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  • 1.
    Blom, Björn
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Dukes, Kimberly A.
    DM-STAT, One Salem Street Suite 300, Malden, MA 02148 USA; Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215 USA.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. School of Social Work, Boston University, USA.
    Sullivan, Lisa M.
    Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215 USA.
    Register data in the evaluation and program planning of addiction treatment programs: using Sweden as an example2015In: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, p. 185-191Article in journal (Refereed)
    Abstract [en]

    Data from large-scale registers is often underutilized when evaluating addiction treatment programs. Since many programs collect register data regarding clients and interventions, there is a potential to make greater use of such records for program evaluation. The purpose of this article is to discuss the value of using large-scale registers in the evaluation and program planning of addiction treatment systems and programs. Sweden is used as an example of a country where register data is both available and is starting to be used in national evaluation and program planning efforts. The article focuses on possibilities, limitations and practicalities when using large-scale register data to conduct evaluations and program planning of addiction treatment programs. Main conclusions are that using register data for evaluation provides large amounts of data at low cost, limitations associated to the use of register data may be handled statistically, register data can answer important questions in planning of addiction treatment programs, and more accurate measures are needed to account for the diversity of client populations.   

  • 2.
    Blom Nilsson, Marcus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Chassler, Deborah
    Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215 USA.
    Lundgren, Lena
    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.
    Factors associated with work and taking prescribed methadone or buprenorphine among Swedish opiate addicts2015In: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, p. 172-177Article in journal (Refereed)
    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.

  • 3.
    Blom Nilsson, Marcus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Department of Social Work.
    McCarty, Dennis
    OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, USA.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. University of Denver Graduate School of Social Work, Denver, USA.
    Sexual Abuse and Future Mental Health Hospitalization in a Swedish National Sample of Men Who Use Opioids2020In: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227, Vol. 14, no 4, p. e24-e28Article in journal (Refereed)
    Abstract [en]

    Objective: Experiences of trauma, specifically sexual abuse, have been linked to both mental health and substance use disorders. This study used 14 years of Swedish health registry data to select a sample of adult men who reported frequent opioid use and assessed if those with a self-reported history of sexual abuse had a higher likelihood of hospitalization for a mental health disorder.

    Methods: A Swedish longitudinal (2003–2017) registry study linked Addiction Severity Index (ASI) assessments completed with individuals who sought treatment for substance use disorders with data on hospitalizations for mental health disorders, and assessed associations with self-reported histories of sexual abuse among men who reported sustained and frequent use of opioids (n¼1862). Cox regression methods tested associations and controlled for age, and the7 ASI composite scores: family and social relationships, employment, alcohol use, drug use, legal, physical health, and mental health.

    Results: The ASI composite score for mental health (hazard ratio[HR] 16.6, P<0.001) and a history of sexual abuse (HR 1.93,P<0.001) were associated with an elevated risk of future mental health hospitalization.

    Conclusion: Both the ASI composite scores for mental health andself-reported history of sexual abuse reflected complex needs amongmen who used opioids and increased risk for mental health hospitalization.Treatment providers should strive to provide integrated careand address the negative aspects of victimization.

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  • 4.
    Blom-Nilsson, Marcus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Samsjuklighet, substansanvädning och psykisk ohälsa2023In: Effektiv insatsplanering vid svår substansanvändning / [ed] Lena Lundgren, Lund: Studentlitteratur AB, 2023, p. 121-132Chapter in book (Other academic)
  • 5.
    Grahn, Robert
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Chassler, Deborah
    Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA, 02215 USA.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Repeated addiction treatment use and compulsory care 2001-20092014In: Institutionsvård i fokus: uppföljningar och registerstudier av klienter i LVM-vård, 2014Conference paper (Other academic)
    Abstract [sv]

    Repeated addiction treatment use and compulsory care 2001-2009.

    Uppföljningar och registerstudier av klienter i LVM-vård.

    Att vårda en klient mot sin vilja är ett långtgående ingrepp i en persons liv. Det innebär samtidigt att det är extra viktigt att ta reda på hur det går på längre sikt och följa upp den vård som getts. Hur det hade gått om samhället inte ingripit vet vi förstås inte men kunskap om utfallet är ett första, viktigt steg. Att följa upp klienter är emellertid mycket krävande, åtminstone om man vill försöka nå många för att exempelvis intervjua dem personligen. Därför används ofta registeruppgifter, med alla sina brister och förtjänster.

    Studiens syfte är att identifiera och beskriva särskilda grupper av klienter som återkommande är föremål för LVM-behandling i Sverige, t.ex. med avseende på kriminell bakgrund, samsjuklighet, psykiska problem och föräldrar med barn som är omhändertagna.

    Undersökningen bygger på befintliga databaser som Statens institutionsstyrelse förfogar över. Data avser personer som med stöd av Lagen om vård av missbrukare (LVM) placerats på behandlingshem – vid ett eller flera tillfällen – under perioden 2001-2009.

  • 6.
    Grahn, Robert
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Chassler, Deborah
    Boston University.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Repeated addiction treatment use in Sweden: a national register data base study2013Conference paper (Other academic)
    Abstract [en]

    Objectives: This study examines alcohol and drug treatment utilization among a nationally representative sample of 13, 464 individuals interviewed and assessed for an alcohol and/or drug use disorder in the Swedish welfare system. The aim of this study is to identify and describe specific groups who are treatment repeaters of the Swedish addiction treatment system.

