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Use or Misuse?: Addiction Care Practitioners’ Perceptions of Substance Use and Treatment
Stockholm University, Faculty of Social Sciences, Department of Social Work.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis has been to study boundary-making in addiction care practitioner’s perceptions of substance use and treatment. The four papers are based on three data collections in Swedish outpatient addiction care: a) a survey conducted in 2006 (n=655), b) a factorial survey using randomly constructed vignettes conducted in 2011 (n=474), and c) a focus group interview study from 2013 (n=30) with a sample of the respondents from the factorial survey.

The analyses show that practitioners tend to draw boundaries between various forms of substance use, with alcohol use being perceived as a less severe problem than narcotics use and requiring less extensive treatment measures. There are also partially varying perceptions in different parts of addiction care. By comparison with social services staff, regional healthcare staff generally see a greater need for treatment, recommend medical treatment to a greater extent, and display less confidence in the possibility of handling problematic use without professional treatment. Despite an ongoing medicalization at the policy level, psychosocial treatment interventions appear to have legitimacy in both regional healthcare and social services settings.

Boundary-making processes are also found in relation to the specific user’s age, family situation, socio-economic status and in some cases gender, with young women’s drinking being seen as more severe than young men’s drinking for example. The boundary-making between different substance users may be interpreted as a sign of an approach based on a professional consideration of the person’s socially exposed situation, which might require more comprehensive support. At the same time, it may be an expression of a stereotyped approach, involving a normative evaluation of women’s behaviour as being more deviant than men’s, thereby having a limiting effect on the conduct norms that regulate women’s behaviour and making the problems of men invisible. To avoid disparities in addiction care delivery, it is of major importance that practitioners are given room to reflect upon the assumptions and values that underlie the assessments they make in practice. Combining a factorial survey with focus group interviews is proposed as one means of facilitating this type of reflection. 

Place, publisher, year, edition, pages
Stockholm: Department of Social Work, Stockholm University , 2015. , 121 p.
Series
Stockholm studies in social work, ISSN 0281-2851 ; 30Dissertations at the Centre for Social Research on Alcohol and Drugs (SoRAD), 14
Keyword [en]
substance use, treatment, practitioners’ perceptions, social services, regional healthcare, factorial survey, multi-level analysis, focus group interviews, discourse analysis, Sweden
National Category
Social Work
Research subject
Social Work
Identifiers
URN: urn:nbn:se:su:diva-112132ISBN: 978-91-7649-060-0 (print)OAI: oai:DiVA.org:su-112132DiVA: diva2:778213
Public defence
2015-02-13, Aula Svea, Socialhögskolan, Sveavägen 160, Stockholm, 10:00 (Swedish)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2006-1523
Note

At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 3: Submitted. Paper 4: Submitted.

Available from: 2015-01-22 Created: 2015-01-09 Last updated: 2017-11-22Bibliographically approved
List of papers
1. Addiction and recovery: perceptions among professionals in the Swedish treatment system
Open this publication in new window or tab >>Addiction and recovery: perceptions among professionals in the Swedish treatment system
2013 (English)In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, Vol. 30, no 1-2, 51-66 p.Article in journal (Refereed) Published
Abstract [en]

AIMS - The objective of the study was to explore perceptions of different addictions among Swedish addiction care personnel. DATA - A survey was conducted with 655 addiction care professionals in the social services, health care and criminal care in Stockholm County. Respondents were asked to rate the severity of nine addictions as societal problems, the individual risk to getting addicted, the possibilities for self-change and the perceived significance of professional treatment in finding a solution. RESULTS - The images of addiction proved to vary greatly according to its object. At one end of the spectrum were addictions to hard drugs, which were judged to be very dangerous to society, highly addictive and very hard to quit. At the other end of the spectrum were smoking and snuff use, which were seen more as bad habits than real addictions. Some consistent differences were detected between respondents from different parts of the treatment system. The most obvious was a somewhat greater belief in self-change among social services personnel, a greater overall change pessimism among professionals in the criminal care system and a somewhat higher risk perception and stronger emphasis on the necessity of treatment among medical staff. CONCLUSION - Professionals’ views in this area largely coincide with the official governing images displayed in the media, and with lay peoples’ convictions.

