Association between the discontinuation of substance use inpatient treatment and the risk of committing a crime leading to imprisonment: A Finnish registry-based 5-year follow-up.

BACKGROUND: Discontinuation of substance use inpatient treatment is common, generally due to dropout and rule breaking. In turn, this is associated with worse long-term substance use outcomes. AIM: To investigate whether people who discontinued voluntary inpatient substance use treatment have a higher risk of imprisonment for a crime within 5 years of discontinuance than those who completed treatment. METHODS: This registry-based follow-up study focused on all inpatient treatment episodes between 2002 and 2009 (N = 2893) in a Finnish hospital for treating addictions. Data from national registers on criminality, hospitalisations and education were linked. Cox regression analysis was used. RESULTS: Discontinued treatment episodes were 1.4 times more likely to be followed by criminality leading to imprisonment during the 5-year follow-up period compared with completed treatment periods, after adjusting for age, gender, education, substance use diagnoses, earlier mental health disorders and prior imprisonments. CONCLUSIONS: Our findings strengthen the argument for ensuring completion of substance use treatment episodes; better completion rates could decrease the harm caused by serious criminality. Indeed, we recommend that crime reduction should be included to the long-term goals of substance use treatment.

Imprisonment, community sanctions and mortality by cause of death among patients with substance use disorder - a 28-year follow-up using Finnish register data.

BACKGROUND: The first few weeks' post-imprisonment are associated with high mortality, particularly among individuals with a history of substance use. Excess risk may vary by societal context due to a range of penal systems and substance use patterns. Using data on Finnish individuals who had sought treatment for substance use, we studied the association between criminal sanctions with cause-specific mortality. METHODS: The database contained 10887 individuals who had sought treatment between 1990 and 2009. Their treatment data were combined with register data on imprisonments and community sanctions and weekly mortality between 1992 and 2015. Mortality was analysed using discrete-time survival models. We controlled for age and sociodemographic factors, and analysed whether education, type of substance used and the type of latest sentence modified the associations. FINDINGS: Mortality was high in the first two weeks after sanctions (all-cause odds ratio [OR] 2.61, 95% confidence interval [CI] 1.67-4.07; drug-related deaths OR 8.52, 95% CI 4.64-15.7). Excess risk declined over time (OR after 12 weeks: 1.19, 95% CI 1.07-1.31). Most of the excess risk was attributable to external causes. Mortality was low during imprisonment, but not during community sanctions. The patterns were similar by level of education, substance use and the type of latest sentence. CONCLUSIONS: Community sanctions were not associated with mortality among people with substance use disorders. Mortality was low during imprisonment, but high post-release. Criminal sanctions should be better utilised as intervention touchpoints and follow-up resources should target prisoners with substance use treatment history to reduce post-release mortality.

Mortality of treatment-seeking men and women with alcohol, opioid or other substance use disorders - A register-based follow-up study.

BACKGROUND: Alcohol (AUD), opioid (OUD) and other substance use disorders (SUD) are associated with an increased risk of premature death. The aim of this register-based follow-up study was to compare the risk of death between individuals who had sought treatment for AUDs, OUDs and other SUDs in Finland. DESIGN, SETTING, PARTICIPANTS: Data included 10,888 individuals who had sought help from three clinics at some point between 1990 and 2009. Treatment data were linked to national register data concerning education, hospitalizations and death by the year 2018. MEASUREMENTS: Individuals were categorized into four groups: only alcohol (AUD-only), all OUDs (OUD-all), other or multiple SUDs (SUD-other) and outpatients without substance-related diagnoses or hospitalizations (SU-NAS); in mortality analyses, those who had started in opioid substitution treatment (OST) were analyzed separately. COX regression analyses were used to calculate the risk of death by the year 2018 or up to 15 years after seeking treatment. RESULTS: Among the 10,888 treatment-seeking individuals the cumulative mortality rates during 1-, 5- and 15-year follow-up were 2.5% (n = 271), 10.9% (n = 1191) and 28.4% (n = 3096), respectively. The mean age at death varied according to substance of use (55.0 years for AUD-only, 35.8 OUD-all, 45.8 SUD-other and 55.6 SU-NAS). The patients who had started in OST had a lower risk of death compared to the other groups, as did the SU-NAS group that likely included individuals with a less severe course of AUDs/SUDs. There were no differences between the AUD-only, OUD-other and SUD-other groups for the risk of death during the 15-year follow-up period when gender and year of birth were included as covariates. CONCLUSIONS: The mortality rates were very high; however, most of the deaths occurred several years after seeking treatment. The lower mortality amongst the patients who had initiated OST solidifies previous knowledge on the benefits of OST and efforts should be made to improve access to treatment. These results show that treatment plays a role in lowering the risk of death among individuals with AUDs/SUDs.