    Methodology: Univariate descriptive statistics, chi-square, one-way ANOVA, and correlation methods were used to examine the characteristics associated with history of number of addiction treatment episodes. A linear regression model was developed with variables that were significant at the bivariate level.

    Results: On average, the respondents reported 4.3 prior addiction treatment episodes. Results of the study show that those who were older, men, those who reported more years of polydrug and alcohol use to intoxication, who reported more compulsory treatment episodes for narcotics and alcohol, who had ever been charged with crime, who had ever been inpatient mental health treatment, and who reported a more mental health symptoms were significantly more likely to report having a history of engaging in more addiction treatment episodes. The strongest significant association with the number of treatment episodes was the number of compulsory treatment episodes for alcohol and/or for drugs.

    Conclusion: Implications include the need to change perspectives about addiction treatment from it being an acute care model to a viewing addiction treatment as a chronic care model. Many individuals have multiple- treatment episodes and need multiple treatment. Further, with respect to effectiveness, overall, the Swedish treatment system responds to need in the meaning that the individuals who need treatment for their addiction also have access to treatment. Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.

  • 7.
    Grahn, Robert
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Chassler, Deborah
    School of Social Work, Boston University, Boston, Massachusetts, USA.
    Lundgren, Lena
    School of Social Work, Boston University, Boston, Massachusetts, USA.
    Repeated addiction treatment use in Sweden: a national register database study2014In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 49, no 13, p. 1764-1773Article in journal (Refereed)
    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.

  • 8.
    Grahn, Robert
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. Center for Addictions Research and Services, Boston University School of Social Work, USA.
    Chassler, Deborah
    Center for Addictions Research and Services, Boston University School of Social Work, USA.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Repeated entries to the Swedish addiction compulsory care system: A national register database study2015In: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, p. 163-171Article in journal (Refereed)
    Abstract [en]

    This study identified and described specific client groups who have repeated entries to the Swedish addiction compulsory care system. Specifically, through the use of baseline data from the Swedish government Staten’s Institutions Styrelse (SiS) database, for 2658 individuals who were assessed at their compulsory care intake interview by social workers in the national social welfare system between 2001 and 2009 the study identified the associations between specific predisposing, enabling and need characteristics and repeated addiction compulsory care entries. The logistic regression model identified that individuals whose children have been mandated to the child welfare system, who have experienced prior compulsory care including compulsory treatment through LVU (law (1990:52) with specific provision about care of young people under 18), and those who have been in prison are more likely to have two or more entries in the addiction compulsory care system compared to their counterparts. Individuals who have been mandated to compulsory care for their substance use disorder two or more times have significant multiple complex problems and repeated experiences of institutionalization. These individuals are a group in need of a well-coordinated and integrated system of aftercare services to reduce the likelihood of re-entry into addiction compulsory care. 

  • 9.
    Grahn, Robert
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hall, Taylor
    Lundgren, Lena
    University of Denver Graduate School of Social Work, Denver, Colorado, USA.
    The Associations between Risky Psychosocial Environment, Substance Addiction Severity and Imprisonment: A Swedish Registry Study2020In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 55, no 5, p. 697-706Article in journal (Refereed)
    Abstract [en]

    Objective: Both childhood and adult psychosocial stressors have been identified as links to both increased risk for substance use disorder (SUD) and increased risk of imprisonment. The aim of this retrospective study is to identify, for a sample of 14,914 adults who all were assessed for risky substance use or a SUD, the importance of having a history of psychosocial stressors compared to current addiction severity. The analyses control for age, gender and education on the likelihood of future imprisonment. 

    Method: Baseline Addiction Severity Index data (ASI) were merged with national registry data on prison sentences from 2003 to 2016. In the analysis, a Cox regression was used to study the association between independent variables and the likelihood of future imprisonment. 

    Results: In the regression, five variables showed significant association to increased risk of imprisonment: ASI drugs other than alcohol Composite Score (positive relationship), ASI alcohol Composite Score (negative relationship), age (younger), education (lower) and parental problems with drugs other than alcohol. The factor with strongest association with imprisonment was the ASI drugs other than alcohol Composite Score, which showed the highest HR = 10.63 (3.50–32.31) for women and HR = 5.52 (3.77–8.08) for men to predict the likelihood of imprisonment. 

    Discussion: Research is needed on why individuals with history of psychosocial stressors have a higher likelihood of imprisonment compared to their counterparts. Findings indicate that a high ASI Composite Score for drugs other than alcohol are strong predictors of future criminality and criminal justice system involvement.

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  • 10.
    Grahn, Robert
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    The importance of risky psychosocial childhood for repeated addiction compulsory care as adultManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Treatment for substance use disorder (SUD), results, in general, in improvements in terms of both drug use and social functioning. However, there are clients who are in need of repeated treatment. The aim of this retrospective study is to identify, for adults in compulsory care for severe SUD, the association between and reporting have experienced a risky psychosocial childhood and repeated entries into the Swedish compulsory care system for SUD.

