Transforming Substance Use Treatment

Like the U.S., Sweden is facing a public health epidemic where opioid and other drug use is concerned. Although there are evidence-based practices for substance use disorder treatment and continuity of care, the health workforce — which includes social workers — is not always well trained in these practices.

DU Graduate School of Social Work (GSSW) Professor Lena Lundgren and a guest professor at Umeå University in Sweden, is working to transform delivery of substance use disorder treatment in both countries.

Lundgren is the principal investigator of STANCE, a research program that includes several studies and the implementation of a new national data system to help Swedish social services to better identify and examine the effectiveness of services received by individuals with or at risk for a substance use disorder.

“We have to respond [to the drug use epidemic] with prevention, with treatment and create a workforce that can respond,” Lundgren says, “but the current system really is a barrier to living.”

Although substance use disorder is a health-related condition that can be chronic, she explains, continuity of care may be absent, short term or poor quality. And, she says, “Substance use is still stigmatized as a personal moral failure” although evidence shows it should be treated more like long-term medical conditions, such as diabetes.

Sweden hosts some of the world’s most comprehensive health registries, and one STANCE component is an epidemiological study looking at a decade of Swedish registry data collected on 15,000 people who were assessed for a substance use disorder. The goal is to understand the range of health, employment and treatment interventions they received and identify which groups are most vulnerable to negative outcomes (such as death by overdose).

“People with long-term chronic substance use disorders use a lot of services,” Lundgren explains. “We need to be able to identify which clusters of services provide the best outcomes.” For example, is a combination of medication and psychosocial services more effective than either medication alone or psychosocial services alone? How does continuity of care (or lack of care) affect outcomes? “The Swedish data is unique because it collects a range of services so we can actually look at real outcomes,” Lundgren says. “One real outcome is unfortunately mortality, and we need to reduce mortality.”

Lundgren is working with colleagues at the U.N. Office on Drugs and Crime to determine whether the study data can also be used to identify differences in emergency room admission and mortality rates for those using medical interventions to treat substance use disorders. She also hopes to compare treatment outcomes in Sweden and the U.S.

STANCE started in 2016, and Lundgren aims to continue the program through 2022, supported by approximately $3 million in funding from the Swedish Council for Health and Work Life. Lundgren is undertaking the program in collaboration with Associate Professor Mojgan Padyab, Professor Bengt-Ake, Professor Kerstin Armelius and Professor Mikael Sandlund at Umeå University; Siv Nystrom at the Swedish National Board of Health and Welfare; and researchers at the Butler Institute.

The STANCE research team spans social work, medicine, psychology and statistics. GSSW–Umeå research collaborations and faculty and student exchanges are planned, and Lundgren expects that doctoral students and post-docs at both GSSW and Umeå University will participate and publish from this effort.

Lundgren is lead author of the forthcoming book Screening, Assessment and Treatment of Substance Use Disorders: Evidence Based Practices in the Era of Integrated Care.

In a related project, Lundgren is the principal investigator for a National Institutes of Health grant to train U.S. social work faculty to teach social work students evidence-based treatment methods for substance abuse and dependence. The aim, Lundgren says, is to create a social work workforce prepared to effectively treat substance use disorders. For instance, Lundgren says, “We don’t take into account how important case management is — helping people reconnect with treatment when there are relapses. We need to teach social workers that relapse isn’t failure — it’s an aspect of the condition.”

GSSW faculty are catalyzing social change through research projects like this.

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