39 research outputs found
Hvilken nytte, for hvem og til hvilken kostnad? En prospektiv studie av stoffmisbrukere i behandling
Hvert år bruker det offentlige betydelige ressurser på ulike tilbud til
rusmiddelmisbrukere, men det har vært gjort få sammenlignende studier
av nytten i forhold til kostnadene
i ulike behandlingstiltak. Det er med
andre ord et gap mellom de store pengesummene som brukes og den
begrensede kunnskapen man har. Formålet med "nytte-kostnad"
undersøkelsen og denne rapporten er derfor å bidra til et bedre
kunnskapsgrunnlag for de som skal ta beslutninger om behandling av
narkotikamisbrukere i Norge.
For å kunne sammenligne ulike be
handlingstiltak, samlet vi inn
informasjon fra 482 klienter i 20 ulike behandlingstiltak. Klientene ble
intervjuet tre ganger med ett års me
llomrom. Utvelgelsen av klientene
foregikk ved at alle klienter som kom til behandling i en viss tidsperiode
ble spurt om å være med i undersøkelsen. De fleste klientene ble intervjuet
for første gang i 1998/1999 da de bl
e tatt inn til behandling, bortsett fra
klientene i medikamentassistert rehabilitering (MAR) som ble rekruttert i
1999/2000. De forskjellige tiltakene bl
e valgt slik at de representerte ulike
behandlingsformer (døgnbehandling, poliklinisk behandling (PUT), MAR),
samtidig som de var innenfor en pr
aktisk geografisk rekkevidde for
oppfølging.
Oppfølgingsprosenten er meget god - 92% ved første oppfølging etter
rekrutteringsintervjuet og 88% etter andre. I tillegg til de som ikke ble
intervjuet ved noen av oppfølgingsund
ersøkelsene, enten fordi de var
døde eller fordi de ikke ble gjenfunn
et, var det også noen som fortsatt var
i behandling, noen som var i fengsel,
på sykehus eller i andre "kontrollerte
miljøer". Fordi vi ønsket å se hvor
dan det gikk med klientene etter
behandling, ble de som var i ulike "kontrollerte miljøer" ekskludert. Vi satt
da igjen med en gruppe på 356 klienter, som vi hadde informasjon om før
behandling, og som ikke var i
et "kontrollert miljø" ved ett av
oppfølgingsintervjuene Dersom vi ser på utvalget som helhet, viser tallene at klientene rapporterte
om en betydelig reduksjon i rusmi
ddelmisbruken etter behandling. I
gjennomsnitt gikk bruken av heroin
ned med 58% (fra 14 dager per
måned før behandling til 6 dager per måned ved oppfølgingen).
Tilsvarende gikk bruken av amfetami
n ned med 67% og antall dager med
bruk av cannabis gikk ned med 35%.
Avhengig av hvordan man måler, var
mellom 30 og 40% av klientene helt
rusfrie ved oppfølgingsintervjuene.
Ungdomstiltakene hadde den største andelen helt rusfrie ved
oppfølgingene (over 39%), så fulgte døgntiltakene (minst 26%), og
deretter PUT og MAR med henholdsvis 23% og 20% som hadde vært helt
uten bruk av rusmidler den siste
måneden før oppfølgingsintervjuet (i
hovedsak to år etter påbegynt behandling).
Klientene rapporterte også om en sterk reduksjon i antall dager med
kriminalitet; fra gjennomsnittlig 9
dager per måned før behandling til 3
etter behandling (en reduksjon på 66%). Den selvrapporterte endringen
bekreftes også av data innehentet fra strafferegisteret som viser at
klientene hadde et gjennomsnitt på 20 dager per år i fengsel i årene før
1998, mens gjennomsnittet sank til 7 da
ger i 2000. På andre indikatorer -
som antall dager med psykiske problemer
og antall dager i arbeid - var det
også en forbedring, selv om denne
ikke var så stor som for de andre
indikatorene.