    Method: Hierarchical logistic regression and mediation analysis methods were used to analyze data from the Swedish National Board of Institutional Care (SiS) database. The sample included 2719 adults assessed at their compulsory care intake. The study examined the association between history of institutional care, family with SUD or psychiatric problem and repeated compulsory care entries as adult controlling for main drug, age and gender.

    Results: In the regression model the factor with the strongest association with repeated compulsory care intakes for SUD, was that as a child having been in mandated institutional care (OR=2.0 (1.60-2.51)). The proportion of the total effect that is mediated through LVU was 33% for SUD problems in family during childhood, 44% for psychiatric problems in family during childhood, and 38% for having been in foster care.

    Conclusion: Having been in mandated institutional care as a youth was strongly associated with repeated compulsory care for SUD as an adult. This is concerning since receipt of services as a child is supposed to mediate against the consequences of risky childhood conditions. These adults, as a group are in need of a well-coordinated and integrated system of extensive after care services to reduce the likelihood of re-entryinto compulsory care for an SUD.

  • 11. He, Amy S.
    et al.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Sedivy, Jennifer A.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. Graduate School of Social Work, University of Denver, Denver, CO, USA.
    A Swedish national study: Immigrant-country of birth status and child welfare compulsory care among a sample of parents with risky substance use2020In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 101, article id 104316Article in journal (Refereed)
    Abstract [en]

    Background: Sweden has a high percentage of foreign-born residents (18.5 %) and one of the highest overdose death rates in Europe. For immigrant parents with risky substance use (RSU), risk factors associated with immigration status (e.g., economic strain and psychological stress) potentially heightening the risk of involvement with the child welfare system (CWS). Using Swedish registry national data, this study explored the relationship between immigration-country of birth status, psychosocial risk factors, and child compulsory care for parents with RSU.

    Methods: Study sample consisted of 5932 parents from 65 Swedish municipalities assessed for psychosocial problems (including alcohol and drug use) using the Addiction Severity Index (2007–2017). Stepwise multinomial logistic regression models examined the relationship between immigration-country of birth status (Swedish born, Nordic-born, and non-Nordic born), psychosocial problems, and compulsory care in the CWS.

    Results: Compared to Swedish-born parents, parents not born in Sweden, Norway, Denmark or Finland (non-Nordic born parents) had a lower probability of children living in compulsory care (family homes or institutions). However, after accounting for psychosocial problems, immigration status was no longer significantly associated with children’s living arrangements.

    Conclusions: Study findings indicate that parental immigrant status (even among parents dealing with RSU) in itself is not a risk factor for compulsory care in the CWS. Moreover, parental employment and health problems posed greater risk for children being in compulsory care. Receipt of targeted services for employment and health problems may help to maintain stable child living arrangements for immigrant parents dealing with RSU.

  • 12.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). The Swedish National Graduate School on Aging and Health (SWEAH), Faculty of Medicine, Lund University, Lund, Sweden.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    McCarty, Dennis
    School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, United States.
    Lundgren, Lena M.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Cross-National Behavioral Health Laboratory, Graduate School of Social Work, University of Denver, Denver, CO, United States.
    Hospital admission rate, cumulative hospitalized days, and time to admission among older persons with substance use and psychiatric conditions2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 882542Article in journal (Refereed)
    Abstract [en]

    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.

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  • 13.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). The Swedish National Graduate School on Aging and Health (SWEAH), Faculty of Medicine, Lund University, Sweden.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    McCarty, Dennis
    Oregon Health and Science UniversityPortland State University, School of Public Health, Portland, OR, USA.
    Lundgren, Lena M.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Cross-National Behavioral Health Laboratory, Graduate School of Social Work, University of Denver, Denver, Colorado, USA.
    Recurrent risk of hospitalization among older persons with problematic alcohol use: a multiple failure‐time analysis with a discontinuous risk model2022In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 117, no 9, p. 2415-2430Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Older persons with problematic alcohol use vary in psychosocial functioning, age of onset for problem drinking and use of other drugs. The study measured the differential risks of all-cause, alcohol, polydrug and psychiatric-related repeated hospitalizations among older persons with problematic alcohol use.

    Design: A linked register-based cohort study with discontinuous multiple-failure (time-to-repeated-event) data. Hospitalization and mortality were considered as failure.

    Setting: Sweden, March 2003-November 2017, using data from the Addiction Severity Index (ASI) register linked to National Inpatient Register and the Swedish Cause of Death Register.

    Participants: 50 years and older (n= 1741; 28% women), with one or more alcohol problem days in the 30 days before an ASI assessment.

    Measurements: Five mutually exclusive latent classes of problematic alcohol use, identified with eleven ASI items, were the independent variables: “Late Onset with Fewer Consequence (LO:FC; reference group)”; “Early Onset/Prevalent Multi-Dimensional problems (EO:MD)”; “Late Onset with co-occurring Anxiety and Depression (LO:AD)”; “Early Onset with co-occurring Psychiatric Problems (EO:PP)”; and “Early Onset with major Alcohol Problem (EO:AP)”. Covariates included sociodemographic characteristics, previous hospitalization and Elixhauser comorbidity index. Outcome measurements included recurrent hospitalization, and/or mortality due to: (a) all-cause, (b) alcohol-related disorders and diseases (c) polydrug use (d) other psychiatric disorders.

