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  • 1.
    Blom, Björn
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. 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 example2015Ingår i: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, s. 185-191Artikel i tidskrift (Refereegranskat)
    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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. 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 addicts2015Ingår i: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, s. 172-177Artikel i tidskrift (Refereegranskat)
    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.
    Grahn, Robert
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Repeated addiction treatment use and compulsory care 2001-20092014Ingår i: Institutionsvård i fokus: uppföljningar och registerstudier av klienter i LVM-vård, 2014Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 4.
    Grahn, Robert
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Chassler, Deborah
    Boston University.
    Lundgren, Lena
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Repeated addiction treatment use in Sweden: a national register data base study2013Konferensbidrag (Övrigt vetenskapligt)
    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.

  • 5.
    Grahn, Robert
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    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 study2014Ingår i: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 49, nr 13, s. 1764-1773Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Grahn, Robert
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lundgren, Lena
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. 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 universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Repeated entries to the Swedish addiction compulsory care system: A national register database study2015Ingår i: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, s. 163-171Artikel i tidskrift (Refereegranskat)
    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. 

  • 7.
    Grahn, Robert
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Padyab, Mojgan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lundgren, Lena
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    The Importance of Risky Psychosocial Childhood for Repeated Addiction Compulsory Care as AdultManuskript (preprint) (Övrigt vetenskapligt)
  • 8.
    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 study2013Ingår i: Journal of Substance Abuse Treatment, ISSN 0740-5472, E-ISSN 1873-6483, Vol. 45, nr 5, s. 457-465Artikel i tidskrift (Refereegranskat)
    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.

  • 9.
    Lundgren, Lena
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Center for Addictions Research and Services, Boston University School of Social Work, 264 Bay State Road, Boston, MA, 02215 USA.
    Blom, Björn
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    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 implications2015Ingår i: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, s. 149-152Artikel i tidskrift (Övrigt vetenskapligt)
  • 10.
    Lundgren, Lena
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Brännström, Jan
    Armelius, Bengt-Åke
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Chassler, Deborah
    Morén, Stefan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    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 system2012Ingår i: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 47, nr 1, s. 67-77Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    Lundgren, Lena M
    et al.
    Center for Addictions Research and Services, Boston University School of Social Work, Boston, MA., USA.
    Armelius, Bengt-Åke
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Armelius, Kerstin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    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 missbruksvård2012Ingår i: Socialvetenskaplig tidskrift, ISSN 1104-1420, Vol. 19, nr 3/4, s. 200-216Artikel i tidskrift (Refereegranskat)
    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.

  • 12.
    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 universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Mental Health, Substance Use, and Criminal Justice Characteristics of Males With a History of Abuse in a Swedish National Sample2013Ingår i: Journal of Dual Dignosis, ISSN 1550-4263 (Print), 1550-4271 (Online), Vol. 9, nr 1, s. 47-60Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Lundgren, Lena
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Butler Institute of Families, Graduate School of Social Work, University of Denver, Denver, CO.
    Padyab, Mojgan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Lucero, Nancy M.
    Butler Institute of Families, Graduate School of Social Work, University of Denver, Denver, CO.
    Blom-Nilsson, Marcus
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    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 universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Immigration Status and Substance Use Disorder-related Mortality in Sweden2019Ingår i: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227Artikel i tidskrift (Refereegranskat)
    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.

  • 14.
    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 universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Armelius, Bengt-Åke
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Armelius, Kerstin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    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 problems2014Ingår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, nr 1, s. 59-79Artikel i tidskrift (Refereegranskat)
    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.

  • 15.
    Nilsson Blom, Marcus
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    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 system2014Ingår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, nr 2, s. 175-188Artikel i tidskrift (Refereegranskat)
    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

  • 16.
    Nilsson Blom, Marcus
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lundgren, Lena
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Deborah, Chassler
    Arbete som bakgrundsfaktor i underhållsbehandling2014Ingår i: popnad.comArtikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    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.

  • 17.
    Padyab, Mojgan
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Armelius, Bengt-Åke
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Armelius, Kerstin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nyström, Siv
    Department for Knowledge-Based Policy of Social Services, National Board of Health and Welfare, Stockholm, Sweden.
    Blom, Björn
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Gröonlund, Ann-Sofie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lundgren, Lena
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. 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 Study2018Ingår i: Journal of dual diagnosis, ISSN 1550-4263, Vol. 14, nr 3, s. 187-191Artikel i tidskrift (Refereegranskat)
    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.

  • 18.
    Padyab, Mojgan
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Grahn, Robert
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lundgren, Lena
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. 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 system2015Ingår i: Evaluation and Program Planning, ISSN 0149-7189, E-ISSN 1873-7870, Vol. 49, s. 178-184Artikel i tidskrift (Refereegranskat)
    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. 

  • 19.
    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 samples2013Ingår i: Journal of Addictive Diseases, ISSN 1055-0887, E-ISSN 1545-0848, Vol. 32, nr 2, s. 180-193Artikel i tidskrift (Refereegranskat)
    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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