Dersom vi ser på gruppen klienter
hvor vi har opplysninger ved begge
oppfølgingstidspunktene (182 klie
nter som hadde vært i et "ikke-
kontrollert miljø" i minst ett år), vise
r det seg at noen av de viktigste
endringene også var overraskende st
abile. For eksempel var reduksjonen i
bruken av heroin på 58% når man sammenligner bruken ved
rekrutteringsintervjuet og første oppfølgi
ngsintervju ett år etter. To år etter
rekrutteringsintervjuet var reduksjone
n fortsatt nesten like stor (56%) i
forhold til rekrutteringsintervjuet
Pregnant substance-abusing women in involuntary treatment: attachment experiences with the unborn child
Use of coercion against pregnant women who misuse substances was legalised
in Norway in 1996. The background for the law was that substance abuse during pregnancy represents
a significant health problem for the child. AIM – The main aim of this study was to explore
if an attachment between the mother and her unborn child was possible in a context of coercion
as experienced from the woman’s perspective. The women had many challenges, such as lack of
social support and poor living conditions. MATERIAL – Data were collected in eight qualitative indepth
interviews. FINDINGS – The main findings show how involuntary detention enabled safety
for and connection with the unborn child. Within this context, the pregnant substance-abusing
women’s own relational experiences and developmental histories represent the most significant
barrier for their ability to bond with the expected child. CONCLUSIONS – The study underlines
the importance of helping women with their own attachment experiences in order to break the
generational transference of risk and pathology, and in this way, start the attachment process to
the unborn child during the coerced treatment stay. Implications of the findings are discusse
Tapering from Methadone or Buprenorphine during Pregnancy: Maternal and Neonatal Outcomes in Norway 1996-20
Background: The tapering of methadone or buprenorphine during pregnancy is an understudied and controversial issue. The aim of this study was to determine to what extent women tapered their opioid medication dose during pregnancy and what the neonatal outcomes were for those who tapered compared to the women who did not. Methods: The study was a mixed prospective/retrospective national cohort study of 123 Norwegian women in opioid maintenance treatment (OMT) during pregnancy and their neonates. A standardized questionnaire was administered to the women and medical information that could be used for verification was collected from hospitals and municipalities. Results: Two of the women came off the OMT-medication during pregnancy and another 15% tapered their OMT-medication dose more than 50%. The birth weights of methadone-exposed neonates of the women who tapered more than 50% were significantly higher than for the methadone-exposed neonates of the women tapering between 11 and 50%. No other significant differences were found. Conclusion: Pregnant women in OMT who taper their OMT-medication dose should be monitored closely. We need studies that document the maternal well-being and fetal safety of maternal tapering of the OMT-medication during pregnancy.
This is the peer-reviewed but unedited manuscript version of the following article: Tapering from Methadone or Buprenorphine during Pregnancy: Maternal and Neonatal Outcomes in Norway 1996-2009. Welle-Strand GK, Skurtveit S, Tanum L, Waal H, Bakstad B, Bjarkø L, Ravndal E. Eur Addict Res. 2015;21(5):253-61. The final, published version is available at http://www.karger.com/?doi=10.1159/00038167
Results from a Large, Multinational Sample Using the Childhood Trauma Questionnaire
Childhood maltreatment has diverse, lifelong impact on morbidity and
mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most
commonly used scales to assess and quantify these experiences and their
impact. Curiously, despite very widespread use of the CTQ, scores on its
Minimization-Denial (MD) subscale—originally designed to assess a positive
response bias—are rarely reported. Hence, little is known about this measure.
If response biases are either common or consequential, current practices of
ignoring the MD scale deserve revision. Therewith, we designed a study to
investigate 3 aspects of minimization, as defined by the CTQ’s MD scale: 1)
its prevalence; 2) its latent structure; and finally 3) whether minimization
moderates the CTQ’s discriminative validity in terms of distinguishing between
psychiatric patients and community volunteers. Archival, item-level CTQ data
from 24 multinational samples were combined for a total of 19,652
participants. Analyses indicated: 1) minimization is common; 2) minimization
functions as a continuous construct; and 3) high MD scores attenuate the
ability of the CTQ to distinguish between psychiatric patients and community
volunteers. Overall, results suggest that a minimizing response bias—as
detected by the MD subscale—has a small but significant moderating effect on
the CTQ’s discriminative validity. Results also may suggest that some prior
analyses of maltreatment rates or the effects of early maltreatment that have
used the CTQ may have underestimated its incidence and impact. We caution
researchers and clinicians about the widespread practice of using the CTQ
without the MD or collecting MD data but failing to assess and control for its
effects on outcomes or dependent variables
Women Maintained on Opioid Drugs in Pregnancy. Investigation of Outcomes for Mother and Child. Evaluation of Care and Follow Up (EuropASI), 2011.