    Findings: During the study period, 73.2% were hospitalized at least once, 57.3% were alcohol-related, 8.5% polydrug use and 18.5% psychiatric-related diagnoses. Compared with LO:FC, EO:PP had higher risk for all-cause (adjusted hazard ratio [aHR]= 1.27, 95% confidence interval [CI]= 1.02—1.59) and alcohol-related (aHR= 1.34, 95% CI= 1.02—1.75) hospitalizations. Adjusted risks for polydrug-related hospitalization were 2.55, 95%CI= 1.04—6.27 for EO:MD and 2.62, 95%CI= 1.07—6.40 for EO:PP. Adjusted risk for psychiatric-related hospitalization was higher for LO:AD (aHR= 1.78, 95%CI= 1.16—2.73 and EO:PP (aHR= 2.03, 95%CI= 1.22—3.38).

    Conclusions: Older addiction service users in Sweden have varying risks of hospitalization due to alcohol use, polydrug use and psychiatric disorders. Older persons with problematic alcohol use who have multiple needs and are assessed in social services may benefit from earlier interventions with an integrated focus on substance use and mental health.

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  • 14.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Snellman, Fredrik
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. The Cross-National Behavioral Health Laboratory; Graduate School of Social Work, University of Denver, Denver, Colorado.
    A Multidimensional Latent Class Analysis of Harmful Alcohol Use Among Older Adults: Subtypes Within the Swedish Addiction Severity Index Registry2020In: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227, Vol. 14, no 4, p. e89-e99Article in journal (Refereed)
    Abstract [en]

    Objectives: The present study aimed to identify multidimensional typologies of harmful alcohol use based on the Swedish Addiction Severity Index (ASI) assessment data on individuals aged 50 years and above.

    Methods: Latent class analysis examined 11 indicators from ASI data on 1747 individuals (men = 1255, women = 492) who reported they were troubled by alcohol problem at least one day in the past 30 days before their assessment. The discriminative validity of the classes was assessed by comparing other measures of individual characteristics and problem severity of other ASI dimensions.

    Results: Five subtypes of harmful alcohol use were identified. Two classes with alcohol problems varying in psychosocial functioning, age composition and ages of onset of both regular and heavy drinking. Two with psychiatric comorbidity but varying in violence, criminality, gender composition and ages of onset of regular and heavy drinking. One with high prevalence of concurrent use of other substances, psychiatric, legal, and employment problems.

    Conclusions: The analysis identified, in a national sample, heterogeneous risk groups of older adults with harmful alcohol use. These findings suggest a need for healthcare providers to assess older adults not only for their substance use but also for associated problems and needs. Given these findings, the Addiction Severity Index is a valuable assessment tool for older adults with harmful alcohol use.

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  • 15.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Snellman, Fredrik
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. Graduate School of Social Work, University of Denver, Denver, Colorado.
    Alcohol subtypes in older adults: A multidimensional Latent Class Analysis of harmful alcohol use among oder adults: Subtypes within the Swedish addiction severity index registry2019Conference paper (Other academic)
  • 16.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). The Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH), Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Grönlund, Ann-Sofie
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Blom Nilsson, Marcus
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Priest, Kelsey Caroline
    MD/PhD Program, School of Medicine, Oregon Health & Science University, Portland, OR, United States.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Snellman, Fredrik
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    McCarty, Dennis
    Oregon Health & Science University- Portland State University, School of Public Health, Portland, OR, United States.
    Lundgren, Lena M.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Cross-National Behavioral Health Laboratory, Graduate School of Social Work, University of Denver, Denver, CO, United States.
    Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions2020In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 11, article id 714Article in journal (Refereed)
    Abstract [en]

    COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.

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  • 17.
    Lindner, Stephan R.
    et al.
    Center for Health Systems Effectiveness (CHSE), Oregon Health & Science University, Portland, USA.
    Scarpa, Simone
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    McCarty, Dennis
    OHSU-PSU School of Public Health, Portland, USA.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. Cross-National Behavioral Health Laboratory, University of Denver, Denver, USA.
    Addiction severity and re-employment in Sweden among adults with risky alcohol and drug use2023In: Journal of Substance Use and Addiction Treatment, ISSN 2949-8767Article in journal (Refereed)
    Abstract [en]

    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.

  • 18.
    Lundgren, Lena
    et al.
    Center for Addictions Research and Services, Boston University School of Social Work, Boston.
    Amodeo, M
    Center for Addictions Research and Services, Boston University School of Social Work, Boston.
    Chassler, Deborah
    Center for Addictions Research and Services, Boston University School of Social Work, Boston.
    Krull, I
    Center for Addictions Research and Services, Boston University School of Social Work, Boston.
    Sullivan, L
    Boston University School of Public Health, Boston.
    Organizational readiness for change in community-based addiction treatment programs and adherence in implementing evidence-based practices: a national study2013In: Journal of Substance Abuse Treatment, ISSN 0740-5472, E-ISSN 1873-6483, Vol. 45, no 5, p. 457-465Article in journal (Refereed)
    Abstract [en]

