Five years followup study of female substance

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Five years follow-up study of female substance
abusers in compulsory treatment in Sweden
Mats Fridell, Johan Billsten, Iréne Jansson,
Richard Amylon
Dept. Of psychology, Lund Universitet
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COMPULSIVE CARE

• A 21 bed inpatient residential treatment care
  unit, Lund
• 12 beds for adults and 9 for youth
• Law on Compulsory Care for Substance Abusers
  (LVM, act 1988870)
• The Care of Young Persons Act (LVU, act 19905r2)

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Sampling and Methodology

• Sampling procedure Consecutively admitted to
  compul-sory treatment 1997-01-01 2000-12-31 at
  Lundens LVM-/LVU-center for women in LUND
• Cohort N 230 (138 LVM and 92 LVU)
• Sample 132 persons diagnosed (60)
• All patients hade previously agreed to
  participate.
• Study was approved by the ethics committe of the
  medical
• faculty of Lund University Lund University
• Oral agreement was further approved for each
  participant
• at the time of the interview.
• Representativeness 28 variabler, 2 sign.
  Dropout-analysis
  
  
  
  
  

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Women at index admissionCohort design 1997 -
2000
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DATA COLLECTED AT INDEX ADMISSION

• Background data ASI-equivalent documentation
• Test and rating scales
• Personality inventories (BCT, CMPS),
• Psychiatric symptom scales (SCL-90)
• Global function (GAF),
• SCID I och SCID II, DSM-III-R-diagnoses.
• PCL-R psychopathy
• Neuropsychological assessment
• Intelligence level (WAIS)

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BACKGROUND baseline data

• LVM LVU
• Psychiatric problems in family 40 29
• of origin
• Drug/alcohol abuse in family of 58 46
• origin
• At least one Suicidal attempt 48 42
• Homeless 35 54
• Prostitution 41 23

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Personality Disorders (N132)

• AXIS II diagnosis LVM (80) LVU
  (52)
• Borderline 26
  17
• Anti-social PD 23 0
• Conduct Disorder 1 44
• ANY Pd 62 69

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PSYCHIATRIC DISORDERS (AXIS I) IN THE COHORT
(N132) DIAGNOSIS LVM (80) LVU (52)
AXIS I Psychopathy 3 6
Toxic psychosis 17 15
Schizoprenia 0 5 Sociofobia
1 2 Depression 13
13 Depressive disorders 13
13 Dysthymia 3 0 Anxiety, any
25 20 TOTAL 60 61
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TREATMENT LAST YEAR

• LVM LVU
• - Treatment in psychiatry 61 50
• Gynaecology 26 17
• Dental treatment 59 48
• Pregnancy care 35 48
• - Hepatitis B and/or C 57 43

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Five-year follow-up
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TRIANGULATION APPROACH

• Half structured interview
• Background data, actual situation, etc.
• Standardized Psychological tests and rating
  scales
• Register data from 1970-ties to present
• a) Compulsive care,
• b) Criminal records (BRÅ),
• c) Hospital admissions all kinds (EPC),
• d) Causes of Death register (EPC), Death
  certificates and
• completing ortopsy reports.

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INTERVIEWS

• Face-to-face interview 106 in 32
  different communities
• Telephone interview 3
• Deceased 8
• Outcome known, inkl deceased 117 (88) (83
  itt)
• Additional register data 130 (98)
• Independent Social workers 69 (84)
• rating 2003
• Stable abstinence (29), definitely improved
  (23), active
• drug use (25), diseased (7), unknown (13),
  Prison or compulsory care LVM (3)

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Abstinence at five-year follow-up
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D

• Outcome at five year follow-up

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Cluster Analysis of continous trends for the
first three years after discharge from Lunden
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Time-line-diagrams demonstrating level of drug
use and abstinence until three years post
treatmentMissbruksdagar delas i fem grupper
0 dgr 1-2 dgr 3-5 dgr 6-15
dgr 16-30 dgr
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--- not abstinent --- Sporadic drug use __
Continous abstinence

