substance use-related causes. Propensity scores analyses confirmed the results.

Conclusion: In Sweden, a significant concern is the higher likelihood of women and young individuals to be court-ordered to compulsory care. Although compulsory care is often advocated as a life-saving intervention, our findings do not provide strong support for this claim. On the contrary, our findings show that admission to compulsory care is associated with a higher risk of substance use-related mortality. Factors such as compulsory care often not including any medical or psychological therapy, together with relapse and overdose after discharge, may be possible contributing factors to these findings.

Denna kvantitativa studie utvärderar kunskapsförändringar hos deltagare i EPI universitetskursen. Majoriteten av deltagarna var socialsekreterare inom miss-bruksområdet. Kursen resulterade i betydande förbättringar av deltagarnas kunskap, särskilt vad gäller insats- och vårdkontinuitetsmodeller samt använd-ning av motivationshöjande intervjutekniker. Kunskapen om äldre personer med beroendeproblem och fördelarna med ASI-uppföljningar för socialarbe-tare och klienter förbättrades också.

This quantitative study assesses knowledge improvement among partici-pants of the EPI university course. The majority were social workers in sub-stance abuse. The course led to significant enhancements in participants’ knowledge, particularly concerning intervention and care continuity and the use of motivational interview techniques. Knowledge about older individuals with substance dependencies and benefits of ASI follow-up interviews for social workers and clients also improved.

Sweden and many other countries have experienced increases in suicide and accidental overdose deaths. Ananalysis examined the associations between recency of non-medical opioid misuse and frequency of use of nonmedicalopioids with death due to either suicide or accidental overdose within a sample of 15,000 Swedish adultswho completed an Addiction Severity Index (ASI) assessment for risky substance use or a substance use disorder.Methods and materials: Suicide (n = 136) and death due to overdose (n = 405) were identified in the official Causeof Death Registry from the Swedish National Board of Health and Welfare. Control variables included demographiccharacteristics and risks associated with either overdose or suicide. Cox regression analyses controlledfor variables statistically significantly at the bivariate level.Results: At the multivariable level: a) a higher (modified) ASI Composite Score for mental health; b) history ofsuicide attempt; c) having used non-medical opioids for 1–2 times per week for at least a year; d) history ofinjection drug use; and, e) early onset of drug use, were all significantly and positively associated with death dueto suicide. At the multivariable level: a) a higher the revised ASI Composite Score for mental health; b) recency ofuse of non-medical opioids; c) frequency of non-medical opioid use; d) being a male; and e) being of ages 18–24years compared to ages 43–51 years were all positively and significantly associated with death due to accidentaloverdose.Conclusion: These findings underscore the need to integrate mental health and substance use disorder treatmentand provide suicide and overdose prevention interventions for individuals with an opioid use disorder. Recencyand frequency of non-medical opioids were only associated with death due to overdose and not suicide. However,other drug use related variables (using opioids 1–2 times per week for at least a year, early onset of drug use anddrug injection) were significantly associated with death due to suicide.

Background: Substance use among older persons occurs with medical and psychiatric comorbidities. This study examined the associations of substance use disorder (SUD), psychiatric, and dual diagnoses with 12-month cumulative hospitalized days, hospital admission rate and number of days to first hospitalization.

Methods: The cohort of 3,624 individuals (28.2% women) aged 50 years or older was assessed for substance use severity in 65 Swedish municipalities during March 2003–May 2017. Addiction Severity Index data were linked to hospital discharge records and crime statistics. The outcomes were (a) 12-month cumulative hospitalized days; (b) Hospital admission rate, and (c) days to first hospitalization. Generalized linear regression techniques investigated associations between outcomes and SUD, psychiatric and dual diagnoses at admission.

Results: During 2003–2017, 73.5% of the participants were hospitalized. Twelve-month hospitalized days were positively associated with SUD (Incidence rate ratio (IRR) = 1.41, 95%CI: 1.26–1.58), dual diagnosis (IRR = 2.03, 95%CI: 1.74–2.36), and psychiatric diagnoses (IRR = 2.51, 95%CI: 2.09–3.01). Hospital admission rate was positively associated with SUD (IRR = 4.67, 95%CI: 4.28–5.08), dual diagnosis (IRR = 1.83, 95%CI: 1.64–2.04), and psychiatric diagnoses (IRR = 1.73, 95%CI: 1.55–1.92). Days to first hospitalization were negatively associated with SUD (IRR = 0.52, 95%CI: 0.47–0.58), dual diagnosis (IRR = 0.57, 95%CI: 0.50–0.65), and psychiatric diagnoses (IRR = 0.83, 95%CI: 0.73–0.93). The marginal effects of SUD and/or mental disorders increased with age for all outcomes, except for days to first hospitalization.

Conclusion: Three of four older persons assessed for substance use severity were later hospitalized. Substance use disorders, dual diagnoses and other mental disorders were the primary reasons for hospitalization and were associated with longer stays, earlier hospitalization, and repeated admissions. Sensitizing service providers to old age substance use and sharing data across the care continuum could provide multiple points of contact to reduce the risk of hospitalizations among older persons with problematic substance use.