    Prior studies by the authors identified that clinical staff who reported that their treatment unit had lower levels of organizational readiness to change experienced higher levels of barriers in implementing an evidence-based practice (EBP). The current study examined whether clinical staff perceptions of their treatment unit's organizational readiness to change were also associated with their adherence to EBP protocols during EBP implementation. Adherence was examined through a variable measuring the extent to which staff modified EBP standards and manuals when implementing a new EBP. Multivariate regression analyses identified that clinical staff who had five or more years of addiction counseling experience, who rated staff in their organization as having higher levels of influence, who less frequently implemented new counseling interventions and who reported higher levels of barriers when implementing a newly funded EBP also reported that their program made more modifications to the EBP in the implementation process. Finally, staff who implemented MI compared to any other EBP reported lower levels of EBP modifications. Implications: Continued federal funding is needed to enhance treatment unit organizational resources in order to reduce barriers and promote adherence to EBPs. Also, funders of treatment need to continue to provide ongoing technical assistance and training opportunities to promote implementation of EBPs with fidelity.

  • 19.
    Lundgren, Lena
    et al.
    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.
    Blom, Björn
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Chassler, Deborah
    Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA, 02215 USA.
    Sullivan, Lisa M
    Crosstown Center, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118 USA.
    Using register data to examine patterns of compulsory addiction treatment care in Sweden: program planning and methodological implications2015In: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, p. 149-152Article in journal (Other academic)
  • 20.
    Lundgren, Lena
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Brännström, Jan
    Armelius, Bengt-Åke
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Chassler, Deborah
    Morén, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Trocchio, Sarah
    Association between immigrant status and history of compulsory treatment in a national sample of individuals assessed for drug use disorders through the swedish public welfare system2012In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 47, no 1, p. 67-77Article in journal (Refereed)
    Abstract [en]

    In-person interview data from 13,903 individuals assessed for a drug use disorder in the Swedish welfare system from 2002-2008, were analyzed using logistic regression methods. Second generation immigrants with non-Scandinavian parents were 41% more likely to report a history of compulsory treatment compared to those born in Sweden to Swedish parents after controlling for age, gender, education, mental health treatment homeless status history, and criminal justice history. Implications include the need to study acculturation, stigma, and discrimination-related factors as well as to promote culturally competent outreach to immigrant populations.

  • 21.
    Lundgren, Lena
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. University of Denver Graduate School of Social Work, USA.
    Jemberie, Wossenseged Birhane
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). The Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH), Faculty of Medicine, Lund University, Sweden.
    McCarty, Dennis
    OHSU-PSU School of Public Health, Oregon Health & Science University, USA.
    Introduction to a Special Issue: Care and treatment for substance use disorders: Studies from around the world2022In: Journal of Substance Abuse Treatment, ISSN 0740-5472, E-ISSN 1873-6483, Vol. 134, article id 108620Article in journal (Other academic)
  • 22.
    Lundgren, Lena
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Jemberie, Wossenseged Birhane
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Biopsykosocialt perspektiv och implementeringsteori2023In: Effektiv insatsplanering vid svår substansanvändning / [ed] Lena Lundgren, Lund: Studentlitteratur AB, 2023, p. 43-58Chapter in book (Other academic)
  • 23.
    Lundgren, Lena M
    et al.
    Center for Addictions Research and Services, Boston University School of Social Work, Boston, MA., USA.
    Armelius, Bengt-Åke
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Armelius, Kerstin
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Brännström, Jan
    Field Research and Development Unit (UFFE), Umeå Social Services, Sweden.
    Chassler, Deborah
    Center for Addictions Research and Services, Boston University School of Social Work, Boston, MA., USA .
    Sullivan, Lisa
    Department of Biostatistics, Boston University School of Public Health, Boston, MA., USA.
    Beskriving av tre klientprofiler inom svensk missbruksvård2012In: Socialvetenskaplig tidskrift, ISSN 1104-1420, E-ISSN 2003-5624, Vol. 19, no 3/4, p. 200-216Article in journal (Refereed)
    Abstract [sv]

    En klusteranalys av intervjuarskattningar från ASI-intervjuns sju olika livsområden för 12833 klienter visade att klienterna kan delas in i tre olika klientprofiler: Narkotikaprofil, Avgränsade alkoholproblem och Alkohol och psykiska problem. I artikeln jämförs de tre profilerna med avseende på missbruksmönster, demografiska faktorer, sociala och psykiska problem, hälsa och immigrationsstatus.

  • 24.
    Lundgren, Lena M.
    et al.
    Center for Addictions Research and Services , Boston University School of Social Work , Boston , Massachusetts , USA .
    Brännström, Jan
    Field Research and Development Unit, Umeå, Sweden.
    Chassler, Deborah
    Center for Addictions Research and Services , Boston University School of Social Work , Boston , Massachusetts , USA .
    Wilkey, Catriona
    Center for Addictions Research and Services , Boston University School of Social Work , Boston , Massachusetts , USA .
    Sullivan, Lisa
    Department of Biostatistics , Boston University School of Public Health , Boston , Massachusetts , USA .
    Nordström, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Mental Health, Substance Use, and Criminal Justice Characteristics of Males With a History of Abuse in a Swedish National Sample2013In: Journal of Dual Dignosis, ISSN 1550-4263 (Print), 1550-4271 (Online), Vol. 9, no 1, p. 47-60Article in journal (Refereed)
    Abstract [en]

