Embed Size (px)
DESCRIPTION
- PowerPoint PPT Presentation
Citation preview
Association Between Immigrant Status and History of Compulsory Drug Treatment in a National Sample of
Individuals Assessed for Drug Use Disorders Through the Swedish Public Welfare System
Lena Lundgren, Jan Brännström, Bengt-Åke Armelius, Deborah Chassler, Stefan Moren and Sarah Trocchio
Published in: Substance Use & Misuse, 47:67–77, 2012
Presentation Prepared by Sarah Trocchio, MSW & Ivy Krull, MSW, MPH
1
Background: Increasing Ethnic and Cultural Diversity in Sweden
2
Background: Compulsory Drug Treatment in Sweden
The compulsory treatment law (LVM) is civil in nature and does not include a punitive component .
Steps to enter compulsory treatment:
1. Individual brought into Immediate custody (danger to themselves or others due to substance abuse)
2. Assessment of need by social welfare agency-social worker3. Mandated to enter treatment if agency determines need
Nearly 80 % of individuals brought into custody were mandated to go into treatment in 2008 (Gerdner & Berglund, 2011)
Average length of treatment = 141 days (Gerdner & Berglund, 2011)
3
Background: studies on Compulsory Treatment Users Compared to Voluntary Treatment Users
4
Background: Drug Use and Treatment Disparities Research in the U.S.
U.S. Research Findings: Immigrants and refugees utilize drug use disorder services less than native-
born populations (McLean-Leow, Goldstein,& McGlinchy, 2006).
Racial and ethnic minorities experience more difficulties in obtaining the most appropriate treatment services, are more vulnerable to gaps in service, and may encounter bias in treatment assignments (National Institute on Drug Abuse, 2003).
Use of compulsory treatment can be understood as ineffective use (or non-use) of voluntary treatment
Using a health disparities lens:
5
Research Question:
6
Exploratory, cross-sectional study
Methods: database
In Sweden, nearly half of all counties use the ASI (McLellan et al., 1992) to collect baseline data on individuals with drug use disorders This data is entered into a national database, which includes data
spanning from 2002- present
In 2009, Armelius et al (2009) used the Swedish ASI data to create a nationally representative, individual level database for research purposes
7
Methods: Sample Description
Study sample was 13,309 adults in the Swedish welfare system who had been assessed for a drug use disorder (Lundgren et al., 2012)
69.1 % were males, 69.0 % were native born Swedes, and the mean age was 40.1 years (Lundgren et al, 2012 )
A substantial number of the sample had a history of mental health treatment Nearly half (44 %) had a history of outpatient psychiatric treatment Almost a quarter (23 %) had been in inpatient psychiatric treatment
15 % reported a history of compulsory treatment for narcotics
8
Methods: Independent Variables
Demographic Characteristics (age, gender, education)
Psychiatric Treatment History Criminal Justice Status Housing Status Immigrant status (one five category variable):
o Individual and their parents born in Swedeno Individual born in either Norway, Denmark, or Finland o Individual born outside of Sweden, Norway, Denmark, and
Finland o Individual born in Sweden and at least one parent born in
Norway, Denmark, or Finland o Individual born in Sweden and at least one parent born outside
Sweden, Norway, Denmark, and Finland
9
Methods: Dependent Variable
10
Data analysis
Bivariate statistical analyses
Binomial logistic regression methods where all variables significant at the bi-variate level were entered as a single block.
11
Results: Bivariate Analyses
12
Table 1: Descriptive and Bivariate statistics
Independent variables
History of compulsory drug treatment
% or Mean (SD)
Never had compulsory drug treatment
% or Mean (SD)
Age*** (Mean = 40.1, SD =12.8)) 35.1 (10.3) 41.0 (13.0)Gender**
Male (69.1%) 16.0 84.0Female (30.9%) 14.0 86.0
Number of years of education*** (Mean = 10.9, SD = 2.9)) 10.0 (2.1) 11.1 (2.9)Ever received medications for psychological or emotional problems***
Yes (13.2%) 7.2 92.8No (86.8%) 16.6 83.4
Ever been in inpatient treatment for psychiatric problems*** Yes (23.4%) 19.2 80.8No (76.6%) 14.2 85.8
Ever been in outpatient treatment for psychiatric problems* Yes (43.9%) 14.6 85.4No (56.1%) 16.0 84.0
Currently on parole or probation*** Yes (12.8%) 31.5 68.5No (87.2%) 13.0 87.0
Number of drug related crimes*** (Mean = 1.6, SD = 5.3)) 5.0 (9.1) 1.0 (3.9)Homeless status***
Yes (8.2%) 29.9 70.1No (91.8%) 14.1 85.9
Immigration status*** (one five category variable) Individual and their parents born in Sweden (69.0%) 14.4 85.6Individual born in either Norway, Denmark, or Finland (6.0) 9.8 90.2Individual born outside of Sweden, Norway, Denmark and Finland (10.0%) 17.1 82.9Individual born in Sweden and at least one parent born in Norway, Denmark or Finland (no other country outside Sweden) (8.0%) 17.8
82.2
Individual born in Sweden and at least one parent born outside Sweden, Norway, Denmark and Finland (7.0%)
23.6 76.4
*p<.05 **p<.01 ***p<.001
Results: Multivariate Analyses
13
Multivariate Results: Significant results
Respondents with higher levels of education were 12 % less likely to report a CT history
Those with a history of inpatient psychiatric mental health treatment were 57 % more likely to report a CT history
Individuals with a history of criminal drug charges were 12 % more likely to report a CT history
Respondents on parole or probation were 70 % more likely to report a CT history
Those that were homeless were 88 % more likely to report
