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  • 1.
    Blomqvist, Jan
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Palm, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    'More cure and less control' or 'more care and lower costs'? Recent changes in services for problem drug users in Stockholm and Sweden2009In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 16, no 6, p. 479-496Article in journal (Refereed)
    Abstract [en]

    This article deals with the development of drug services in Stockholm, Sweden since the mid-1990s. Initially, data were collected as part of a European Union comparative study of the development of drug services in six major European cities. However, the present article uses these data to analyse to what extent the traditional 'Swedish model' of dealing with narcotic drugs can be said to have come to a crossroad. The article describes and analyses changes in drug use, and in the structure, organization and utilization of social services based, as well as healthcare-based drug services in Stockholm during the past decade. As pointed out in the article, the 'drug-free society' is still the ultimate goal of Swedish drug policy. However, as the Stockholm example hints, when it comes to the care and treatment of individual drug problems, there seems to be an on-going shift, from in-patient treatment towards measures such as substitution treatment, outpatient care and housing. The article discusses whether these changes signify a softening of Sweden's restrictive drug policy, or whether they rather point to a 're-medicalization' of drug services, and shift in focus from 'cure' and social re-integration towards a focus on 'care' and on attempts to avoid 'public nuisance'.

  • 2.
    Eriksson, Antonina
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Palm, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kvinnor och män i svensk missbruksbehandling: En beskrivning av klientgruppen inom socialtjänstens missbrukarvård i Stockholms län 2001-20022003Report (Other academic)
  • 3. Fäldt, Johannes
    et al.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Palm, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Oscarsson, Lars
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Vårdkedjeprojektet: Tre utvärderingsperspektiv2007Report (Other academic)
  • 4. Heim, Derek
    et al.
    Blomqvist, Jan
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Edman, Johan
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Room, Robin
    University of Melbourne, Australia.
    Storbjörk, Jesisca
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Addiction: Not just brain malfunction2014In: Nature, ISSN 0028-0836, Vol. 507, p. 40-40Article in journal (Other (popular science, discussion, etc.))
  • 5.
    Jessica, Storbjörk
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Commentary on Witkiewitz et al (2017): Abstinence or moderation – a choice for whom and why?2017In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 112, no 12, p. 2122-2123Article in journal (Other academic)
    Abstract [en]

    Analyses of low-risk drinking add legitimacy to moderation as an alcohol treatment goal, so increasing choice for some patient groups. Moderation also parallels a dominant model of opioid treatment, opioid maintenance treatment. 

  • 6.
    Jessica, Storbjörk
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Demands to peek into the secret black box: How to provide a glimpse of the treatment content2016In: Nordic Studies on Alcohol and Drugs, ISSN 1458-6126, Vol. 33, no 2, p. 139-141Article in journal (Other academic)
  • 7. Klingemann, Harald
    et al.
    Jessica, Storbjörk
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The Treatment Response: Systemic Features, Paradigms and Socio-Cultural Frameworks2016In: The SAGE Handbook of Drug & Alcohol Studies: Social Science Approaches / [ed] Torsten Kolind, Betsy Thom, Geoffrey Hunt, London: Sage Publications, 2016, p. 260-286Chapter in book (Refereed)
    Abstract [en]

    Following some introductory notes on addiction treatment management as a specific case of societies’ response to deviant behaviours and social problems, an overview of the theoretical classifications and dimensions of addiction treatment systems is presented. The anti-thesis to these ideal-type system concepts is represented by the market New Public Management model oriented towards outcomes, regardless of the nature and organizational features of addiction interventions. As complementary to these general theoretical orientations, this serves as a review of specific issues concerning ‘a combined and integrated approach versus a specialized and segregated approach’, ‘the quest for the best treatment modalities’, ‘empirical and ethical aspects of coercion in treatment’ and ‘the relevance of user needs and orientation’. The empirical part begins by highlighting the ‘expert survey‘, ‘case study‘ and dynamic diffusion‘  approaches as treatment mapping strategies and informs on some key results, e.g. from the WHO Atlas –SU survey and the International Studies in the Development of Alcohol and Drug Treatment Systems. Results from an expert survey from fourteen countries conducted in 2014 illustrate the role of general political changes, efforts to control treatment systems, integration dynamics, the treatment gap and changing outcome criteria with concrete current examples. The conclusions point to the relative importance of professional addiction interventions drawing upon self-change research and the role of alternative lay help and outline factors in impeding system changes.

