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Opioidberoende: en studie om beroendevården och det sociala sammanhangets betydelse
Umeå University, Faculty of Social Sciences, Department of Social Work.
2018 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Opioid dependence is highly associated with health problems relating to physical health (infectious diseases) as well as mental health (depression, anxiety, antisocial behavior). In addition, research has found an association between use of opioids and increased risk of premature death as a consequence of overdose or other circumstances, such as suicide. Furthermore, opioid dependent individuals experience a high level of social exclusion and problems with relationships, housing, income and livelihood. Overall, there is a connection between opioid dependence and physical, psychological and social vulnerability as well as premature death.

The importance of social cohesion has rarely been the focus in research on opioid dependence. Therefore, there is a need to further explore whether differences in outcomes (medication assisted treatment, mortality and co-morbidity) in addition to individual characteristics, can be derived from social aspects of the opioid dependent individual’s life.

The overall aim of the dissertation is to examine individual and social factors among individuals who are dependent on opioids and how they are associated with outcomes relating to: a) medication assisted treatment; and b) mortality and co-morbidity.

This dissertation is based on data from four different registers. The first and second sub-studies use ASI data. The third uses DOK data from the National Board of Institutions (SiS) and the Death Registry (National Board of Health and Welfare). The fourth study is based on both DOKdata and data from the national patient registry (National Board of Health and Welfare).

Overall, this dissertation confirms the understanding of opioid dependence as associated with a high level of vulnerability. This dissertation shows that opioid dependence is characterized by extensive care efforts, low levels of employment, and a high level of mental health and comorbidity.

This dissertation shows that the characteristics related to the social network (parenting, work and education) are of significance for being in treatment, but also remaining in care (medication assisted treatment), which in turn promotes the individual's health and long-term health development. In that, this dissertation shows that for individuals dependent on opioids, there is an association between being part of a social network and favorable health development.

Place, publisher, year, edition, pages
Umeå: Institutionen för socialt arbete, Umeå universitet , 2018. , p. 97
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 91
Keywords [en]
Opioid dependence, medication assisted treatment, compulsory care, social cohesion, register-based research, social work
National Category
Social Work
Identifiers
URN: urn:nbn:se:umu:diva-147704ISBN: 978-91-7601-894-1 (print)OAI: oai:DiVA.org:umu-147704DiVA, id: diva2:1205714
Public defence
2018-06-08, S213H, Samhällsvetarhuset, 901 87 Umeå, Umeå, 10:15 (Swedish)
Opponent
Supervisors
Available from: 2018-05-18 Created: 2018-05-15 Last updated: 2018-06-09Bibliographically approved
List of papers
1. Predisposing, enabling, and need factors of heroin addict's using prescribed methadone or buprenorphine for a year or longer: an exploratory study of drug treatment for heroin addicts in the Swedish welfare system
Open this publication in new window or tab >>Predisposing, enabling, and need factors of heroin addict's using prescribed methadone or buprenorphine for a year or longer: an exploratory study of drug treatment for heroin addicts in the Swedish welfare system
2014 (English)In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, no 2, p. 175-188Article in journal (Refereed) Published
Abstract [en]

AIM

- This exploratory study draws on national register data for 2,638 opioid users from 2004- 2008 to examine whether or not certain predisposing, enabling and need factors are associated with taking methadone or buprenorphine continuously on doctor’s orders for one year or more.

DESIGN

- Chi-square analysis, one-way Anova and logistic regression methods were used to explore the association between self-reported demographic characteristics, alcohol/drug use severity, substance use disorder treatment history, criminal justice history, level of mental health symptomatology, mental health treatment history, and whether or not adult opioid users had taken methadone or buprenorphine continuously on doctor’s orders for one year or longer.

RESULTS

- Having a job and having had more voluntary treatment episodes were significantly associated with using methadone or buprenorphine. Those opioid users who had a job were 19 times more likely to be on methadone or buprenorphine than opiate users who did not have a job.

CONCLUSIONS

- In our study, individuals who were working were significantly more likely to medicate against their opioid abuse. This suggests that they may be more socially integrated than their non-medicating counterparts

Place, publisher, year, edition, pages
Walter de Gruyter, 2014
Keywords
opioid, heroin, methadone, buprenorphine, work
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-86494 (URN)10.2478/nsad-2014-0014 (DOI)000335903700005 ()
Available from: 2014-02-27 Created: 2014-02-27 Last updated: 2018-06-08Bibliographically approved
2. Factors associated with work and taking prescribed methadone or buprenorphine among Swedish opiate addicts
Open this publication in new window or tab >>Factors associated with work and taking prescribed methadone or buprenorphine among Swedish opiate addicts
2015 (English)In: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, p. 172-177Article in journal (Refereed) Published
Abstract [en]

Background/aims: Using national register data from 2002 to 2008, this exploratory study examines for opiate addicts (n = 2638) whether there is an association between predisposing, enabling and need factors and working and taking methadone or buprenorphine prescribed by a physician for a year or more.

Methods: Chi-square analyses and One-way ANOVA were used to determine significant relationships between the independent variables and the dependent variable. A binomial logistic regression model, with variables entered as a single block, measured statistical associations between the independent variables and the dichotomous dependent variable.

Results: Men and those with greater number of years of education (7%) and those with children were 7.08 times more likely to be working and taking prescription methadone or buprenorphine. Those who had more inpatient drug treatment episodes (5%), those who had been charged with crime 3.23 times, and those who had used psychiatric medications were 8.43 times more likely to be working and to have taken prescription methadone or buprenorphine one year or more.

Conclusion: This study highlights that clients in treatment for opiate addiction who are working and have received methadone or buprenorphine treatment may have better treatment retention and be more integrated socially than their counterparts even though they have a higher level of problem severity and treatment needs.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
opiate use, MMT, BMT, employment and medication addiction treatment use
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-101133 (URN)10.1016/j.evalprogplan.2014.12.015 (DOI)000352663700019 ()25624097 (PubMedID)
Available from: 2015-03-22 Created: 2015-03-22 Last updated: 2018-06-07Bibliographically approved
3. Cause of death: Factors associated with opioid related mortality among opioid users in the Swedish compulsory care treatment system
Open this publication in new window or tab >>Cause of death: Factors associated with opioid related mortality among opioid users in the Swedish compulsory care treatment system
(English)Manuscript (preprint) (Other academic)
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-147701 (URN)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-06-09
4. Factors associated with experience of hospitalization for mental health disorders among opioid users in a compulsory care setting
Open this publication in new window or tab >>Factors associated with experience of hospitalization for mental health disorders among opioid users in a compulsory care setting
(English)Manuscript (preprint) (Other academic)
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-147703 (URN)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-06-09

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Nilsson Blom, Marcus

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