| 1. |
- Billsten, Johan, 1971-
(författare)
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Dissemination and Implementation of the Swedish National Guidelines for Treatment of Substance use : A five year evaluation
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis contains four empirical studies. The data derives from an evaluation project named Knowledge to Practice (KtP) that aimed to disseminate and implement the Swedish National Guidelines for Alcohol and Substance Abuse in Substance Use Disorder-treatment from 2010–2014. The aim of this thesis was to identify key determinants affecting implementation.The data collection consisted of:- Web surveys that were distributed annually from 2010–2014 to a panel of 3,852 respondents working in substance abuse treatment in social services and health care- Web surveys distributed to approximately 10,000 participants in the national core curriculum course. Surveys were distributed before the start of the course and immediately after the course ended. A follow-up web survey was distributed one year later- Semi-structured surveys for all regions’ user organizations to answer in focus groups- Interviews with process managers in every regionThe aim of Study I was to describe KtP's efforts and the situation in 2012. Web surveys were distributed to a panel of 3,852 respondents and 10,000 participants from core curriculum courses. Process managers from all 21 regions were interviewed. Study II used an instrument named Organizational Readiness for Change (ORC).The aim was to: (a) identify clusters of employees with different ORC profiles and (b) investigate whether belonging to a specific profile predicted the use of therapy methods, assessment instruments and cross-sectional collaboration. The ORC instrument was part of an annual web survey to a panel of 3,852 respondents.The aim of Study III was to evaluate, via a four-year follow-up study, whether user organizations continued existing after national support concluded and if their influence within social services and health care was implemented over time. The aim of Study III was to evaluate, via a four-year follow-up study, whether user organizations continued existing after national support concluded and if their influence within social services and health care was implemented over time. The aim of Study IV was to evaluate the extent of the dissemination and implementation work organised by KtP and whether there was increased use of treatment methods, assessment instruments and changes in cross-sectional collaboration between authorities. Factors associated with success were studied on three organizational levels: regional, municipal and individual. Results show that setting and person-related determinants, as measured by the ORC instrument, predicted implementation of assessment instruments and treatment methods. Profiles with high scores on institutional resources, staff attributes and organizational climate and low scores on motivational readiness were associated with more successful implementation. Respondent-level specialist competence and the ORC factors of staff attributes and institutional resources were related to the use of treatment methods. The ORC factor of organizational climate was related to the increase of cross-sectionalcollaboration at a respondent level. Years of employment working with substance users predicted increased use of assessment instruments and in contrast, the ORC factor institutional resources available were negatively related to instrument use. No predictors were found at the region/municipality level. The majority of respondents were positive to the national guidelines and found them useful in their daily work. They also reported positive attitudes to the KtP project. In 2011, two-thirds of the process managers from Sweden's 21 counties assessed that KtP's most important results were access to education and method support. The one-year follow-up web survey distributed to the participants in core curriculum courses showed that memory retention of the course content was fair. Eighty per cent of the respondents gave the correct answer to seven out of nine questions. User organizations still existed in most regions and they reported increased influence in the field of substance use treatment, both in social services and within health care services.
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| 2. |
- Fridell, Mats, et al.
(författare)
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15-årsuppföljning av drogberoende personer.
- 2006
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Ingår i: Vad vet vi om narkotikaanvändarna i Sverige? Mobilisering mot narkotika: rapport. - : Vad vet vi om narkotikaanvändarna i Sverige? Mobilisering mot narkotika: rapport Mobilisering mot narkotika. ; 14, s. 14-21
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- En representativ sample drogberoende patienter på sjukhus 1988 - 89 (n=125) följdes upp vid 5 år och vid 15 år. Kliniska ata och utfallsdata registrerades vid indevårdtillfället och vid uppföljningarna med en semistrukturerad intervju omfattande demografiska karakteristika, kliniska diagnoser kompletterade med kliniska test och skattningsskalor. Registerdata används för validering och jämförelse. Säkre utfallsdata vid 5 år finns registrerade för 112 personer av hela samplet (90 %) och för 110 (88 %) vid 15 år.
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| 3. |
- Fridell, Mats, et al.
(författare)
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Antisocial personality disorder as a predictor of criminal behaviour in a longitudinal study of a cohort of abusers of several classes of drugs: Relation to type of substance and type of crime.