Keyword
treatment, addiction general, surveys, social work, health/social services administration, probation services, Sweden
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-89585 (URN)10.2478/nsad-2013-0005 (DOI)000318420100005 ()
Projects
Theories of addiction and images of addictive behaviours
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2006-1523Swedish Research Council, 2004-1831
Available from: 2013-04-30 Created: 2013-04-30 Last updated: 2017-11-22Bibliographically approved
2. Disentangling practitioners’ perceptions of substance use severity: a factorial survey
Open this publication in new window or tab >>Disentangling practitioners’ perceptions of substance use severity: a factorial survey
2014 (English)In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 22, no 4, 348-360 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to examine the influence of user, staff and work unit characteristics on addiction care practitioners’ assessments of the severity of alcohol and drug use. A factorial survey was conducted among 489 social workers, therapists, nurses, doctors and executives from 77 addiction care units in the three largest Swedish counties. Staff assessed the severity of 10 fictive scenarios, vignettes (n = 4724), describing persons with varying social characteristics who were users of alcohol, cannabis or cocaine. The effects of user, respondent and work-unit variables on the practitioners’ severity assessments were estimated using multilevel regression analysis. The results show that perceived severity was influenced not only by the substance, the frequency and character of the negative consequences of the use, but also by the age, socio-economic status and family situation of the user. Women, older respondents and respondents with a medical education rather than a social work education were on average more inclined to assess the vignettes as being more severe. Analyses of various interactions revealed that practitioners viewed the drinking of young men as being less severe than that of young women. Doctors saw women's use as more problematic than men's, irrespective of the context. To conclude, alcohol and drug consumption is judged by different norms, depending on various characteristics of the users, of the practitioners and also of their workplaces. To avoid potential negative consequences of the application of such varying standards in addiction care, more individual reflection and workgroup discussion are needed.

Place, publisher, year, edition, pages
London: Informa Healthcare, 2014
Keyword
Alcohol and drug consumption, factorial survey, multilevel analysis, practitioners’ perceptions, severity
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-96786 (URN)10.3109/16066359.2013.856887 (DOI)000339139000008 ()
Projects
Centre of Excellence Exclusion and Inclusion in the Late Welfare State: the Case of Alcohol and Drugs
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2006-1523
Available from: 2013-11-26 Created: 2013-11-26 Last updated: 2017-12-06Bibliographically approved
3. Perceptions of treatment needs: A factorial survey of Swedish addiction care practitioners
Open this publication in new window or tab >>Perceptions of treatment needs: A factorial survey of Swedish addiction care practitioners
2015 (English)In: Addiction Research and Theory, ISSN 1058-6989, Vol. 23, no 6, 469-480 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to analyze addiction care staff (N=447) perceptions of needs for psychosocial and medical treatment, and possibilities for self-change in relation to fictitious cases. By means of a factorial survey and multilevel analysis, the importance of user, respondent and work characteristics were estimated, with a particular focus on the comparison between healthcare staff and social services staff. Healthcare staff were more skeptical than social services staff towards self-change and assessed the need for medical treatment to be greater. Despite the ongoing medicalisation of Swedish addiction care, psychosocial interventions were still seen as a central part of treatment by both groups. The importance of user characteristics for the assessments was surprisingly similar across the two groups of staff, suggesting that staff perceptions are analogous to the governing images of substance use and treatment needs that prevail in society.

Keyword
Alcohol and drug use, health and social care, perceptions, practitioners, self-change, treatment recommendations
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-112128 (URN)10.3109/16066359.2015.1034696 (DOI)000369901900003 ()
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-2016
Available from: 2015-01-09 Created: 2015-01-09 Last updated: 2017-12-05Bibliographically approved
4. Substance use and treatment needs: constructions of gender in Swedish addiction care
Open this publication in new window or tab >>Substance use and treatment needs: constructions of gender in Swedish addiction care
2015 (English)In: Contemporary Drug Problems, ISSN 0091-4509, E-ISSN 2163-1808, Vol. 42, no 3, 188-208 p.Article in journal (Refereed) Published
Abstract [en]

Men’s and women’s drinking tend to elicit different societal reactions, which may be attributed to different perceptions of masculinity and femininity. This study analyzes addiction care practitioners’ constructions of substance use and treatment needs in relation to gender. Data were collected by means of six focus group interviews with 30 addiction care practitioners. An interpretative repertoire of difference emerged, whereby women were constructed as being different from men in psychological, social, and biological respects. The practitioners related to gender in addiction care as an ideological dilemma resulting from the contradictory ideals of on the one hand treating everybody equally and on the other giving special attention to what is regarded as women’s needs. Reflections emerged regarding the need to be aware of one’s own stereotyped assumptions, and also to be attentive toward men’s specific problems, thus constituting a reflective repertoire. In order to avoid potentially stereotyped treatment, the application of a gender-sensitive approach should acknowledge the variety of ways in which femininity and masculinity may be performed.

Keyword
addiction care, gender-sensitive approach, practitioners, interpretative repertoires, ideological dilemma, focus group interviews
National Category
Social Work
Research subject
Social Work
Identifiers
urn:nbn:se:su:diva-112129 (URN)10.1177/0091450915592912 (DOI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-2131
Available from: 2015-01-09 Created: 2015-01-09 Last updated: 2017-12-05Bibliographically approved

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