رها کردن از سیستم مراقبت اجباری اعتیاد به مواد سوئدی

Drop-out of addiction treatment is common, however, little is known about drop-out of compulsory care in Sweden. Data from two national register databases were merged to create a database of 4515 individuals sentenced to compulsory care 2001–2009. The study examined (1) characteristics associated with having dropped out from a first compulsory care episode, (2) the relationship between drop-out and returning to compulsory care through a new court sentence, and (3) the relationship between drop-out and mortality. Methods Multivariable logistic regression analysis was used to address Aim 1 and Cox proportional hazards regression modeling was applied to respond to Aims 2 and 3. Findings Age and previous history of crime were significant predictors for drop-out. Clients who dropped out were 1.67 times more likely to return to compulsory care and the hazard of dying was 16% higher than for those who dropped-out. Conclusion This study finds that 59% of clients assigned to compulsory care drop-out. Younger individuals are significantly more likely to drop-out. Those who drop out are significantly more likely to experience negative outcomes (additional sentence to compulsory care and higher risk of mortality). Interventions need to be implemented that increase motivation of youth to remain in compulsory care.

Legislation to reduce substance misuse problems has been created in numerous countries since the early 20th century. The laws on compulsory commitment to care are applied to individuals who are by law mandated to enter and remain in such care. A survey of 38 European countries showed that 74% of these countries have a law concerning compulsory care (Israelsson, 2011). In Sweden in 1916, the first law on compulsory care for alcohol abusers was enacted and with some modifications, it is still in place (Edman, 2005). There are so-called special indicators that in addition to a high level of substance abuse make individuals eligible for compulsory institutional care including being a danger to other people or themselves, a failure to meet their familial obligations, being an economic burden to family or society, being a vagrant or otherwise getting into trouble, or having extensive drinking arrests (Edman, 2005). It took years until the recognition of laws on compulsory care which was historically based on social sanction was translated to laws on treatment. From the 1960s onwards, the role of treatment (medical as well as psychological or social therapy) was stronger in public discussions on social care with international recognition of alcohol and drug dependence syndromes as disease and its inclusion in the ninth version of International Classification of Diseases and Causes of Death (ICD-9) in 1976 (Edwards et al., 1977). In Sweden when individuals are initially entering the compulsory care system, care workers aim to motivate each individual to enter voluntary treatment, while still being under the laws of compulsory care. As individuals move into to the actual addiction treatment system, drop out from treatment is relatively common. Individuals who dropout are not permitted to return to their homes, instead they are returned back to compulsory care. This study presented here is one of the first exploring client level factors associated with drop-out from the Swedish compulsory care system. Second, the study identifies if compulsory care drop-out is associated with repeated compulsory care sentencing and with higher rates of mortality.