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The importance of risky psychosocial childhood for repeated addiction compulsory care as adult
Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
(engelsk)Manuskript (preprint) (Annet vitenskapelig)
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.

Emneord [en]
Compulsory Care, Substance Use Disorder, Sweden, Psychosocial Childhood
HSV kategori
Identifikatorer
URN: urn:nbn:se:umu:diva-141603OAI: oai:DiVA.org:umu-141603DiVA, id: diva2:1155724
Tilgjengelig fra: 2017-11-09 Laget: 2017-11-09 Sist oppdatert: 2022-12-29
Inngår i avhandling
1. Treatment repeaters: re-entry in care for clients with substance use disorder within the Swedish addiction treatment system
Åpne denne publikasjonen i ny fane eller vindu >>Treatment repeaters: re-entry in care for clients with substance use disorder within the Swedish addiction treatment system
2017 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

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

sted, utgiver, år, opplag, sider
Umeå: Umeå universitet, 2017. s. 62
Serie
Studier i socialt arbete vid Umeå universitet : avhandlings- och skriftserie, ISSN 0283-300X ; 86
Emneord
addiction treatment, treatment repeaters, substance use disorder, compulsory care, register database study, Sweden, chronic condition, drop-out, continuing care, bio-psycho-social
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-141601 (URN)978-91-7601-796-8 (ISBN)
Disputas
2017-12-01, Hörsal A, Samhällsvetarhuset, Umeå, 10:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2017-11-10 Laget: 2017-11-09 Sist oppdatert: 2018-06-09bibliografisk kontrollert

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