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• Changes in Smoking Rates Among Pregnant Women and the General Female Population in Australia, Finland, Norway, and Sweden

  2017. Therese Reitan, Sarah Callinan. Nicotine & tobacco research 19 (3), 282-289

  Artikel

  Introduction:

  Smoking rates have dropped substantially in most developed countries in recent decades. This general trend has, however, not always been evident among women—particularly younger women. Smoking habits do, however, often change in connection with pregnancy and the aim of this study is to determine whether smoking during pregnancy follows general trends in smoking rates in the general female population in four countries with active anti-tobacco policies and decreasing population smoking rates.

  Methods:

  Changes in rates of persistent smoking, that is, smoking in late pregnancy or daily smoking among all women of childbearing age were described according to age groups. Data were retrieved from the Australian Household Drug Surveys during 2000–2013 and from registries and surveys in Finland, Norway, and Sweden between 1995 and 2014.

  Results:

  In general, persistent smoking has decreased and late-pregnancy smoking rates are lower than daily smoking rates among all women. However, younger women are more likely to be persistent smokers regardless of pregnancy status. In Norway and Finland, persistent smoking was most common among young pregnant women and in Sweden there was an increased polarization between age groups. In Australia, a steady decrease in smoking rates appears to have stalled in younger pregnant women.

  Conclusion:

  Although smoking has declined substantially in recent decades, there are groups lagging behind this general trend. Young pregnant women are of particular concern in this respect. The possibility that these findings reflect the changing characteristics of younger pregnant women is discussed.

  Implications:

  This study puts recent trends in maternal smoking into a broader context by relating developments to changes in smoking rates among women in general. By using similar data from four countries we were able to follow changes in smoking rates “within” groups of women within the four countries without being limited by methodological problems related to cross-country or inter-group comparisons. We were above all able to show that aggregate data disclose the strong age gradient in maternal smoking habits.

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• Patterns of polydrug use among pregnant substance abusers

  2017. Therese Reitan.

  Artikel

  Aim: Studies of drug use during pregnancy have generally focused on individual substances or specific combinations of drugs. The aim of this article is to increase our knowledge about polydrug use and pregnancy in a Nordic context by describing the sociodemographic characteristics of a clinical population of pregnant women with severe substance use, examining the scope and type of polydrug use and analysing factors associated with concurrent use of many, as opposed to a few, drugs. Method: A cross-sectional study of pregnant women on admission to compulsory care for substance abuse in Sweden between 2000 and 2009 (n = 119 women, representing 128 pregnancies). Data were retrieved from administrative registers and client records. Univariate links between demographic, social, obstetrical, treatment history variables and polydrug use were examined. Binary logistic regression was used to analyse the association between explanatory variables and polydrug use. Results: The average number of drugs being used concurrently was 2.65, and injection drug use was recorded in 73% of the pregnancies. Opiates and amphetamines were the most common primary drugs, followed by alcohol. The likelihood of polydrug use increased with first trimester pregnancy, planned (as opposed to emergency) committals, as well as the combination of partner substance abuse and injection drug use. Conclusions: Polydrug use was widespread among pregnant substance abusers. Policies, interventions and research often focus on individual drugs separately, but for clinical populations in particular there is a need to address drug use broadly, including a systematic recording of smoking habits. This also entails awarding more attention to those not eligible for established interventions, such as opiate maintenance treatment, and giving more consideration to a variety of life circumstances, such as partner drug use.

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• Arguing the case

  2016. Therese Reitan. The international journal of alcohol and drug research 5 (3), 131-139

  Artikel

  Aims: To analyse how social services relate to compulsory care legislation in applications for compulsory care for substance abuse in cases involving pregnant women, given that such commitments cannot be made solely for the sake of the fetus/unborn child. Design: Applications for compulsory care to administrative courts involving pregnant women categorized according to how the pregnancy was presented or emphasized. Setting: Compulsory care for substance abuse in Sweden. Participants: 116 cases involving 107 individuals who were pregnant at the time of application for commitment to compulsory care between 2000 and 2009. Findings: In 43% of the cases the risks for both the woman and the fetus’/child’s health was emphasized. In 28% of the cases the applications were primarily for the sake of the fetus/child. In 17% of the cases the pregnancy was mentioned in a neutral manner, while in 8% of the cases the fact that the woman was abusing substances during pregnancy was presented as an indication of the severity of the problem. Conclusions: References were commonly made to the interests of the woman and the fetus/child as an entity, but social services also openly claimed the need for commitment primarily for the sake of the child. Arguments also mirrored the debate when legislation was first introduced; for example, that substance abuse during pregnancy is a clear indication of how serious the problem is, and how this situation may be hazardous to the woman’s mental health should she become the cause of severe and irrevocable harm to her child.

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• Commitment without confinement

  2016. Therese Reitan. International Journal of Law and Psychiatry 45, 60-69

  Artikel

  In Sweden, a person with severe substance abuse or a severe mental disorder may be committed to compulsory care according to two different legislations. Both acts include an option of providing involuntary care outside the premises of an institution - care in other forms (COF) and compulsory community care (CCC), respectively. As co-occurring disorders are commonplace many individuals will be subject to both types of compulsory care. The structures of both legislations and their provisions for compulsory care in the community are therefore scrutinized and compared. Based on a distinction between "least restrictive" or "preventative" schemes the article compares COF and CCC in order to determine whether they serve different purposes. The analysis shows that COF and CCC both share the same avowed aims of reducing time spent in confinement and facilitating transition to voluntary care and the community. But they also serve different purposes, something which is reflected in disparate scopes, eligibility criteria, rules, and practices. Overall, COF was found to be a more "least restrictive" and CCC a more "preventative" scheme. The distinction is associated with COF being an established part of legislation on compulsory care for substance abuse with a universal scope and CCC being a recent addition to compulsory psychiatric care legislation with a selective character.

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• Increased risk of death immediately after discharge from compulsory care for substance abuse

  2022. Anders Ledberg, Therese Reitan. Drug And Alcohol Dependence 236

  Artikel

  Background: In Sweden, approximately 1000 persons per year are committed to compulsory care for substance abuse for a maximum duration of six months. People admitted to compulsory care are known to suffer high mortality risks, but whether the risk of dying is further heightened immediately after discharge is not known.

  Methods: Individual data from Swedish national registers were used to follow all persons discharged from a six months compulsory care episode in the period 2000–2017 (N = 7, 929). Based on a competing risks framework including re-admissions to compulsory care or imprisonment, hazard rates were estimated in five non-overlapping time windows covering the first year after discharge.

  Results: In total, 494 persons died during follow-up, corresponding to an overall mortality rate of 7.1 per 100 person years (95% confidence interval: 6.5, 7.8). The risk was higher for men than for women and increased with age. The risk of dying during the first two weeks after discharge was higher than during the remaining follow-up period – hazard rate ratios comparing the first two weeks with subsequent time windows were between 2.6 (1.3, 5.0) and 3.7 (2.4, 5.9). This heightened risk in close proximity to discharge was only observed for deaths due to external causes, and only for people below the median age of 36 years.

  Conclusions: The risk of dying immediately after discharge from compulsory care is very high, especially for younger clients, and more efforts should be made to prevent these deaths.

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• Substance abuse during pregnancy: a 5-year follow-up of mothers and children

  2019. Therese Reitan. Drugs 26 (3), 219-228

  Artikel

  Introduction: The study investigates health and social conditions among pregnant substance abusers and the children that were born from these pregnancies, and analyses outcomes in relation to type of substance abuse.

  Methods: Register data concerning 97 pregnant substance abusers and 104 children, at birth and 5 years on, were analysed with descriptive statistics and chi square tests.

  Results: The women presented a multitude of problems, including low education, substance abusing partners, and elevated smoking rates. Compared with the population, more children were born prematurely and average birth weight was almost 350 g lower. About 14% were diagnosed as being affected by maternal substance abuse. During follow-up, 5 women died and 88% showed continued substance-related mental and health problems. All children survived and 85% experienced placement in out-of-home care. Purchase of psychotropic drugs and mental health problems were more common among women with alcohol as one drug of preference.

  Conclusions: Parenthood did not represent a turning point for pregnant substance abusers. Comprehensive and persistent support is necessary, but in the short-term, efforts should be made to curb excessive smoking rates. The children faced several disadvantages at birth, but a longer follow-up is required to assess the impact of maternal substance abuse properly.

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• Lagen eller magen? Förvaltningsrätten och LVM-mål rörande gravida kvinnor

  2017. Therese Reitan. Retfærd. Nordisk Juridisk Tidsskrift 40 (3-4), 132-150

  Artikel

  According to the Swedish Substance Abuse (Special Provisions) Act a person may be sentenced to compulsory care for a maximum of six months by an administrative court if she has a serious ongoing substance abuse and needs care which cannot be provided through voluntary measures. The person must also risk seriously harming her physical or mental health, destroying her life, or harming herself or a next of kin. The latter does not include an unborn child and the courts are only to assess whether the grounds for commitment are sufficient in terms of the woman’s needs and risk for harm. The legislation does, however, leave ample scope for so called fairness arguments (“reella hänsyn”). This article studies the extent to which the pregnancy is accentuated in court rulings and in what way – with a special focus on fairness arguments.

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• Negotiating Space in Confined Places: Co-Production of Public Services with Unwilling Users

  2019. Therese Reitan. Scandinavian Journal of Public Administration 23 (3-4), 61-81

  Artikel

  An expanding body of research on co-production, participation, co-creation and other forms of user involvement in public services has not sufficiently reflected their coercive nature. Coercion, like persuasion, is a central dimension of public administration and a defining element of, for example, compulsory care. It is, however, seldom properly addressed in the literature on co-production. The aim of this study is twofold; to propose a broadened definition of co-production which more adequately reflects the complexities of human services by distinguishing between users (clients) and consumers (social services), and to investigate the relevance and practice of co-production in a non-voluntary setting. Examples of enhanced, participative, consumer, and user co-production were identified based on organizational and individual data from the Swedish government agency responsible for compulsory care for substance abusers. Forms of user co-production at the operational level were highlighted through client records and administrative data concerning transfers to community care – so called Care in Other Forms (COF). COF placements are intricate processes involving many different stakeholders and the analysis revealed how clients actively partake in negotiations on the terms and content of service delivery. The idiosyncrasies of involuntary human services should be considered in future research on co-production.

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