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Compulsory care of individuals with severe substance use disorders and alcohol- and drug-related mortality: a Swedish registry study
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0002-8532-1019
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0003-1368-7879
Umeå University, Faculty of Social Sciences, Department of Social Work. University of Denver, Denver, CO, United States.
2023 (English)In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 14, article id 1106509Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023. Vol. 14, article id 1106509
Keywords [en]
compulsory care, addiction treatment, alcohol-related mortality, drugs other than alcohol-related mortality, Addiction Severity Index
National Category
Substance Abuse Social Work
Identifiers
URN: urn:nbn:se:umu:diva-203400DOI: 10.3389/fpsyt.2023.1106509ISI: 000919995700001PubMedID: 36741106Scopus ID: 2-s2.0-85147213135OAI: oai:DiVA.org:umu-203400DiVA, id: diva2:1728238
Part of project
STANCE ? Program: Studying social services, treatment and other interventions for Alcohol and Narcotics and resulting health outcomes ? A Collaborative longitudinal research program , Forte, Swedish Research Council for Health, Working Life and Welfare
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016–07213Available from: 2023-01-18 Created: 2023-01-18 Last updated: 2024-01-17Bibliographically approved

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Scarpa, SimoneGrahn, RobertLundgren, Lena

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CiteExportLink to record
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Citation style
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