Seller's reputation and capacity on the illicit drug markets: 11-month study on the Finnish version of the Silk Road.

AIMS: This 11-month study analyzed illicit drug sales on the anonymous Tor network, with a focus on investigating whether a seller's reputation and capacity increased daily drug sales. DESIGN AND SETTING: The data were gathered from Silkkitie, the Finnish version of the Silk Road, by web crawling the site on a daily basis from (November 2014 to September 2015). The data include information on sellers (n=260) and products (n=3823). MEASUREMENTS: The measurements include the sellers' reputation, the sale amounts (in euros), the number of available products and the types of drugs sold. The sellers' capacity was measured using their full sales potential (in euros). Fixed-effects regression models were used to estimate the effects of sellers' reputation and capacity; these models were adjusted for the types of drugs sold. FINDINGS: Overall, illicit drug sales totalled over 2 million euros during the study, but many products were not sold at all, and sellers were active for only a short time on average (mean=62.8days). Among the products sold, stimulants were most widely purchased, followed by cannabis, MDMA, and psychedelics. A seller's reputation and capacity were both associated with drug sales. CONCLUSION: The Tor network has enabled a transformation in drug sales. Due to the network's anonymity, the seller's reputation and capacity both have an impact on sales.

PARADISE 24: A Measure to Assess the Impact of Brain Disorders on People's Lives.

OBJECTIVE: To construct a metric of the impact of brain disorders on people's lives, based on the psychosocial difficulties (PSDs) that are experienced in common across brain disorders. STUDY DESIGN: Psychometric study using data from a cross-sectional study with a convenience sample of 722 persons with 9 different brain disorders interviewed in four European countries: Italy, Poland, Spain and Finland. Questions addressing 64 PSDs were first reduced based on statistical considerations, patient's perspective and clinical expertise. Rasch analyses for polytomous data were also applied. SETTING: In and outpatient settings. RESULTS: A valid and reliable metric with 24 items was created. The infit of all questions ranged between 0.7 and 1.3. There were no disordered thresholds. The targeting between item thresholds and persons' abilities was good and the person-separation index was 0.92. Persons' abilities were linearly transformed into a more intuitive scale ranging from zero (no PSDs) to 100 (extreme PSDs). CONCLUSION: The metric, called PARADISE 24, is based on the hypothesis of horizontal epidemiology, which affirms that people with brain disorders commonly experience PSDs. This metric is a useful tool to carry out cardinal comparisons over time of the magnitude of the psychosocial impact of brain disorders and between persons and groups in clinical practice and research.

Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions.

PURPOSE: There has been a lack of comprehensive reviews targeting specific aspects of functioning and the difficulties faced by persons with alcohol dependence. The aim of the present review was to systematically compile the existing literature on activity limitations and participation restrictions as defined in the International Classification of Functioning, Disability and Health (ICF) in the context of alcohol dependence. METHODS: A database search (MEDLINE and PsychINFO) was performed for studies published in English (2005-2012), examining the activity limitations and participation restrictions in alcohol dependence. Using a standardised protocol, information about the studies' characteristics and data on activity limitations and participation restrictions, their evolution, onset, determinants and associations with other variables were extracted from the studies under review. RESULTS: A total of 211 difficulties in activities and participation in persons with alcohol dependence were extracted from 125 papers. The spectrum of studies was wide, and their overall quality was good. A common reason for the exclusion of studies was an inconclusive definition of alcohol dependence. Issues with interpersonal interactions, economic and professional life, dealing with aggression and legal problems were the most frequently reported difficulties. Problems with high-risk behaviours and in seeking appropriate treatment were also common. The most frequent determinants of the onset and evolution of the identified difficulties were factors pertaining to the course of alcohol dependence. These difficulties were rarely the studies' focus; therefore, the data on their underlying causes and courses were limited. CONCLUSIONS: The results confirm that alcohol dependence profoundly affects the family and social network of the afflicted person. The treatment of alcohol dependence can contribute to the alleviation of these associated difficulties. The ICF offers a new perspective on evaluating the wide range of difficulties encountered in the context of alcohol dependence. IMPLICATIONS FOR REHABILITATION: Alcohol dependence profoundly affects the family and social network of the afflicted person. The most frequent difficulties in activities and participation have to do with interpersonal interactions, economic and work life, dealing with aggression and legal problems. Problems with high-risk behaviours and in seeking appropriate treatment are also common. Treatment targeted at reduction or cessation of alcohol use is effective in reducing these psychosocial difficulties. The ICF offers a structure for systematic evaluation of the wide range of difficulties encountered in alcohol dependence.