The project "Women Maintained on Opioid Drugs in Pregnancy. Investigation of Outcomes for Mother and Child. Evaluation of Care and Follow Up, 2011" aims to investigate women in opioid maintenance treatment (OMT) and their partners over time. Women in OMT inhave a past characterized by drug abuse, which can be challenging in the beginning of parenthood. The study examines changes in mothers' substance use, psychological problems, and other challenges, from one to four years after their children were born. The project also describes kindergarten attendance and prevalence and type of child protective services involvement when the children were four years old. The project is divided in to three projects; the EuropASI, SCL-25 and MCMI-III. This file consists of data from EuropASI
Women Maintained on Opioid Drugs in Pregnancy. Investigation of Outcomes for Mother and Child. Evaluation of Care and Follow Up (SCL-25), 2011.
The project "Women Maintained on Opioid Drugs in Pregnancy. Investigation of Outcomes for Mother and Child. Evaluation of Care and Follow Up, 2011" aims to investigate women in opioid maintenance treatment (OMT) and their partners over time. Women in OMT inhave a past characterized by drug abuse, which can be challenging in the beginning of parenthood. The study examines changes in mothers' substance use, psychological problems, and other challenges, from one to four years after their children were born. The project also describes kindergarten attendance and prevalence and type of child protective services involvement when the children were four years old. The project is divided in to three projects; the EuropASI, SCL-25 and MCMI-III. This file consists of data from the SCL-25
Women Maintained on Opioid Drugs in Pregnancy. Investigation of Outcomes for Mother and Child. Evaluation of Care and Follow Up (MCMI-III), 2011.
The project "Women Maintained on Opioid Drugs in Pregnancy. Investigation of Outcomes for Mother and Child. Evaluation of Care and Follow Up, 2011" aims to investigate women in opioid maintenance treatment (OMT) and their partners over time. Women in OMT inhave a past characterized by drug abuse, which can be challenging in the beginning of parenthood. The study examines changes in mothers' substance use, psychological problems, and other challenges, from one to four years after their children were born. The project also describes kindergarten attendance and prevalence and type of child protective services involvement when the children were four years old. The project is divided in to three smaller projects; the EuropASI, SCL-25 and MCMI-III. This file consists of data from MCMI-III
A 10-year prospective study of mortality among Norwegian drug abusers after seeking treatment
Injecting drug users have a mortality risk between 10 and 20 times higher than the general population, and the persistent high mortality rate in most Western countries, and especially in Norway, is a major public health concern. Naturalistic, prospective studies following drug abusers over many years are needed in order to investigate the most important predictors of mortality and for planning strategic preventive measures. Four hundred and eighty-one drug abusers were followed prospectively for 10 years after admission to treatment during the period 1998-2009. Following instruments were used: the European Addiction Severity Index, Symptom Checklist-25 and Millon Clinical Multiaxial Inventory-II. Information on deaths and causes of death were obtained from the National Death Register. Cox regression analysis was used to analyze factors hypothesized to be associated with the risk of death. A total of 74 deaths were registered during the observation period, which represents a mortality rate of 1.5 per 100 person-years. The main cause of death was overdose, and the relative risk of mortality among males was twice that of females. Fifteen percent of the drug users in the study died during the 10 years after admission to index treatment. This represents an annual mortality rate of 1.5; which is in line with most similar studies from Europe, showing a mortality rates in the range of 1-2% per year. The main cause of death was overdose (68%). Preventive strategies aiming to reduce mortality among drug users have to be manifold and gender specific, taking into account drug abusers’ life conditions, their modes of thought and how they go about living their lives.
© 2015 Ravndal E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited