Mental Health, Substance Use, and Criminal Justice Characteristics of Males With a History of Abuse in a Swedish National Sample

Abstract

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 13 times 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 8 times higher likelihood of having experienced physical abuse,14 times higher likelihood of having experienced sexual abuse, and 13 times 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.

Keywords:

• self-reported mental health symptoms
• men
• substance abuse disorders
• history as victims of abuse
• Sweden
• national study

ACKNOWLEDGMENTS

This study was funded in part through a guest professorship for Dr. Lena Lundgren to Umeå University, Department of Social Work from the Swedish Council for Working Life and Social Research. We also want to acknowledge the generosity of Bengt-Åke Armelius and the Swedish county governments in granting access to their ASI interview data. Results from this paper were presented in October 2012 at the World Psychiatric Association International Congress in Prague, Czech Republic. Thanks to Meredith Munn for her editorial assistance on the reference list.

Notes

1. To assess the impact of missing cases on the dependent variables, for each independent variable that was missing cases, data were compared to complete case data for each of the four dependent variables. No significant differences were found. In addition, means were imputed for all independent variables with missing data and the multivariate analyses were rerun using the imputed means variables. The analyses were essentially the same as the complete cases analysis: The variables that were significant remained significant and directionality of findings was consistent with the complete cases analysis.