- 2008
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Ingår i: Addictive Behaviors. - : Elsevier BV. - 0306-4603. ; 33, s. 799-811
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Tidskriftsartikel (refereegranskat)abstract
- Mixed findings have been made with regard to the long-term predictive validity of antisocial personality disorder (ASPD) on criminal behaviour in samples of substance abusers. A longitudinal record-linkage study of a cohort of 1052 drug abusers admitted 1977-1995 was undertaken. Subjects were recruited from a detoxification and short-term rehabilitation unit in Lund, Sweden, and followed through criminal justice registers from their first treatment episode to death or to the year 2004. In a ML multinomial random effects regression, subjects diagnosed with antisocial personality disorders were 2.16 times more likely to be charged with theft only (p<0.001), and 2.44 times more likely to be charged committing multiple types of crime during an observation year (p<0.001). The findings of the current study support the predictive validity of the DSM-III-R diagnosis of ASPD. ASPD should be taken seriously in drug abusers, and be targeted in treatment to prevent crime in society.
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| 4. |
- Fridell, Mats, et al.
(författare)
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Clinical diagnosis and SCID-II assessment of DSM-III-R personality disorders
- 2006
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Ingår i: European Journal of Psychological Assessment. - : Hogrefe Publishing Group. - 2151-2426 .- 1015-5759. ; 22:2, s. 104-108
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To assess the diagnostic concordance of SCID-II and clinicians' estimation of DSM-III-R personality disorders of substance abusers. Method: Clinical diagnoses of substance abusers in inpatient treatment were compared with SCID-II diagnoses (N = 138). Findings: The overall prevalence of personality disorder was 79% for clinical diagnosis and 80% for SCID-H diagnosis. Substantial agreement was found for borderline personality disorder, and moderate agreement was found for presence of any personality disorder, and antisocial personality disorder. All other disorders had slight to fair agreement. Antisocial personality disorder was overdiagnosed by clinical diagnosis but schizotypal, obsessive-compulsive, passive-aggressive, and masochistic personality disorders were reported more often by SCID-II. Selecting only the primary clinical diagnosis and omitting additional clinical diagnoses, reduced agreement with SCID-II diagnoses. Implications: Clinical diagnosis and structured interviews are not interchangeable, and produce somewhat different profiles of diagnoses for a group of substance abusers, but the two methods for diagnosing personality disorders converge for the two most common personality disorders in substance abusers. Rare and less-known diagnoses tend to be underreported whereas common and well-known disorders tend to be slightly overdiagnosed by clinical diagnosis as compared with a semistructured interview, especially if only one clinical diagnosis is noted.
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| 5. |
- Fridell, Mats, et al.
(författare)
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Criminal behavior in antisocial substance abusers between five and fifteen years follow-up
- 2007
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Ingår i: American Journal on Addictions. - : Wiley. - 1521-0391 .- 1055-0496. ; 16:1, s. 10-14
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Tidskriftsartikel (refereegranskat)abstract
- Antisocial personality disorder (ASPD) is one of the most common co-occurring disorders in substance abusers, characterized among other things by a high propensity for criminal actions. A cohort of 125 substance abusers were followed in a longitudinal design. Patients were diagnosed with ASPD at an index treatment episode, interviewed at five-year follow-up, and followed-up through the Swedish criminal justice register by 2005 for the years 1995-2003. ASPD and non-ASPD subjects were compared using Mann Whitney U test for ordinal variables (number of offenses and months in prison) and chi-square tests for categorical variables. A total of 107 were alive by 1995, when the period of observation began. ASPD diagnosed at baseline was related to criminal offenses and incarceration during the follow-up from 5 to 15 years. For most categories, ASPD diagnosis was associated with higher frequency of offense. An ASPD diagnosis based on SCID-H interview made at five-year follow-up was related to the number of offenses but unrelated to incarceration. In a sample of drug abusers, ASPD was associated with high levels of criminal behavior, even years after the diagnosis was given. A diagnosis based on clinical observation during treatment was at least as predictive of criminal behavior as a diagnosis based on a SCID-II interview.
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| 6. |
- Fridell, Mats, et al.
(författare)
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High prognostic specificity of antisocial personality disorder in patients with drug dependence: Results from a five-year follow-up
- 2006
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Ingår i: American Journal on Addictions. - : Wiley. - 1521-0391 .- 1055-0496. ; 15:3, s. 227-232
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Tidskriftsartikel (refereegranskat)abstract
- A sample of 125 consecutive patients from a Swedish detoxification unit were followed up at five years. Register data on criminal behavior were retrieved for 99% of all subjects, including those who were deceased at follow-up, and 76% of living subjects were interviewed. A diagnosis of antisocial personality disorder (ASPD) at intake was associated with incarceration, continuous drug use, dependence on welfare support, and fulfilling criteria of adult ASPD at follow-up. Regardless of ASPD status, a decline was seen in drug-related convictions, but subjects with ASPD were found to continue to commit other crimes.