  • 8.
    Palm, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kvinnor och män i svensk missbruksbehandling: en beskrivning av patientgruppen i Stockholms läns landstings beroendevård 2000-20012003Report (Other academic)
  • 9. Reissner, V.
    et al.
    Kokkevi, A.
    Shifano, F.
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University of Melbourne, Australia; Turning Point Alcohol & Drug Centre, Australia.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stohler, R.
    DiFuria, L.
    Rehm, J.
    Geyer, M.
    Hölscher, F.
    Scherbaum, N.
    Differences in drug consumption, comorbidity and health service use of opioid addicts across six European urban regions (TREAT-project)2012In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 27, no 6, p. 455-462Article in journal (Refereed)
    Abstract [en]

    Objectives: This comparative study investigated consumption patterns, comorbidity and treatment utilization of opioid addicts in six European cities (Athens, Essen, London, Padua, Stockholm, Zurich). Subjects and methods: Data were collected by structured face-to-face interviews. The representative sample comprises 599 addicts (100 patients per centre, 99 in London) at the start of a treatment episode. Results: Patients were dependent on opioids for about 10 years. Regional differences were significant regarding the patients' drug consumption pattern and their method of heroin administration (up to a fourth of the patients in Essen, London and Zurich usually smoke heroin). Concomitant use of benzodiazepines, cannabis and alcohol was common in all regions with the German and English samples showing the highest level of polydrug use. The prevalence of major depression was high in all regions (50%). Stockholm and London patients worry most about their physical health. Differences in the amount of needle sharing and especially in the use of public health service were prominent between the sites. Opioid addiction was a long-term disorder associated with a high burden of comorbidity and social problems in all cities. Conclusion: The results of the study show significant interregional differences of opioid addicts which might require different treatment strategies in European countries to handle the problem.

  • 10.
    Room, Robin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Palm, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Romelsjö, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kvinnor och män i svensk missbruksbehandling: beskrivning av en studie i Stockholms län2003In: Nordisk Alkohol- og narkotikatidsskrift (NAT), ISSN 1455-0725, E-ISSN 1458-6126, Vol. 20, no 2-3, p. 91-100Article in journal (Refereed)
  • 11.
    Room, Robin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Palm, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Romelsjö, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Women and men in alcohol and drug treatment: An overview of a Stockholm County study2003In: Nordisk Alkohol- & Narkotikatidskrift, ISSN 1455-0725, Vol. 20, no 2-3, p. 91-100Article in journal (Refereed)
  • 12.
    Stenius, Kerstin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Balancing welfare and market logics: Procurement regulations for social and health services in four Nordic welfare states2019In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126Article in journal (Refereed)
    Abstract [en]

    Aim: In increasingly market-oriented welfare regimes, public procurement is one of the most important instruments of influencing who produces which services. This article analyses recent procurement regulations in four Nordic countries from the point of view of addiction treatment. The implementation of public procurement in this field can be viewed as a domain struggle between the market logic and the welfare logic. By comparing the revision of the regulations after the 2014 EU directives in Denmark, Finland, Norway, and Sweden, we identify factors affecting the protection of a welfare logic in procurement. We discuss the possible effects of different procurement regulations for population welfare and health. Data and theoretical perspective: The study is based on the recently revised procurement laws in the four countries, and adherent guidelines. The analysis is inspired by institutional logics, looking at patterns of practices, interests, actors, and procurement as rules for practices. Results: Procurement regulations are today markedly different in the four countries. The protection of welfare and public health aspects in procurement – strongest in Norway – is not solely dependent on party political support. Existing service providers and established steering practices play a crucial role.  Conclusion: In a situation where market steering has become an established practice and private providers are strongly present, it can be difficult to introduce strong requirements for protection of welfare and population health in procurement of social services.