a CT history Individuals who had ever received medication for psychiatric
problems were 64 % less likely to report a CT history
14
Multivariate Results: Immigrant Status and Compulsory Treatment
No significant association between first generation immigrant status and likelihood of reporting a history of compulsory drug treatment for narcotics
Non- Nordic second generation immigrants were 41 % more likely than Swedes with Swedish parents to report having a history of compulsory treatment for drug use after controlling for age, gender, education, history of inpatient and outpatient mental health treatment, history of receiving medications for psychiatric problems, number of times charged with a drug related crime, homeless status, and being on parole
15
Discussion:
Since treatment is provided free of charge, lack of ability to pay does not explain disparate rates of compulsory drug treatment use
Acculturation and Assimilation studies may provide one explanatory lens for these discrepancies; Acculturation research has found that substance abuse
increases as acculturation increases (Gil, Wagner & Vega, 2000; Hahm,Lahiff, & Gutterman,2003, 2004; Ortega,Rosenheck, Alegria, & Desai, 2000)
Also, some studies suggest that some second generation immigrant groups are more likely to assimilate into structurally disadvantaged groups. (Portes and Zhou, 1993; Portes and Rambaut, 2005)
16
Additional theories;
Stigma: Cultural stigma may prevent certain ethnic/cultural groups from
seeking help for their drug use disorders voluntarily (Bhattacharya, 2002; Abe-Kim et al., 2006; Le Myer, Zane, Cho & Takeuchi, 2009)
Unintentional Discrimination: Vyn Ryn and Fu (2003) found that providers’ stereotypes about help
seekers influence practice decisions Providers’ view of help seekers therefore can lead to discrimination and
perpetuate health disparities (Vyn Ryn & Fu, 2003)
17
Policy and Practice Implications Culturally competent and specific outreach and drug
disorder treatment should be promoted through Sweden
Practitioners who complete ASI assessments for drug use disorders should be trained in conducting assessments with culturally diverse populations
More research is needed exploring the role of acculturation, stigma and discrimination on patterns of addiction treatment use.
18
Limitations
19
References Armelius, B-Å. & Armelius, K. (2011). En naturalistisk studie av 14000 svenska missbruksklienter
baserad på Addiction Severity Index, ASI. In Missbruket, Kunskapen, Vården. Missbruksutredningens forskningsbilaga. SOU 2011:6, Chapter 6,
Armelius, B-Å., Nyström, S., Engström C. & Brännström, J. (2009) Referensmaterial för bättre använding av ASI intervjun. The Institute for the development of methodology in social work. Socialstyrelsen (National Board of Health and Welfare). Stockholm Sweden.
Gerdner, A (2004). LVM-vårdens genomförande, utfall och effekt - En kontrollerad registerstudie i Jämtland. I: Forskningsrapporter, Bilagedel till LVM-utredningens betänkande "Tvång och förändring", SOU 2004:3, Socialdepartementet, s. 415-476.
Gerdner, A. & Berglund, M. (2011). Tvångsvård vid missbruk – effekt och kvalitet. In: Missbruket, kunskapen, vården. Missbruksutredningens forskningsbilaga SOU 2011:6, s. 653-770.
Gil, A. G., Wagner, E. F. & Vega, W. A. (2000). Acculturation, familism and alcohol use among Latino adolescent males: Longitudinal relations. Journal of Community Psychology ,28(4), 443-458.
Hahm, H. C., Lahiff, M., & Guterman, N. (2004). Asian American adolescents’ acculturation, binge drinking, and alcohol and tobacco using peers. Journal of Community Psychology, 32(3), 295-308.
Hahm, H. C, Lahiff, M., & Guterman, N. B. (2003). Acculturation and parental attachment in Asian American adolescents’ alcohol use. Journal of Adolescent Health, 33, 119-129.
McLellan, A.T., Kushner H., Metzger, D., Peters, R., Smith, I., Grissom, G., Pettinati, H., & Argeriou, M. (1992). The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9, 199-213.
20
References: Continued McLean Leow, D., Goldstein, M. & McGlinchy, L. (2006). A selective literature review:
Immigration, acculturation & substance abuse. Newton, MA: Education Development Center, Inc. National Institute on Drug Abuse (NIDA) (2003). Drug use among racial/ethnic minorities. Rockville:
Maryland. Ortega, A. N., Rosenheck, R., Alegria, M., & Desai, R. A. (2000). Acculturation and the lifetime risk of
psychiatric and substance use disorders among Hispanics. Journal of Nervous and Mental Disease, 188, 728–735.
Portes, A., & Zhou, M. (1993). The new second generation: Segmented assimilation and its variants. Annals of the American Academy of Political and Social Science, 530, 74-96.
Portes, A., & Rambaut, R.G. (2005). Introduction: The second generation and children of immigrants longitudinal study. Ethnic and Racial Studies, 28 (6), 983-989.
Statistics Sweden, (2010) Born in Sweden – but still different? The significance of parents’ country of birth. Statistiska Centralbyrån, Stockholm, Sweden.
Storbjörk, J. (2010). Vem tvångsvårdas? Utmärkande drag för tvångsvårdade respektive frivilligt vårdade personer med alkohol- och narkotikaproblem. Nordic Studies on Alcohol and Drugs, 27(1), 19-46.
U.S. Department of Health and Human Services. (2004). National Institute on Drug Abuse: Drug use among racial/ethnic minorities. Retrieved from http://archives.drugabuse.gov/pdf/minorities03.pdf
Van Ryn, M. & Fu, S.S. (2003). Paved with good intentions: Do public health and human service providers contribute to racial/ethnic disparities in health? American Journal of Public Health, 93(2), 248-255.
21
