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It aimed to determine whether the protective association between education and despair-related mortality risk, commonly observed in broader population studies, also applies to this high-risk, treatment-seeking population.\n                    <jats:bold>Methods:<\/jats:bold>\n                    We linked data from municipal Addiction Severity Index (ASI) assessments to various population registers. The study population included adults aged 25\u00a0years or older who were assessed for substance use severity between 1999 and 2019. Fine\u2013Gray competing risk regression models were employed to examine the association between educational attainment and despair-related mortality, both overall and by subtype (alcohol-related, drug use-related, suicide).\n                    <jats:bold>Results:<\/jats:bold>\n                    Tertiary education was unexpectedly associated with increased risks of overall despair-related mortality, alcohol-related and drug use-related mortality, after controlling for demographic characteristics, ASI composite scores and substance use onset age. No significant associations were found between education and suicide.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    The counterintuitive finding that tertiary education is linked to a greater risk of despair-related mortality among social service users may be attributed to differences between the treatment-seeking population and the general population. Highly educated individuals who seek treatment from municipal social services might have severe substance use and complex psychosocial problems and\/or contact social services after exhausting other treatment options. Further research is necessary to understand how educational and socioeconomic factors influence treatment pathways for individuals with severe substance use problems in Sweden and how these different pathways impact health-related outcomes.\n                  <\/jats:p>","DOI":"10.1177\/14550725251326757","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T17:57:56Z","timestamp":1741888676000},"page":"479-498","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Educational attainment and deaths of despair among individuals assessed for substance use severity: Findings from Swedish Addiction Severity Index (ASI) data"],"prefix":"10.1177","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8532-1019","authenticated-orcid":false,"given":"Simone","family":"Scarpa","sequence":"first","affiliation":[{"name":"Ume\u00e5 University"},{"name":"University of Denver"},{"name":"University of Denver"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4378-6803","authenticated-orcid":false,"given":"Wossenseged Birhane","family":"Jemberie","sequence":"additional","affiliation":[{"name":"Ume\u00e5 University"},{"name":"Ume\u00e5 University"},{"name":"University of Denver"},{"name":"University of Denver"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"H\u00f6gberg","sequence":"additional","affiliation":[{"name":"Ume\u00e5 University"},{"name":"Ume\u00e5 University"},{"name":"University of Denver"},{"name":"University of Denver"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Lundgren","sequence":"additional","affiliation":[{"name":"Ume\u00e5 University"},{"name":"University of Denver"},{"name":"University of Denver"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"e_1_3_2_2_1","first-page":"1","article-title":"Disease burden attributed to drug use in the nordic countries: A systematic analysis for the global burden of diseases, injuries, and risk factors study 2019","author":"Agardh E. 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