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| 7. |
- Fridell, Mats, et al.
(författare)
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Personality Disorders in Substance Abusers
- 2005
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Ingår i: Evidence based practices? Challenges in Substance Abuse Treatment.. - : Evidence based practices? Challenges in Substance Abuse Treatment. NAD-publication, Helsingfors. - 0359-7024. - 9515326249 ; 47, s. 65-80
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Fridell, Mats, et al.
(författare)
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Prediction of psychiatric comorbidity on premature death in a cohort of patients with substance use disorders : A 42-year follow-up
- 2019
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 19:1, s. 150-150
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Tidskriftsartikel (refereegranskat)abstract
- Background: We need to better understand how the use of different substances and psychiatric comorbidity influence premature death generally and cause-specific death by overdose, intoxication and somatic disorders in people with substance use disorders. Method: A cohort of 1405 patients consecutively admitted to a Swedish detoxification unit for substance use disorders in 1970-1995 was followed-up for 42 years. Substances were identified by toxicological analyses. Mortality figures were obtained from a national registry. Causes of death were diagnosed by forensic autopsy in 594 patients deceased by 2012. Predictions were calculated by competing risks analysis. Results: Forty-two per cent of the cohort died during follow-up; more men than women (46.3% vs 30.4%). The standardised mortality ratio (SMR) was calculated as the ratio of observed deaths in males and females in specific age groups in the cohort versus expected deaths in corresponding groups in the general population. SMR was 5.68 for men (CI 95%; 5.04-6.11) and 4.98 (CI 95%; 4.08-5.88) for women. The crude mortality rate (number of deaths divided by number of person observation years) was 2.28% for men and 1.87% for women. Opiates predicted increased risk of premature death while amphetamine and cannabis predicted lower risk. Comorbid psychiatric disorders were identified in 378 cases and personality disorders in 763 cases. Primary psychoses or mood/depression and anxiety disorders predicted a higher risk of premature mortality. Death by overdose was predicted by male gender, younger age at admission to substance treatment, opiate use, and comorbid depression and anxiety syndromes. Cannabis and amphetamine use predicted a lower risk of overdose. Death by intoxication was predicted by male gender, use of sedatives/hypnotics or alcohol/mixed substances, primary psychoses and depression/anxiety syndromes. Premature death by somatic disorder was predicted by male gender and alcohol/mixed abuse. Conclusion: Psychiatric comorbid disorders were important risk factors for premature drug-related death. Early identification of these factors may be life-saving in the treatment of patients with substance use disorders.
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| 9. |
- Fridell, Mats, et al.
(författare)
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Psychiatric severity and mortality in substance abusers - A 15-year follow-up of drug users
- 2006
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Ingår i: Addictive Behaviors. - : Elsevier BV. - 0306-4603. ; 31:4, s. 559-565
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Tidskriftsartikel (refereegranskat)abstract
- Previous research has shown that most transitions into abstinence happens in the stages of the drug career quickly after the first treatment episode. Mortality is somewhat reduced for patients who become abstinent, but remains high for patients who remain addicted. However, even among substance abusers who become abstinent, mortality is often higher than in the general population. A consecutive sample of drug users admitted for detoxification was followed for 15 years. Face-to-face interviews were conducted at 5-year follow-up. At 15-year follow-up, 24% were dead. Cox proportional hazard regression was conducted to predict mortality for continuous variables, and Gehan's Wilcoxon test was used to predict mortality for dichotomous variables. Psychiatric status at 5-year follow-up was predictive of 15-year mortality, whereas abstinence was not. Subjects who later died had higher scores on the Symptom Checklist 90 [SCL-90] Global Severity Index, lower meaningfulness on the Sense of Coherence scale, and lower Global Assessment of Functioning [GAF] scores at 5-year follow-up. By contrast, there were no associations between baseline drug use and antisocial personality disorder diagnoses and mortality. Psychiatric treatment, including psychotherapy, may be more life-saving for substance abusers than drug-abuse services. (c) 2005 Elsevier Ltd. All rights reserved.
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