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Likegyldighetens tvetydighet: Overdosedødsfall etter rusmiddelbehandling

Abstract

Ambiguous indifference – fatal overdoses among marginalized drug users after discharge from inpatient treatment

BACKGROUND – In the European context, Norway is one of the countries with the highest overdose-related mortality rate. Research proves that the risk of overdose mortality among marginalized drug users is particularly high during the first weeks after discharge from inpatient treatment. AIM – It is therefore interesting to investigate whether there might be a connection between marginalization and treatment culture to understand fatale overdoses after discharge from inpatient treatment.

DESIGN & METHODS – The case study is based on a previous field study connected to the death register. The study focuses on a single individual, Sam, and his treatment process. Data is analyzed in the light of a cultural analytical perspective.

RESULTS – The results shows how the treatment system can be a social arena for institutional exclusion and marginalization that aggravate the person’s self-esteem and life situation. One central aspect of the process of treatment was that it generated indifference. Sam’s treatment motivation developed into treatment indifference. In the last part of the article, the author discusses indifference as a risk aspect of overdose mortality after discharged from treatment. It is not possible to conclude if Sam’s overdose death was an accident or suicide. However, in the light of action theory the case shows that indifference can be a central aspect of both an unintentional and intentional overdose. Sam’s death can be understood in the light of the concept ambiguous indifference.

CONCLUSION – The case shows that there may be a relationship between marginality, treatment culture and overdose mortality. Cultural and structural aspects of the treatment system put Sam in an empty and risky situation that probably contributed to his death. In a comparison of risk situations in this case-history with recent research on treatment system, we can see several worrisome resemblances considering overdose mortality after discharge from inpatient treatment.

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Rusmisbruk, angst og depresjon etter 10 år: En prospektiv undersøkelse av stoffmisbrukere med og uten LAR-behandling

Abstract

Substance abuse, anxiety and depression after 10 years: A prospective study of drug users in and outside OMT treatment AIMS - The national Opiate Maintenance Treatment (OMT) program in Norway started officially in 1998. The same year a treatment study was initiated, including the most used treatment measures for drug users in Norway. The main aim in the present study was to investigate the prevalence of live OMT patients in the total sample after 10 years, and to compare the outcome of primarily substance abuse, anxiety and depression among OMT patients versus non-OMT patients. DESIGN & METHODS - Four hundred and seven patients, in Oslo and the nearby regions, who started in 16 different in- and outpatients programs, were followed from intake to treatment and during ten years (1998-2009). Patients in the sample were interviewed after one, two, seven and ten years, and they were divided into three different treatment groups: inpatient residency for grown-ups, outpatient psychiatric youth teams and youths living in collectives. Data was collected through use of EuropASI and HSCL-25 at all follow-ups. RESULTS - After ten years 15 % were deceased. Of the 333 persons left, 73 % (n=248) were interviewed after ten years. Forty percent (n=99) were then in OMT. After ten years there were no gender differences regarding attendance to OMT, but the OMT-group was older (30 vs .28 yrs, p<0.05), and they used more benzodiazepines (p<0.000) and cannabis (p<0.01) than the others. The OMT-group reported to a larger extent more anxiety and depression throughout the total observation period than the non OMT participants. Use of heroin and criminality were significantly reduced in both groups. CONCLUSIONS - In spite of reduced use of heroin, the OMT patients seemed to have more difficulties in reducing the use of benzodiazepines and cannabis, whereas the anxiety and depression scores were high and stable through the total observation time.

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Problematic Alcohol Use and Problem Gambling: Associations to Structural and Functional aspects of Social Ties in a Finnish Population Sample

). Mail and Internet surveys: The total design method (2nd ed.). New York: Wiley. Ekholm, O., Eiberg, S., Davidsen, M., Holst, M., Larsen, C. V. L., & Juel, K. (2014). The prevalence of problem gambling in Denmark in 2005 and 2010: A sociodemographic and socioeconomic characterization. Journal of Gambling Studies, 30 (1), 1–10. Ewing, J. A. (1984). Detecting alcoholism. The CAGE questionnaire. Journal of the American Medical Association ; 252 (14), 1905–1907. Ewing, J. A. (2000). CAGE Questionnaire. In Task force for the handbook of psychiatric

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