    Objective: The primary goals of this study were to (a) provide the first estimate of prevalence of self-reported history of having been emotionally, physically, and/or sexually abused for men with a substance use disorder in Sweden and (b) identify, for men with a substance use disorder, mental health, substance use, and criminal justice characteristics associated with having a history of abuse. Methods: Assessment interviews for a substance use disorder were conducted in 50 out of 300 Swedish counties for the time period 2003 to 2008. Participants were a nationally representative sample of 9,571 Swedish men interviewed in county welfare offices. The Addiction Severity Index (ASI) was used as an assessment tool in these counties. From the ASI, answers to questions asking about lifetime history of emotional, physical, and sexual abuse were analyzed to provide this initial measure on history of abuse. Bivariate statistical analysis and multivariate logistic regression methods were used to explore the relationships between substance use severity, level of mental health problems reported, criminal justice history, and history of being abused. Results: Overall, 47.9% of the men in this sample reported having experienced abuse; specifically, 26.9% of clients reported a history of physical abuse, 4.5% reported a history of sexual abuse, and 40.7% reported a history of emotional abuse. Results from logistic regression modeling identified that higher ASI mental health symptomology scores were associated with 13times higher likelihood of having experienced any abuse. Further, results from logistic regression models identified that scoring higher on the ASI mental health symptoms core was associated with an 8times higher likelihood of having experienced physical abuse,14times higher likelihood of having experienced sexual abuse, and 13times higher likelihood of having experienced emotional abuse. Conclusions: Both the high prevalence of reporting a history of abuse among men with substance use disorders and the strong association between reporting more mental health symptoms and history of abuse indicate a need for Swedish substance use disorder treatment programs to start using more comprehensive and clinically appropriate trauma assessment tools and to provide empirically supported trauma treatments.

  • 25.
    Lundgren, Lena
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Butler Institute of Families, Graduate School of Social Work, University of Denver, Denver, CO.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Lucero, Nancy M.
    Butler Institute of Families, Graduate School of Social Work, University of Denver, Denver, CO.
    Blom-Nilsson, Marcus
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Nyström, Siv
    National Board of Health and Welfare, Stockholm, Sweden.
    Carver-Roberts, Tabitha
    Butler Institute of Families, Graduate School of Social Work, University of Denver, Denver, CO.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Immigration Status and Substance Use Disorder-related Mortality in Sweden: A National Longitudinal Registry Study2019In: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227, Vol. 13, no 6, p. 483-492Article in journal (Refereed)
    Abstract [en]

    Objectives: First-generation immigrants, in many countries, are healthier than their native counterparts. This study examined the association between first- and second-generation immigrant status and alcohol- or drugs other than alcohol-related (primarily opioids) mortality for those with risky substance use.

    Methods: A Swedish longitudinal, 2003 to 2017, registry study combined Addiction Severity Index (ASI) assessment data with mortality data (n = 15 601). Due to missing data, the analysis sample for this study was 15 012. Multivariate models tested the relationship between immigration status and drugs other than alcohol or alcohol-related mortality, controlling for demographics and the 7 ASI composite scores (CS).

    Results: Age, a higher ASI CS for alcohol, a lower ASI CS family and social relationship, a lower ASI CS for drug use and a higher ASI CS for health significantly predicted mortality because of alcohol-related causes. Higher ASI CS for drugs other than alcohol, employment, and health, age, male sex, and immigration status predicted drugs other than alcohol, related mortality. Individuals born in Nordic countries, excluding Sweden, were 1.76 times more likely to die of drugs other than alcohol compared with their Swedish counterparts. Individuals born outside a Nordic country (most common countries: Iran, Somalia, Iraq, Chile) were 61% less likely to die of drugs other than alcohol compared with their Swedish counterparts. Those with parents born outside Nordic countries were 54% less likely to die of drugs other than alcohol.

    Discussion: Research is needed on why people with risky substance use from Nordic countries (not Sweden) residing in Sweden, have higher mortality rates because of drugs other than alcohol (primarily opioids drugs other than alcohol compared with the other population groups in our study). Findings indicate that ASI CSs are strong predictors of future health problems including mortality due to alcohol and other drug-related causes.

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  • 26.
    Lundgren, Lena
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. University of Denver Graduate School of Social Work, USA.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    McCarty, Dennis
    OHSU-PSU School of Public Health, Oregon Health & Science University, USA.
    Frequency and recency of non-medical opioid use and death due tooverdose or suicide among individuals assessed for risky substance use: Anational registry study in Sweden2022In: Journal of Substance Abuse Treatment, ISSN 0740-5472, E-ISSN 1873-6483, article id 108567Article in journal (Refereed)
    Abstract [en]

    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.