  • 13.
    Stenius, Kerstin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Dynamiken bakom historien om en gränsomdragande reform. Den snabba avknoppningen av Maria-enheten2003In: Socialvetenskaplig tidskrift, ISSN 1104-1420, Vol. 10, no 4, p. 366-387Article in journal (Refereed)
    Abstract [sv]

    I artikeln analyseras de motiv och konflikter inom beroendevårdens organisation och i dess omgivning som utgjorde bakgrunden till privatiseringen av en landstingsägd missbruksenhet i Stockholm.

  • 14.
    Stenius, Kerstin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Dynamiken bakom historien om en gränsomdragande reform: Den snabba avknoppningen av Maria-enheten2003In: Socialvetenskaplig tidskrift, ISSN 1104-1420, no 10, p. 366-386Article in journal (Refereed)
  • 15.
    Stenius, Kerstin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Romelsjö, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Decentralisation and integration of addiction treatment - Does it make any difference?2007Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    Resistance in part of Stokcholm county to introduce a reform of the addiction treatment system to intergate and decentralsie the services created possibilties for a quasi-natural expereiment. This paper looks at the effects from a population level of certain qualities of a treatment system

  • 16.
    Stenius, Kerstin
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Ullman, Sara
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Nyberg, Katarina
    En långtidsuppföljning av personer med tungt missbruk i Stockholms läns missbruksvård2011Report (Other academic)
  • 17.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    A study of a Swedish treatment policy reform proposal2013In: Snapshots of social drug research in Europe / [ed] Jane Fountain, Marije Wouters, Dirk J. Korf, Lengerich: Pabst Science Publishers, 2013, p. 57-59Chapter in book (Other academic)
    Abstract [en]

    The chapter summarizes the rationale, aims, methods, results and conclusions of the study "A reformed substance abuse treatment system? Actors, arguments and power". The project studies a far-reaching reform proposal in which it was suggested that Swedish substance abuse treatment should be transferred from the municipal social services to the regional level health care system.

    Book Abstract: Globalisation influences not only legitimate economicsectors, but also affects developments onthe illicit drug market and the proportion of thosein treatment who are members of minority ethnicpopulations. In a rapidly changing world, theneed for information increases accordingly. Here,then, emerges an important task for science, especiallyin the light of the European endeavour forevidencebased drug policy. Recent years show analmost exponential increase in the use of onlinedata collection and analysis in social drug researchand, in some European countries fasterthan in others, research ethic committees havecome to play an important role in social drug research.The usual format of the European Society for SocialDrug Research’s annual book is 8-10 chapters,but this year the choice has been made to incorporatea greater number of short contributions,in the form of 21 ‘snapshots’, written by social scientistsworking in 11 European countries.

  • 18.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Alcohol and drug treatment systems research: a question of money, professionals and democracy (editorial)2010In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, Vol. 27, no 6, p. 543-548Article in journal (Other academic)
  • 19.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Convictus Bryggan City: Gästerna, deras nätverk, problem, behov och resurser2006In: Vad vet vi om narkotikanvändarna i Sverige? / [ed] Mobilisering mot narkotika (MOB), Stockholm: Mobilisering mot narkotika (MOB) , 2006, p. 26-30Chapter in book (Other academic)
  • 20.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Drug users as social change agents: increasing but limited possibilities in Sweden2012In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 47, no 5, p. 606-609Article in journal (Other academic)
    Abstract [en]

    This commentary discusses some prerequisites for and potential changes in drug user participation in treatment, decision-making, and policy in Sweden. What possibilities and obstacles are there for drug users to serve as social change agents? To what extent are drug users able to bring about change in social organizations and institutions—changes that are beneficial from their point of view?

  • 21.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Events as precipitators to treatment: Important for both well-integrated and marginalized alcohol and drug users of a Swedish treatment system2009In: Contemporary Drug Problems, ISSN 0091-4509, E-ISSN 2163-1808, Vol. 36, no 1/2, p. 345-373Article in journal (Refereed)
    Abstract [en]

    "Women and Men in Swedish Alcohol and Drug Treatment" studies how people with alcohol and drug problems come to treatment. The focus is on different alcohol- and drug-related life events in the year prior to treatment and whether or not these events contributed to treatment entry. The importance of these events is also studied in relation to level of marginalization. The representative crosssectional sample includes 1865 clients (71% men) interviewed inperson when entering inpatient and outpatient treatment facilities. Most respondents reported events in the year prior to treatment and these were also perceived as contributors to treatment. Events related to significant others and health workers seem to be of greatest importance for treatment entry. These events happen to a lot of the problematic alcohol and drug users and are viewed as strong contributing factors by the respondents. More marginalized people and misusers with more severe addiction problems experience more events. A curvilinear relationship (somewhat Ushaped) was found between level of marginalization and events as contributors to treatment: the least marginalized people are most likely to report events as contributors, people in between are the least likely and the most marginalized people are likely to report events as contributors to treatment, given that they have experienced the event.

