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Drop-out from the Swedish addiction compulsory care system
Umeå University, Faculty of Social Sciences, Department of Social Work.
Umeå University, Faculty of Social Sciences, Department of Social Work.
Umeå University, Faculty of Social Sciences, Department of Social Work. Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, USA.
2015 (English)In: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, 178-184 p.Article in journal (Refereed) Published
Abstract [en]

Drop-out of addiction treatment is common, however, little is known about drop-out of compulsory care in Sweden. Data from two national register databases were merged to create a database of 4515 individuals sentenced to compulsory care 2001-2009. The study examined (1) characteristics associated with having dropped out from a first compulsory care episode, (2) the relationship between drop-out and returning to compulsory care through a new court sentence, and (3) the relationship between drop-out and mortality. Methods: Multivariable logistic regression analysis was used to address Aim 1 and Cox proportional hazards regression modeling was applied to respond to Aims 2 and 3. Findings: Age and previous history of crime were significant predictors for drop-out. Clients who dropped out were 1.67 times more likely to return to compulsory care and the hazard of dying was 16% higher than for those who dropped-out. Conclusion: This study finds that 59% of clients assigned to compulsory care drop-out. Younger individuals are significantly more likely to drop-out. Those who drop out are significantly more likely to experience negative outcomes (additional sentence to compulsory care and higher risk of mortality). Interventions need to be implemented that increase motivation of youth to remain in compulsory care. 

Place, publisher, year, edition, pages
Elsevier, 2015. Vol. 49, 178-184 p.
Keyword [en]
Drop-out, Compulsory care, Mortality, Sweden
National Category
Social Work
Identifiers
URN: urn:nbn:se:umu:diva-103153DOI: 10.1016/j.evalprogplan.2014.12.016ISI: 000352663700020PubMedID: 25563530OAI: oai:DiVA.org:umu-103153DiVA: diva2:815229
Available from: 2015-05-29 Created: 2015-05-18 Last updated: 2017-12-04Bibliographically 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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