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The social ecology of alcohol and drug treatment: Client experiences in context
Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this thesis is to study how individuals with alcohol and drug problems come to treatment – who is in treatment and who is not? It further studies the goal and role of treatment according to different groups – clients, staff and politicians. How can we understand clients’ experiences in a context?

The main data is from the Women and men in Swedish alcohol and drug treatment-study, with a representative sample of clients as well as complementary data on the views of staff and the general population.

The thesis comprises four related papers: (1) explores who is in treatment and who is not by analysing the client and the general population samples; (2) studies reasons for coming to treatment among clients by focussing on self-choice in relation to informal, formal, and legal social pressures to seek treatment; (3) investigates alcohol and drug related events among misusers and the role of these events in treatment entry, and in relation to level of marginalization of the clients; (4) analyses motives for and conflicts surrounding changes in the treatment system on an organizational level.

The thesis reveals that clients in treatment are marginalized (regarding housing, work, family, etc.). At treatment entry, clients report self-choice as well as a range of pressures to seek treatment as reasons for coming. The events are influential in treatment seeking, especially events and pressures in relation to significant others. In addition, it is shown that changes in the treatment system are not only driven with the interests of the clients in mind. Professional struggles, economic cuts, and coincidences are of importance. It is shown that different actors have competing as well as compatible and matching views on the goals of treatment. Finally, some notable changes in the treatment system are discussed.

Place, publisher, year, edition, pages
Stockholm: Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD) , 2006. , 248 p.
Series
Centre for Social Research on Alcohol and Drugs, ISSN 1650-819X ; 6
Keyword [en]
alcohol, drugs, treatment system, clients, marginalization, social ecology, context, Sweden
National Category
Sociology
Identifiers
URN: urn:nbn:se:su:diva-1317ISBN: 91-7155-310-X (print)OAI: oai:DiVA.org:su-1317DiVA: diva2:189858
Public defence
2006-11-17, Högbomsalen, Geovetenskapens hus, Svante Arrhenius väg 8 C, Stockholm, 10:00
Opponent
Supervisors
Available from: 2006-10-26 Created: 2006-10-26 Last updated: 2016-05-19Bibliographically approved
List of papers
1. The two worlds of alcohol problems: Who is in treatment and who is not?
Open this publication in new window or tab >>The two worlds of alcohol problems: Who is in treatment and who is not?
2008 (English)In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 16, no 1, 67-84 p.Article in journal (Refereed) Published
Abstract [en]

In the study “Women and Men in Swedish Alcohol and Drug Treatment,” it is possible to compare alcohol consumption and problems among respondents in the general population with those in clients entering alcohol treatment. The differences between these groups have led researchers to talk about the “two worlds” of alcohol problems-in general and in clinical populations. The aim of this article is to study the relative strength of factors in predicting entering and the clinical population. The studied factors are demographics and marginalization; volume and frequency of drinking; alcohol dependence; social response to drinking (suggestions to cut down or seek treatment by informal actors, e.g. family and friends, and formal actors such as employer, the social services or judicial system); and treatment history. The client sample includes 1202 clients (71% men) interviewed face-to-face when entering inpatient and outpatient treatment facilities in Stockholm. In the general population survey, 3557 persons aged 18-75 years were interviewed. The two samples differ significantly. As expected, clients were older, more marginalized and reported more severe alcohol problems, and many reported previous treatment experiences and social responses. Logistic regression analyses show that previous treatment, unemployment/institutionalization and having an unstable living situation are the strongest predictors of who is in treatment, followed by age, alcohol dependence and frequency of drinking. Formal pressures to cut down or seek treatment are also important and males are more likely to be in treatment. The results support a notion of the treatment system as a place for handling marginalized people, beyond and beside their extent of drinking.

Keyword
General and clinical populations, treatment, alcohol, marginalization
National Category
Social Work
Identifiers
urn:nbn:se:su:diva-22981 (URN)10.1080/16066350701578136 (DOI)
Available from: 2006-10-26 Created: 2006-10-26 Last updated: 2017-12-13
2. The interplay between perceived self-choice and reported informal, formal and legal pressures in treatment entry
Open this publication in new window or tab >>The interplay between perceived self-choice and reported informal, formal and legal pressures in treatment entry
2006 (English)In: Contemporary Drug Problems, ISSN 0091-4509, E-ISSN 2163-1808, Vol. 33, no 4, 611-643 p.Article in journal (Refereed) Published
Abstract [en]

This article focuses on the interplay between reported informal, formal and legal pressure and self-choice in treatment entry. The representative sample of those entering treatment for alcohol or drugs problems in Stockholm County, Sweden includes 1865 clients (71% men). Most respondents reported that it was their own idea to come to treatment (81%). It was also common to report reasons for entering treatment indicating different forms of perceived pressures, especially informal pressures (75%), but also formal and legal pressures. Informal pressure from someone close was a particularly important reason for treatment entry. Informal pressure was found to be positively associated with the feeling of self-choice in treatment entry, whereas perceptions of formal pressure (and particularly legal pressure) mainly were negatively related to self-choice. Most of those reporting self-choice in treatment entry also reported informal, formal, or legal pressure as reasons for coming to treatment.

Keyword
alcohol; drugs; formal, informal, legal pressures; Paths to treatment; self-choice; Sweden
National Category
Social Sciences
Identifiers
urn:nbn:se:su:diva-22982 (URN)
Available from: 2006-10-26 Created: 2006-10-26 Last updated: 2017-12-13
3. Events in problematic alcohol and drug users’ lives: Contributions to treatment and the impact of marginalization
Open this publication in new window or tab >>Events in problematic alcohol and drug users’ lives: Contributions to treatment and the impact of marginalization
(English)Article in journal (Refereed) Submitted
National Category
Sociology
Identifiers
urn:nbn:se:su:diva-22983 (URN)
Note

Part of urn:nbn:se:su:diva-1317

Available from: 2006-10-26 Created: 2006-10-26 Last updated: 2016-05-18
4. The dynamics underlying the story of a reform that redefined borders of the addiction treatment system: The rapid privatization of the Maria-unit
Open this publication in new window or tab >>The dynamics underlying the story of a reform that redefined borders of the addiction treatment system: The rapid privatization of the Maria-unit
2003 (English)In: Socialvetenskaplig tidskrift, ISSN 1104-1420, Vol. 10, no 4, 366-386 p.Article in journal (Refereed) Published
Abstract
National Category
Sociology
Identifiers
urn:nbn:se:su:diva-22984 (URN)
Note

Part of urn:nbn:se:su:diva-1317

Available from: 2006-10-26 Created: 2006-10-26 Last updated: 2016-05-24
5. Women and men in alcohol and drug treatment: An overview of a Stockholm County study
Open this publication in new window or tab >>Women and men in alcohol and drug treatment: An overview of a Stockholm County study
Show others...
2003 (English)In: Nordisk Alkohol- & Narkotikatidskrift, ISSN 1455-0725, Vol. 20, no 2-3, 91-100 p.Article in journal (Refereed) Published
National Category
Sociology
Identifiers
urn:nbn:se:su:diva-22611 (URN)
Available from: 2006-05-03 Created: 2006-05-03 Last updated: 2016-05-19Bibliographically approved

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