Background

There is a long-standing international research interest in how substance use and criminality are intertwined. Research on adolescents in substance use treatment has observed high rates of criminality, but little is known in the international literature about how different types of criminality are patterned among patients. The aim of this study was to identify different criminal profiles, in terms of convictions, among adolescents and young adults in Swedish substance use treatment.

Methods

The sample included all patients aged 13 to 25 who were in contact with Sweden's largest specialized regional provider of substance use treatment for adolescents and young adults, Maria Ungdom (MU) Stockholm, between 2011 and 2021 (n = 29,960). Data on convictions were gathered from the Swedish National Conviction Register and linked to data from patient journals and other Swedish registers. Latent class analysis was used to identify different subgroups based on 12 different offenses. Differences between these sub-groups on socio-demographic and clinical characteristics were also explored.

Results

Over 40% of the patients had been convicted between 2011 and 2021, with drug offenses being the most common. The LCA identified six classes based on offenses included in the convictions, including classes defined by single offense types to a class characterized by multiple offenses. The largest class (47.8%) consisted of patients with primarily drug offenses and the smallest class consisted of patients primarily defined by shoplifting (6.5%). Comprising only about 5% of all patients, the class with multiple offenses accounted for 32.8% of all convictions. Classes differed across socio-demographic and clinical variables, where the class with multiple offenses was the most severe. Patients with no convictions scored more favorably on socio-demographic and clinical variables compared to those who had been convicted.

Conclusion

A large share of adolescents and young adults in substance use treatment have been convicted for criminal offenses. However, there is profound heterogeneity in this group related to type of offenses as well as to socio-demographic and clinical characteristics. This heterogeneity should be considered in further research and in the provision of treatment.Previous article in issue

Much sociological research on young people's drug consumption seeks to push past the narrow public health focus on risk and harm by centering pleasure as a key dynamic shaping the motivations and outcomes of these practices. This scholarship demonstrates the limits of a myopic focus on danger by examining, for example, meaningful forms of intimacy, social connection, and generative embodied pleasures that form alongside drug consumption. This often relies on examinations of acute forms of intoxication and ecstatic pleasures, extraordinary consumption possibilities that, by positively transforming everyday life, starkly contrast with narratives of risk and harm. In this article, we ask whether focusing on ecstatic pleasures contributes inadvertently to reproducing boundaries between the ordinary and extraordinary in ways that position drug consumption as exceptional—outside the realms of ordinary life or the “everyday.” Combining insights from the sociology of the everyday as the site of the mundane and the exceptional with conceptualizations of intoxication as without fixed meaning or consequence, we analyze how more mundane aspects of alcohol and other drug consumption are articulated in interviews with 40 young Australians aged 16–20. Although alcohol and other drug consumption was not an everyday practice for most of these young people in the temporal sense, we examine how they articulate it as part of everyday life by emphasizing: (1) less florid forms of intoxication; (2) routine intoxicated sociality; and (3) solitary pleasures that form part of the fabric of everyday life. We argue that these accounts trouble boundaries between the ordinary and extraordinary and offer an account of youth alcohol and other drug consumption and intoxication that grapples with its potential to be considered an uncontroversial aspect of the everyday.

Background: Youth substance use is considered a high-priority issue in Sweden, yet research on youth treatment trajectories remains limited. This study adopts a narrative approach to explore how young people interpret substance use treatment, and how treatment aims, assumptions, and language resonate with their identity-work.

Methods: We conducted 25 interviews with participants aged 15–20 years who had recently been enrolled in treatment. The data was interpreted using narrative thematic analysis.

Results: Four treatment trajectories were identified: (1) the disruptive, focused on leaving treatment; (2) the misdirected, dominated by coercion and mismanaged interventions; (3) the empowering, emphasizing personal growth; and (4) the supportive, centered on improvements in mental health. The participants drew on different narrative resources to navigate tensions between organizational imperatives such as control and responsibilization, cultural narratives about youth and substance use, and their own evolving identities. While most participants eventually quit using substances, some reported experiences of stigma, distress, and coercion in treatment. The findings highlight the diversity among youth in treatment and the importance of individualized, agency-promoting interventions.

Conclusion: More differentiated approaches are needed. We suggest that Swedish youth substance use treatment would benefit from a stronger focus on self-care, acceptance of gradual change, and client-defined goals.

Background

Individuals with substance use problems have higher mortality risks than the general population. This study aimed to assess all-cause and specific-cause mortality among adolescents and young adults in specialized substance use treatment in Sweden, a largely overlooked group in the literature.

Methods

A registry cohort was compiled of patients (13–25 years) who between 2011 and 2021 were in contact with Sweden’s largest healthcare provider of adolescent substance use treatment, with mortality data covering the same period. Sex, migrant background, parental education, convictions and treatment variables were compiled from registries and included as predictors. We calculated crude mortality rates (CMRs) and estimated Cox regression models to explore the associations between the predictors and mortality. This also included testing for interactions between convictions and treatment variables.

Results

Among 23,709 patients, 229 deaths were recorded, meaning that slightly less than 1% died during the follow-up window. The overall CMR was 1.68 deaths per 1000 person years (95% CI = 1.47–1.91), with differences across some predictors. In the fully adjusted Cox regression, significantly elevated mortality risks were observed among males (HR = 1.69, 95%CI = 1.23–2.32), those who had received inpatient treatment (HR = 1.89, 95% CI = 1.42–2.52), and those who had been convicted (HR = 2.64, 95%CI = 1.92–3.63). No significant difference in mortality risk was observed for migrant status, parental education, or number of outpatient visits in the fully adjusted models. Among convicted patients, more outpatient visits were related to a lower mortality risk (HR = 0.98, 95%CI = 0.98–0.99), whereas inpatient treatment was associated with a higher mortality risk (HR = 2.14, 95%CI = 1.13–4.05).

