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 System

Abstract

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.

RÉSUMÉ

Des données d'entrevues en personne avec 13,903 personnes évaluées pour une dépendance à la drogue ou à l'alcool dans le système suédois de protection sociale, 2002–2008, a été analysé en utilisant des méthodes de régression logistique. Conclusions: les immigrés de deuxième génération de parents non-scandinaves étaient de 41% plus enclins à déclarer avoir eu des traitements obligatoires que les personnes nées en Suède de parents suédois, en prenant compte de l’âge, du sexe, de l’éducation, des antécédents de traitement en santé mentale et du passé judiciaire. Ces résultats soulignent la nécessité d’étudier les facteurs liés à l'acculturation, à la stigmatisation et à la discrimination ainsi que de promouvoir des activités culturellement compétentes auprès des populations immigrées. L’étude a été financée en partie de Conseil suédois pour la vie de travail et de recherches sociales.

RESUMEN

Los datos de entrevistas en persona de 13,903 individuos evaluados por un trastorno de adicción en el sistema de bienestar sueco, desde 2002 hasta 2008, se analizaron utilizando métodos de regresión logística. Resultados: Los inmigrantes de generación segunda con padres no escandinavos eran 41% más propensos a reportar una historia de tratamiento obligatorio en comparación con los nacidos en Suecia de padres suecos después de controlar por edad, sexo, educación, historia de tratamiento de salud mental, y participación en el sistema de justicia criminal. Consecuencias incluyen la necesidad de estudiar los factores de aculturación, el estigma y la discriminación, así como para promover competencia cultural en los alcances de comunidad a las poblaciones inmigrantes. El estudio fue financiado en parte por el Consejo Sueco para la Vida Laboral e Investigaciones Sociales.

Keywords :

• immigration
• addiction
• drug use disorders
• health disparities
• compulsory treatment
• Sweden

THE AUTHORS

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.

Jan Brännström, MSW, is the Coordinator of the Research & Development Unit on Addiction and Addiction Treatment, Umeå Social Services, Sweden. He conducts research on the implementation and use of the Addiction Severity Index in Sweden, and on addiction treatment effectiveness.

Bengt-Åke Armelius, Ph.D., is a Professor of Clinical Psychology at Umeå University. His recent research interests center around addiction with focus on identifying subgroups, treatment evaluation, and development of research tools for clinical use.

Deborah Chassler, MSW, is a Senior Academic Researcher and Associate Director of the Center for Addictions Research and Services at BUSSW. Her current research interests include the implementation of evidence-based practices in community-based organizations and health services utilization among vulnerable populations. She teaches graduate level social work courses at BUSSW including “Social Research Methods” and “Racial Justice and Cultural Oppression.”

Stefan Morén, Ph.D., is a Professor of Social Work at the Department of Social Work at Umeå University in Sweden. His research interests are mainly intervention research as well as evaluation and organizational studies in social work.

Sarah Trocchio, MSW, is a Research Assistant at the Center for Addictions Research and Services at BUSSW. Prior to coming to Boston University, Ms. Trocchio worked at the Department and Children and Families as a Bilingual Social Worker. Her research interests include immigration and acculturation, criminal justice policies, comparative international social policy, and the sociology of law.

Notes

1 Currently, a small number of individuals who are primarily older native-born Swedes enter compulsory treatment for alcohol dependence (Armelius & Armelius, 2011; Armelius et al., 2009). However, this group of alcohol-dependent individuals represents an increasingly smaller share of the compulsory treatment population in Sweden, as a growing proportion of treatment users are now individuals with narcotics addictions (Armelius & Armelius, 2011; Svensson & Hagquist, 2010; Swedish National Institute of Public Health, 2000). For these reasons, our study focused only on compulsory treatment for narcotics use.