• Diagram 2. Drug use trends over three years after
  discharge from Lunden definied
• By drug use the last 6 months before interview.
  Cluster analysis (Wards metod).
• Nu of women 101, Time-Line-Follow-Back-model
  (TLFB)

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CONCLUSIONSControl for
days in treatment is rather constant even if
number of days tend to decrease over time
F(199)7,167) p lt .009). More persons in the
group using drugs get a fairly substantial number
of treatment admissions compared tothe other
women, F4,431 p lt .0,04).
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___ not abstinent _____ abstinent

• Diagram 3. Trends in criminal activity over three
  years past
• treatment in two clusters past discharge
  (n101). TLFB-
• modell

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CONCLUSIONSAlready
in the first year, those who still use drugs,
(group 2 and 3) continue to have a higher number
of offences brought to justice in the Criminal
Justice data-base (BRÅ) F(1,99)9.062 plt0.003.
There is a significantly decreaseing trend
among those abstinent, which does not exsist in
the group still using drugs.

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Aggregated measures of social adjustment over the
three years past discharge (n101)
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CONCLUSIONS In the abstinent group (Group 1)
there is an increase in legal income, number of
non drug friends, social relations to family,
more stable living etc. F(1,99( 4.30, p lt
.04). There is a simliar trend for the first
year after discharge for the drug abusing group,
but it does not continue and the interaction
between the two groups are significant, F (199)
6,37, p lt .013), F (199) 11,168), p lt .001).
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Två missbruksgrupper baserade på 6 mån innan
uppföljning ___ Fortsatt missbruk _______
drogfrihet

• DIAGRAM 11. Course in drug abuse in three
  clusters (1 and, 23) in regard to changes in
  different social dimensions and self support
  (n101)

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CONCLUSIONIN the cluster abstinent there is a
more positive course over time. The same trend
appears, but it does not continuein the control
group. The cluster are diversified.
F(1,99)4,300 p lt .041). Interaction between
the group show one linear and one quadratic
interaktionen F(199)6,374,p lt .013 och F
(199) 11,168, p lt .001.
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Mortality and causes of death8 diseased in the
sample11 in the comparion groupAll but one
women had a drug related death,two suicides. 3
Died from somatic illnesses, substance problems
were a contributing factor in all. 12 Overdoses
and 3 fatal poisonings, SMR9,07
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PSYCHIATRIC SYMPTOMS
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Två missbruksgrupper baserade på 6 mån innan
uppföljning ___ Fortsatt missbruk ___ Drogfria

• Diagram 6. The course of psychiatric symptoms
  like depression, anxiety and aggressive behavour
  is more negative among the persons still having a
  substance abuse compared to abstinent
  persons.(F(2,99)4,445 p lt .038.)
• (n101)

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CONCLUSIONSSymptoms higher on all scales in
groups with non-abstinent women F(2, 99) 4,445
p lt .038).The main difference is in the early
phases of the three year period.
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Patients becoming abstinent have- A Higher
SOC (KASAM) than others- Have lower scores of
symptoms (SCL-90)- A higher level of social
integration (ISSI)- Show personality changes
(BCT) - Have lower levels of criminal activity

• Diagram 5. Jämförelse av SCL-90 vid
  indexvårdtillfället och vid uppföljningen 5 år
• senare (n105) för stabilt drogfria (lt 2 år)
  respektive de som varit drogfria mindre än
• mån respektive mer än 6 månader. Notation
  p lt .05 , p lt .01, p lt .001

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Anti-social Personality disorder and
Conductdisorder have a significantly negative
impact ondrug abuse, criminal behaviour, social
adaptationNo other personality disorder reveal
this !!!
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SUMMARY1. It is a surprisingly positive outcome
for many2. The immediate consequences on short
sight seem to be very important for long-term
outcome.3. When substance problems decreases, so
do problems in social functioning, criminality
4. Improvement in drug patterns give important
gains .5. The assessment of quality show that
patients are mostly satisfied with the
intervention7. NOTE that 15 seem to leave
Lunden with no relapses.