Conclusions

Almost one out of hundred patients died during the follow-up period, greatly exceeding the mortality rate in adolescents and young adults in the general Swedish population. The mortality risk varied according to sex, treatment experiences, and convictions, but not according to migrant background or parental education. In sum, we report a complex relation between convictions, treatment, and excess mortality among adolescents and young adults enrolled in specialized substance use treatment, signaling profound unmet clinical and social work needs.

A juridical commentary to this provision further states: ‘[t]hat which is protected is to be worth more than that which is harmed and the danger is not to be avoidable through any other means’ (Anonymous, 2025, see: https://lagen.nu/1962:700#K24).

Drug testing through urinalysis is extensively used in the treatment system for youth substance use, in Sweden and elsewhere. Still, knowledge is scarce on how treatment staff understand the impact of this assessment method on disciplinary roles, work prioritizations, collaboration with other stakeholders, and meeting service users’ needs. This study aimed to examine assumptions about biotechnology, patients and interventions that professionals in Swedish youth treatment draw on to make drug testing meaningful in their clinical work. Twenty interviews were analyzed with a focus on how urinalysis was interpellated as an object by research participants, and on what subject-positions different interpellations enacted. By drawing on a wide range of narrative forms, the professionals interpellated urinalysis as a multiple and fluid object: it both was and was not: necessary, caring, compulsory, intrusive, a truth producer, and a means to determine treatment progress. These interpellations enacted professional-subjects who were both able and unable to break with clinical protocols and external expectations, but always capable of balancing care and control. They also enacted patient-subjects as vessels of information, youth in need, convicted offenders, citizens with rights, minors under paternal control, and untruthful drug users. The study demonstrates the complexity of urinalysis in youth treatment, and that it builds on and advances suspicion and zero-tolerance towards substance use. The deployment of drug testing appears as the least common denominator among diverse stakeholders with differing interests and ambitions in addressing youth substance use problems, and therefore as a stabilizer of a treatment system that could otherwise disintegrate. In staff interpellations, this biotechnology provides legitimacy as being evidence-based, encouraging between-agency collaboration and representing a shared push towards the same goal: drug-free adolescents. We, however, argue that the centrality of urinalysis in this treatment restrains productive discussions about other ways to address youth drug problems.

In Sweden, possession and personal use of drugs are criminalized since 1988, resulting in police work being directed towards minor drug offenses. Despite this, police and other authorities are encouraged to protect the health and wellbeing of people who use prohibited drugs (PWUPD). Knowledge is scarce on how this drug policy plays out in practice. This study therefore analyzes interviews with 20 PWUPD who visited harm reduction services and interacted with policing agents in Stockholm, Sweden. The analysis is based on the participants’ narratives of drug policing, and it concerns how they produced themselves as subjects through relations between materiality and discourse. We utilize the concept of surveilled subjectivation to elucidate what the participants could do, what they knew and who they could be or become under drug policing. Four themes were identified illustrating the link between discourse and materiality in PWUPD’s surveilled subjectivation: “Material aspects of surveillance”; “Resisting the ‘drug abuser’ identity”; “Fighting power with power”; and “Crossing boundaries and becoming-other”. The participants described nonstop efforts to prevent their bodies, activities, belongings and environments from being enfolded by drug law enforcement, which otherwise would fuel even more surveillance. They therefore disassociated themselves from the “drug abuser” identity, and managed encounters with policing agents by keeping a low profile or acting compliantly. While the study highlights the skills and knowledges the participants deployed to navigate omnipresent drug policing, we conclude that their production of autonomous and empowered subjectivities would be facilitated if possession and use of drugs were no longer criminalized.

Alcohol is everywhere—in our everyday lives, in public debates and, increasingly, at the centre of public health policy.

This book critically examines alcohol as a contemporary research and policy object. It argues that drinking is governed through heavily freighted concepts such as risk, wellbeing, gender and race. The authors interrogate dominant disciplinary sobriety and moderation frameworks, highlighting the overlooked aspects of sociability, pleasure and self-transformation.

In scrutinizing the intensifying public health spotlight on alcohol, the authors issue a call to rethink what it means to live “well” in an era when health is both a personal imperative and a regulatory discourse.

Background: There is little systematic research on what adolescents are provided within specialised substance use treatment. This study explored trends in treatment received (number of outpatient treatment visits and inpatient treatment episodes) according to year and age at first contact among adolescents who were enrolled at Sweden’s largest treatment provider, the Maria Ungdom Clinic in Stockholm, between 2011 and 2021. Methods: The data were derived from electronic health records for all patients (n = 29 967) who were in contact with Maria Ungdom Stockholm between 2011 and 2021. Negative binomial regressions estimated the association between year cohort and age at first contact and number of outpatient visits respective number of inpatient episodes. We also tested whether trends according to year cohort and age at first contact were moderated by sex and treatment type. Results: Patients in earlier cohorts and those who were younger at first contact had more outpatient visits. A similar association with age at first contact was observed for inpatient treatment, but was less evident for year cohort. Differences in outpatient visits according to year cohort and age at first contact were mainly observed in patients enrolled in both outpatient and inpatient treatment, and the same held true for differences in number of inpatient episodes according to age at first contact. Regression models that adjusted for potential different exposure time found a higher treatment rate among later cohorts and patients who were older at first contact. Conclusion: Patients in the earlier year cohorts and who were at younger age at first contact with Maria Ungdom received most treatment. However, later cohorts and patients who were at an older age at first contact with Maria Ungdom had a higher treatment rate, suggesting that these groups were provided with a more intensive treatment.