Repeated Addiction Treatment use in Sweden: A National Register Database Study

Abstract

Sweden has a free, universal addiction treatment system, yet few studies exist 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 predisposing factors such as 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 illicit drug use, more compulsory addiction treatment episodes, a lower ASI legal score, and a history of criminal justice involvement were all associated with more voluntary addiction treatment episodes compared to their counterparts.. There were no differences in the 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.

Keywords :

• addiction treatment
• treatment repeaters
• substance use disorder
• compulsory treatment
• Sweden
• chronic care model

THE AUTHORS

Robert Grahn, Ph.D student, is a doctoral student in Social Work at the Department of Social Work at Umea University in Sweden. His research interests are mainly addiction treatment research in the field of social work.

Deborah Chassler, MSW, is a Senior Academic Researcher and Associate Director of the Center for Addictions Research and Services at Boston University School of Social Work (BUSSW). Her current research interests include health services and addiction treatment utilization, access to treatment, and health care inequities. She teaches graduate-level courses at BUSSW and at the BU General Medical Sciences program.

Lena Lundgren, Ph.D., is a Professor of Welfare Policy, Director of Research, and Director of the Center for Addictions Research and Services at Boston University School of Social Work (BUSSW). She conducts large-scale quantitative research efforts on the relationship between injection drug use, substance abuse treatment utilization, and the spread of HIV. Her current research focus is on health disparities, with a particular emphasis on access to substance abuse treatment.