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  • 27.
    Lundgren, Lena
    et al.
    Boston University School of Social Work Center for Addictions Research and Services.
    Wilkey, Catriona
    Boston University School of Social Work Center for Addictions Research and Services.
    Chassler, Deborah
    Boston University School of Social Work Center for Addictions Research and Services.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Armelius, Bengt-Åke
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Armelius, Kerstin
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Brännström, Jan
    Integrating addiction and mental health treatment within a national addiction treatment system: Using multiple statistical methods to analyze client and interviewer assessment of co-occurring mental health problems2014In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, no 1, p. 59-79Article in journal (Refereed)
    Abstract [en]

    AIMS - For a Swedish national sample of 12,833 individuals assessed for a substance use disorder (SUD) (2002-2008) in the Swedish welfare system, client self-report and clinical staff Addiction Severity Index (ASI) assessment data were used to assess mental health problem severity and needs. METHODS - Analysis of client self-report data using regression methods identified demographic characteristics associated with reporting significant mental health problems. Clinical staff assessment data from the ASI Interviewer Severity Rating (ISR) score were used to develop a K-means cluster analysis with three client cluster profiles: Narcotics (n=4795); Alcohol (n=4380); and Alcohol and Psychiatric Problems (n=3658). Chi-square and one-way ANOVA analyses identified self-reported mental health problems for these clusters. RESULTS - 44% of clients had a history of using outpatient mental health treatment, 45% reported current mental health symptoms, and 19% reported significant mental health problems. Women were 1.6 times more likely to report significant mental health problems than men. Staff assessed that 74.8% of clients had current mental health problems and that 13.9% had significant mental health problems. Client and staff results were congruent in identifying that clients in the Alcohol profile were less likely (5%) to report having significant mental health problems compared to the other two profiles (30% each). CONCLUSIONS - About 19% of clients with SUDs reported significant mental health problems, need integrated addiction and mental health treatment, and these clients are clustered in two population groups. An additional 25% of the addiction treatment population report current mental health symptoms and have at some point used mental health treatment. This national level assessment of the extent and severity of co-occurring disorders can inform decisions made regarding policy shifts towards an integrated system and the needs of clients with co-occurring disorders.

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  • 28.
    Nilsson Blom, Marcus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Center for Addictions Research and Services Boston University School of Social Work.
    Chassler, Deborah
    Center for Addictions Research and Services Boston University School of Social Work.
    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 system2014In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, no 2, p. 175-188Article in journal (Refereed)
    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

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  • 29.
    Nilsson Blom, Marcus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Deborah, Chassler
    Arbete som bakgrundsfaktor i underhållsbehandling2014In: popnad.comArticle in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Sannolikheten för individer som arbetar och har ett opiatberoende att medicinera sitt missbruk med ordinerat metadon eller buprenorfin är 19 gånger större än för de utan arbete. Marcus Blom Nilsson, Lena M. Lundgren och Deborah Chassler skriver om bakgrundsfaktorers betydelse i behandling av opiatberoende.

  • 30.
    Padyab, Mojgan
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Armelius, Bengt-Åke
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Armelius, Kerstin
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nyström, Siv
    Department for Knowledge-Based Policy of Social Services, National Board of Health and Welfare, Stockholm, Sweden.
    Blom, Björn
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Gröonlund, Ann-Sofie
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. The Graduate School of Social Work, University of Denver, Denver, Colorado, USA.
    Is Clinical Assessment of Addiction Severity of Individuals with Substance UseDisorder, Using the Addiction Severity Index, A Predictor of Future InpatientMental Health Hospitalization? A Nine-Year Registry Study2018In: Journal of Dual Diagnosis, ISSN 1550-4263, E-ISSN 1550-4271, Vol. 14, no 3, p. 187-191Article in journal (Refereed)
    Abstract [en]

    Objective: In Sweden, the Addiction Severity Index (ASI) is the Swedish National Board of Health and Welfare's recommended substance use disorder assessment tool and used routinely for patient intakes. Our study of 213 individuals assessed for substance use disorder with the ASI used nine years of the National Patient Register and examined whether clinical social workers' assessments of addiction severity at baseline were associated with later hospitalizations for mental health disorder (MHD). 

    Methods: ASI composite scores and interviewer severity rating were used to measure clients' problems in seven areas (mental health, family and social relationships, employment, alcohol, drug use, health, and legal) at baseline. A stepwise regression method was used to assess the relative importance of ASI composite scores, MHD hospitalization two years prior to baseline, age, and gender for MHD hospitalization seven years post-baseline. 

    Results: Almost two-thirds of the individuals (63%) were hospitalized at least once for MHD in the seven years post-baseline. At the multivariable level, MHD hospitalization prior to baseline was the strongest predictor of future MHD hospitalization, followed by ASI composite scores for drug use, employment, mental health and, last, male gender. Conclusions: A key finding is that higher ASI composite scores for drug use and mental health are predictors of future need for MHD treatment. Future studies will replicate this effort with a national population of individuals with substance use disorder.

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  • 31.
    Padyab, Mojgan
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ghazinour, Mehdi
    Umeå University, Faculty of Social Sciences, Police Education Unit at Umeå University.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. Graduate School of Social Work, University of Denver, Denver, USA.
    Unaccompanied minors and court mandated institutional care: A national registry-based study in Sweden2020In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 109, article id 104698Article in journal (Refereed)
    Abstract [en]

    Background: Sweden received, in 2016, 40% of EUs asylum seeking unaccompanied minors (UAM) (individuals less than 18 years of age). Some of these youth end up in a court mandated compulsory-care institution within months upon their arrival. A key concern is the appropriateness of UAMs ending up in an institutional care system which is aimed at youth with significant criminal justice, violence and/or drug problems. A second concern is that UAMs in compulsory care may display behavioral and acting out behaviors while in care due to their history of trauma and confusion regarding being institutionalized. The research question examined is whether UAMs in compulsory care receive more restrictive actions by compulsory care staff compared to their counterparts who are non-UAMs.

