The liberalization of Sweden's drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.

This article compares the roles of two different addiction treatment systems, one in Stockholm county, surrounding the Swedish capital, and the other in a county in Northern California, in relation to marginalized and socially integrated misusers. It investigates: (a) whether the Swedish treatment system, as suspected, treats more marginalized clients than the American system, (b) where in the two systems those with stronger or weaker social ties show up, and (c) what kind of formal and informal pressures the socially marginalized and more integrated groups experience. The analyses are based on structured interviews with two representative samples of clients/patients entering different parts of the treatment systems (926 persons in the Californian county in 1995, 1,865 persons in Stockholm county 2000–2001). The Stockholm county treatment system has a much higher share of marginalized persons than the Californian, and a large proportion in California, almost one third, has both a job and a stable housing (15% in Stockholm). The Stockholm clients were considerably older. Drug use was connected with a marginalized position in both countries, and particularly so in Stockholm. The socially integrated in Stockholm stood out as the group with the highest share of alcohol-dependent persons, the highest Addiction Severity Index (ASI) alcohol scores, and the highest amount of heavy drinking. In both sites, the marginalized had more treatment experience and were more often found in inpatient treatment. There was a somewhat clearer social division in the U.S. system than in the Swedish. Some reasons for this are discussed, including the relation of the treatment system to other handling systems.

Background/Aims: To determine whether frequent emergency department (ED) users who enter specialized treatment programs for alcohol and/or drug problems have any characteristics that predict their future ED use. Methods: Adult patients (783 alcohol users, 405 illicit drug users) were interviewed. Data from the medical database on utilization of ED and the emergency departments’ specific units for addictive diseases (EDAD) 12 months before and 12 months after the interview were linked with patient characteristics in logistic regression models. Results: Among alcohol users, prior ED/EDAD visits predicted repeat future visits to these sites (OR 11.6; 95% CI 6.5–20.5). Prior inpatient hospital care with addiction diagnosis was a predictor of future multiple visits to the EDAD only (OR 3.1; 95% CI 1.5–6.5). Among drug users, predictors of future ED/EDAD visits were use of heroin (OR 2.7; 95% CI 1.4–5.4) and prior ED/EDAD visits (OR 27.3; 95% CI 12.7–58.4). Drug users’ EDAD utilization was also predicted by inpatient hospital care with addiction diagnosis. Conclusion: The strongest predictive factors of visiting ED repeatedly were previous repeat emergency care use and hospitalization with addiction diagnosis. Entering regular addiction treatment does not appear to alter the pattern of ED utilization.

Changes in alcohol consumption in Sweden was associated with changes in male and female alcohol-related hospitalizations also in analyses based on gender-specific consumption measures. There was no clear evidence that the population level association between alcohol and harm differed between men and women.

Research has shown that the provision of brief interventions in the health care system is effective for reducing hazardous drinking. Using a telephone-administered questionnaire, this study provides a population-based investigation on the extent to which physicians address patients’ alcohol habits in the Swedish health care system, whether there are gender differences in the extent to which patients receive questions about alcohol, and predictors for receiving such questions. Data were obtained from monthly telephone surveys with around 72,000 people in 2006–2009. Having received an alcohol enquiry was defined as having been asked about one’s drinking habits by a physician in any health care visit in the last 12 months. Fourteen percent of the total population had received an alcohol enquiry, but there were considerable gender differences: for hazardous drinkers, 13% of the women and 17% of the men had received an alcohol enquiry; among those with sensible alcohol consumption, 10% of women and 15% of men had received an alcohol enquiry. Patients were more likely to have received an alcohol enquiry if they had self-reported alcohol-related problems, were hazardous drinkers and/or daily smokers. Some of the alcohol enquiry predictors differed by gender; social class was an important predictor for women but not for men.