Umeå University's logo

Aims: This study examined the association between educational attainment and the risk of deaths of despair among individuals assessed for substance use severity at municipal social services in Sweden. It aimed to determine whether the protective association between education and despair-related mortality risk, commonly observed in broader population studies, also applies to this high-risk, treatment-seeking population.

Methods: We linked data from municipal Addiction Severity Index (ASI) assessments to various population registers. The study population included adults aged 25 years or older who were assessed for substance use severity between 1999 and 2019. Fine–Gray competing risk regression models were employed to examine the association between educational attainment and despair-related mortality, both overall and by subtype (alcohol-related, drug use-related, suicide).

Results: Tertiary education was unexpectedly associated with increased risks of overall despair-related mortality, alcohol-related and drug use-related mortality, after controlling for demographic characteristics, ASI composite scores and substance use onset age. No significant associations were found between education and suicide.

Conclusions: The counterintuitive finding that tertiary education is linked to a greater risk of despair-related mortality among social service users may be attributed to differences between the treatment-seeking population and the general population. Highly educated individuals who seek treatment from municipal social services might have severe substance use and complex psychosocial problems and/or contact social services after exhausting other treatment options. Further research is necessary to understand how educational and socioeconomic factors influence treatment pathways for individuals with severe substance use problems in Sweden and how these different pathways impact health-related outcomes.

Bakground: Growing educational disparities in mortality due to suicide, drug overdose, or alcohol-related liver disease – or “deaths of despair” (DoD) – have received increased attention in research and public debate. However, no study has investigated educational differences in despair-related mortality outside of North America. Thus, the aim this study was to investigate changes in the association between academic achievement in compulsory school and subsequent all-cause mortality (ACM) and DoD between 1990 and 2018 in Swedish youths.

Data and methods: Register data on all students graduating from compulsory school in Sweden between 1990 and 2010 were used (N = 2 252 938). Students were followed for a maximum of 8 years using discrete time proportional hazard models. Academic achievement was measured by grades at the end of compulsory school.

Results: ACM declined for medium/high achieving but not for low-achieving youths, while DoD increased slightly for medium/high achieving and markedly for low-achieving youths, resulting in growing achievement-related disparities in both types of mortality. The trends were primarily driven by native-born youth and girls.

Conclusions: The trends in Swedish youths resemble the trends in the American working-age population, but partly contrasts with corresponding trends in other European countries. Future research should investigate if the underlying causes that have been emphasized in the American context – socio-economic transformations and a greater supply of drugs – have also contributed to the Swedish trends.

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.

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.

The ongoing debate on Swedish municipal housing’s universalist characteristics has focused on declining supply, stricter access criteria, and changing tenant demographics. This study addresses a research gap by examining how Swedish municipal housing queues, prioritizing apartment allocation by registration duration, influence tenant selection. Using a unique dataset from Bostaden, Umeå’s municipal housing company, linked to register data, the study investigates factors influencing housing queue accumulation and usage, with a focus on immigrant background. It further analyses how immigrant background affects the timing of exiting the housing queue to secure apartments. Furthermore, the study explores how the immigrant background of individuals obtaining queue-assigned apartments influences neighbourhood demographics. The findings highlight the substantial challenges faced by immigrants, particularly those from the Global South, in terms of housing queue accumulation, utilization, and neighbourhood attainment. These insights reveal how housing queues, as seniority-based rationing mechanisms, contribute to the perpetuation of housing and socio-spatial inequalities in Swedish cities.

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.

Denna kvantitativa studie utvärderar kunskapsförändringar hos deltagare i EPI universitetskursen. Majoriteten av deltagarna var socialsekreterare inom miss-bruksområdet. Kursen resulterade i betydande förbättringar av deltagarnas kunskap, särskilt vad gäller insats- och vårdkontinuitetsmodeller samt använd-ning av motivationshöjande intervjutekniker. Kunskapen om äldre personer med beroendeproblem och fördelarna med ASI-uppföljningar för socialarbe-tare och klienter förbättrades också.

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.

Until recently, comparative social policy research remained strongly influenced by methodological nationalism (i.e. an approach equating social boundaries with state boundaries) and has rarely considered immigration-driven changes in welfare states. Yet, over the past decades, immigrant populations have grown in size and become increasingly diversified, both in terms of origin countries and in terms of integration patterns, in all Western countries. Immigrants are a more visible but also contested presence in Western societies, which affects also the development of national labour market and welfare systems. The chapter focuses on the link between immigration-driven ethnic diversity and welfare state development by considering four interrelated issues: (1) how the patterns of immigrants' labour market incorporation in host societies affect the social rights they are entitled to; (2) how increasing international migration contributed to the reconfiguration of care arrangements; (3) the implications of immigration-driven multiculturalism for welfare state sustainability; and (4) the connection between immigration and public support for the welfare state. Then, we narrow down our analysis by providing a more detailed account of recent development of migration policies in some European countries. Based on the analysis of the country cases, we put forth the argument that recent institutional developments point to an 'Americanization' of European migration policy and, therefore, to an increasing 'racialization' of European welfare states.

Previous research has predominantly analysed the retrenchment of the Swedish welfarestate from a long-term perspective, examining restructuring processes from thefinancial crisis of the early 1990s until recent years. This study instead takes a shorttermperspective and focuses on welfare state developments in the post-consolidationphase, after the recovery from the crisis. The aim is to investigate how the fiscalpolicy reforms introduced during the recovery years forced subsequent governmentsto continue on the path of “frugality”. Specifically, the paper focuses on the effectsof austerity politics on two policy domains: income redistribution through the benefitand tax system and the municipalities’ role as social service providers and employers.The analysis indicates that the Swedish model is showing increasing signs ofdualisation due to the gradual segmentation of prior universalistic welfare programmesand to the worsening of working conditions in the social service sector.

The aim of this chapter is to challenge an axiomatic assumption made in current public debates – namely, that the sustainability of the welfare state in an age of globalisation requires the imposition of limits on immigration. With a particular focus on Sweden and recent changes in Swedish welfare policy, the chapter shows how the current crisis of the Swedish welfare model has, in fact, haunted this model for decades. The argument presented is that the socially integrative capacities of the Swedish model had been compromised well beforethe start of the post-2015 refugee crisis in Europe but that it is not the scale of immigration that made the Swedish welfare state unsustainable. Rather, it is the austerity-driven retrenchment of the Swedish welfare state which, in the past quarter of a century, has steadily undermined the capacity of the welfare model to offer emancipatory and non-discriminatory pathways of incorporation to immigrants. With the neoliberal reforms implemented since the early 1990s, the current reality in Sweden is that of deepening, and increasingly ethnically tinged, class divisions and the long-term social exclusion of sizeable population groups from substantial citizenship rights.