    Materials and methods: The research team used national compulsory-care registry data from 2014-2016 to compare a range of restrictive actions taken by institution staff between UAMs versus non-UAMs while in care. Differences in the rate of compulsory care restrictive actions reported between UAMs and non-UAMs, while in care, were examined using chi-square test and Poisson regression methods.

    Results: A total of 2398 children and youth were placed in compulsory institutional care during the study period, of whom 423 (17.5%) were unaccompanied. The Poisson regression model identified that being subjected to body search, limited body inspection, drug use testing, and care in locked unit were used significantly less often for UAMs individuals compared to non-AUMs. In addition, repeated number of intakes in compulsory care and number of dropouts were lower among UAMs during this time period.

    Conclusion: The finding of this national registry study revealed that restrictive actions by institutional staff within compulsory care were significantly less common for UAMs versus non-UAMs. This study roughly suggests that the Swedish policy makers overseeing NSBIC need to consider and evaluate other care alternatives for UAMs, in addition to youth compulsory institutional care.

  • 32.
    Padyab, Mojgan
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Grahn, Robert
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    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.
    Drop-out from the Swedish addiction compulsory care system2015In: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, p. 178-184Article in journal (Refereed)
    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. 

  • 33.
    Sandlund, Mikael
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Missbruk och missbruksvård2023In: Effektiv insatsplanering: vid svår substansanvändning / [ed] Lena Lundgren, Lund: Studentlitteratur AB, 2023, p. 29-41Chapter in book (Other academic)
  • 34.
    Scarpa, Simone
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Grahn, Robert
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. University of Denver, Denver, CO, United States.
    Compulsory care of individuals with severe substance use disorders and alcohol- and drug-related mortality: a Swedish registry study2023In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 14, article id 1106509Article in journal (Refereed)
    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.

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  • 35.
    Scarpa, Simone
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Grahn, Robert
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Nyström, Siv
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. University of Denver, USA.
    Hur fungerade kursen Effektiv Planering av Insatser/EPI: Baslinje- och uppföljningsresultat2023In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 100, no 5, p. 655-665Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    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.

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  • 36.
    Scarpa, Simone
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. Cross-National Behavioral Health Laboratory, University of Denver, Denver, USA; Graduate School of Social Work, University of Denver,Denver, USA.
    Modeste-James, Akeem
    Cross-National Behavioral Health Laboratory, University of Denver, Denver, USA; Graduate School of Social Work, University of Denver,Denver, USA.
    John-Langba, Johannes
    School of Applied Human Sciences, University of KwaZulu-Natal, Howard College, Durban, South Africa.
    Immigrant background, incarceration history and recidivism among adults assessed for illicit substance use severity: findings from a Swedish registry study2024In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 128, article id 104432Article in journal (Refereed)
    Abstract [en]

    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.

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  • 37.
    Trocchio, Sarah
    et al.
    Center for Addictions Research and Services , Boston University School of Social Work, Boston, Massachusetts, USA.
    Chassler, Deborah
    Center for Addictions Research and Services , Boston University School of Social Work, Boston, Massachusetts, USA.
    Storbjörk, Jessica
    Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm.
    DeLucchi, Kevin
    Department of Psychiatry, University of California–San Francisco, San Francisco, California, USA.
    Witbrodt, Jane
    Alcohol Research Group, Emeryville, California, USA and Department of Public Health Sciences, Karolinska Institutet, Stockholm.
    Lundgren, Lena
    Center for Addictions Research and Services , Boston University School of Social Work, Boston, Massachusetts, USA.
    The association between self-reported mental health status and alcohol and drug abstinence 5 years post-assessment for an addiction disorder in US and Swedish samples2013In: Journal of Addictive Diseases, ISSN 1055-0887, E-ISSN 1545-0848, Vol. 32, no 2, p. 180-193Article in journal (Refereed)
    Abstract [en]

    This study compared whether self-reported mental health status was associated with likelihood of being abstinent from alcohol and drugs five years after baseline assessment for an addiction disorder in two representative samples; one from Sweden (n = 469) and one from the US (n = 667). Self-reported mental health status was measured through the ASI score of mental health symptoms and history of inpatient and/or outpatient treatment. Through logistic regression modeling the study controlled for demographic characteristics including age, gender, employment status and social network connection with individuals who do not use alcohol/drugs. For both the US and Swedish samples employment status and having a social network that does not use alcohol and drugs were associated with being likely to be abstinent from alcohol and drugs five years after initial assessment. For the US sample only, individuals who reported symptoms of anxiety were 50% more likely not to be abstinent from alcohol and drugs at follow-up. For the Swedish sample, current mental health status was not significantly associated with abstinence. However, reporting a lifetime history of inpatient psychiatric treatment at the baseline assessment was significantly associated with not being abstinent at 5 years post assessment; those with a lifetime history of inpatient mental health treatment were 47% less likely to report abstinence. While specific variables differ across Sweden and the US, psychiatric comorbid status, employment and social network are each associated with drug and alcohol abstinence cross-nationally.

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