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Repeated addiction treatment use in Sweden: a national register database study
Umeå University, Faculty of Social Sciences, Department of Social Work.
School of Social Work, Boston University, Boston, Massachusetts, USA.
School of Social Work, Boston University, Boston, Massachusetts, USA.
2014 (English)In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 49, no 13, 1764-1773 p.Article in journal (Refereed) Published
Abstract [en]

Sweden has a free, universal addiction treatment system yet few studies examining utilization of treatment in this country. This study identified predisposing, enabling and need factors associated with history of number of voluntary addiction treatment episodes for a national sample of 12,009 individuals assessed for an alcohol and/or drug use disorder in Sweden. On average, people reported 4.3 prior treatment episodes. Linear regression methods identified that of predisposing factors older age and being male were associated with more voluntary addiction treatment episodes compared to younger and female clients; a higher Addiction Severity Index (ASI) employment score (an enabling factor) was associated with more voluntary addiction treatment episodes; and need factors including a history of inpatient mental health treatment, a higher ASI psychiatric score, a higher ASI alcohol score, higher levels of illict drug use, more compulsory addiction treatment episodes, a lower ASI legal score and history of criminal justice involvement were all associated with more voluntary addiction treatment episodes compared to their counterparts. There were no differences in number of treatment episodes by education or immigrant status. Implications: (1) Need is a key factor associated with more treatment use. (2) Further studies are needed to identify gender differences in access/use of treatment. (3) Given multiple treatment histories Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.

Place, publisher, year, edition, pages
London: Informa Healthcare, 2014. Vol. 49, no 13, 1764-1773 p.
Keyword [en]
addiction treatment, treatment repeaters, substance use disorder, compulsory treatment, Sweden, chronic care model
National Category
Psychology Psychiatry Substance Abuse
Identifiers
URN: urn:nbn:se:umu:diva-93939DOI: 10.3109/10826084.2014.926932ISI: 000343678600003OAI: oai:DiVA.org:umu-93939DiVA: diva2:751736
Available from: 2014-10-01 Created: 2014-10-01 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Treatment repeaters: re-entry in care for clients with substance use disorder within the Swedish addiction treatment system
Open this publication in new window or tab >>Treatment repeaters: re-entry in care for clients with substance use disorder within the Swedish addiction treatment system
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

According to the regulations contained in the Social Services Act (SFS 2001:453), Swedish social services have a legal responsibility to provide support, care, and treatment for individuals with substance use problems.  This law mandate those who are responsible to provide treatment to motivate drug users to actively seek treatment on a voluntary basis, ensuring an end to their dependence on drugs. Studies have shown that although the treatment system largely focuses on promoting abstinence, about two-thirds of client’s relapse into substance use within one year after completing treatment. This dissertation focuses broadly on clients who repeatedly enter and use treatment for substance use disorders in the Swedish addiction treatment system. The aim of this thesis is to examine and identify the population groups who are repeated treatment users of the Swedish treatment system for substance use disorder, including both the voluntary treatment and compulsory care. This thesis was based on three national level databases. The results showed that clients with a higher degree of problems and problems in different areas of life also had an increased risk of having treatment for substance use disorder repeatedly. Clients who were older, men, reported more years of polydrug and alcohol use to intoxication, reported more compulsory care episodes for substance use, had ever been charged with crime, had ever been in inpatient mental health treatment, and had a higher ASI mental health symptom composite score, were significantly more likely to report more voluntary addiction treatment episodes. The strongest significant association with the number of treatment episodes was the number of compulsory treatment episodes for alcohol and drugs. Individuals who experienced prior compulsory care including mandatory treatment through LVU (law (1990:52)), been in prison, and had children mandated to out-of-home care, were more likely to have two or more entries in the compulsory care system for substance use disorder. In addition, this analysis showed that 59% of clients mandated to compulsory care dropped-out during their compulsory care episode, and that younger clients were significantly more likely to drop-out. Those who drop-out were significantly more likely to experience negative outcomes, i.e. additional sentence to compulsory care and higher risk of mortality.  A hierarchal logistic regression model also identified that individuals with riskier childhood conditions were more likely to have had repeated entries to compulsory care for substance use disorder. The indirect effects showed that a family history of substance use disorder and psychiatric problems are both associated with higher probability of institutional care as a child i.e. LVU, and that in turn, mandated childhood institutional care is related to repeated compulsory care intakes as an adult. Individuals who use treatment for substance use disorder repeatedly have a higher degree of problems i.e. an exposed and problematic group of individuals characterized by problem in several different areas of life. Growing up in a home environment with unfavorable conditions, mandated care before the age of 18 (LVU), compulsory care for substance use disorder as an adult, children taken into out-of-home care, and crime are the factors that are primarily associated with repeated treatment for substance use. A change in the view of treatment for clients in need of repeated use of treatment seems important, and access to adapted continuous care efforts are crucial to counteract the risk of relapse after a treatment episode of voluntary or compulsory care. Further, it seems important to motivate the client to complete the compulsory care without any deviation, since this seems to have positive effects on their substance use disorder.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2017. 62 p.
Series
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 86
Keyword
addiction treatment, treatment repeaters, substance use disorder, compulsory care, register database study, Sweden, chronic condition, drop-out, continuing care, bio-psycho-social
National Category
Social Work
Identifiers
urn:nbn:se:umu:diva-141601 (URN)978-91-7601-796-8 (ISBN)
Public defence
2017-12-01, Hörsal A, Samhällsvetarhuset, Umeå, 10:00 (Swedish)
Opponent
Supervisors
Available from: 2017-11-10 Created: 2017-11-09 Last updated: 2017-11-30Bibliographically approved

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