  • 22.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Events in problematic alcohol and drug users’ lives: Contributions to treatment and the impact of marginalizationIn: Article in journal (Refereed)
  • 23.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Frivillig vård är ofta ofrivillig2007In: Socionomen, ISSN 0283-1929, no 2, p. 12-15Article in journal (Other academic)
  • 24.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Gender differences in substance use, problems, social situation and treatment experiences among clients entering addiction treatment in Stockholm2011In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, Vol. 28, no 3, p. 185-209Article in journal (Refereed)
    Abstract [en]

    AIM - While gender differences in substance use/problems have been found to be smaller in more gender-equal countries such as Sweden, gender-specific norms still prevail, and women's (mis)use continues to be more condemned than men's. This article analyses and discusses similarities and differences between the sexes in alcohol and drug treatment in terms of men's and women's treatment experiences, consumption/problems, social situation, and life-domain problems. METHOD - 1865 respondents were interviewed (structured interview) at the beginning of a new treatment episode in 2000-2002 in Stockholm County (sample representative of those starting a new treatment episode for alcohol or drug problems in Stockholm County). Responses are cross-tabulated by sex and multivariate logistic regression is used to predict whether men or women have more severe problems in various life domains of the Addiction Severity Index (ASI composite scores). RESULTS - Bivariate analyses showed that women and men differ significantly in their treatment experiences. Women are more likely to have contact with mental health services, whereas men tend to deal more with the criminal justice system. The sexes do not differ in alcohol and drug problem severity, but women are more likely to have problems with pharmaceuticals. In contrast to the hypothesis, it turned out that men, not women, are more marginalised as concerns housing, income, family situation, lack of friends. Women report more problems related to family, social life and mental/physical health, while men report higher criminality and financial problems. CONCLUSIONS - There are no gender differences among the clients in the treatment system when it comes to substance problem severity but differences occur concerning the clients' social situation and different life-domain problems. As men are more socially exposed a focus on women may obscure problems among men.

  • 25.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Hemlösa och deras sociala nätverk: Convictus Bryggan Citys gäster, deras nätverk, problem, behov och resurser2007Report (Other academic)
  • 26.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    I gränslandet mellan delaktighet och tvång: en sammanfattning av klientstudien i Utvärderingen av Vårdkedjeprojektet (VKP)2008Conference paper (Other (popular science, discussion, etc.))
  • 27.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Implications of enrolment eligibility criteria in alcohol treatment outcome research: generalisability and potential bias in 1- and 6-year outcomes2014In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 33, no 6, p. 604-611Article in journal (Refereed)
    Abstract [en]

    It has been acknowledged that participants in clinical trials differ from real-world service users,primarily due to the extensive use of research eligibility criteria (EC). Generalisability and outcome bias become pressing issueswhen evidence-based treatment guidelines, crystallised from outcome research, influence treatment provision.This study reportson the effects of EC on generalisability and short- and long-term outcomes among real-world treatment-seekers.

    Ten of the most commonly used EC were operationalised and applied to a large representative service user sample(n = 1125) from Stockholm County, Sweden, to determine the percentage of real-world problem alcohol users that would havebeen excluded by each EC and the extent to which EC bias the 1 and 6-year alcohol outcomes.

    Individual EC excluded between 5% and 80% of real-world service users and 96% would have been excluded by at least one EC. Most of the EC introduced a positive/upwards bias in 1- and 6-year outcomes. Most notably, the removal of the unmotivated/non-compliantservice users caused an upwards bias that would considerably boost estimates of treatment effectiveness. Other bias effects weresmaller. Six-year effects were generally higher than for 1 year.

    Outcome studies that excludecomplex and non-compliant cases are not representative of real-world service users, and thus effectiveness estimates from clinicaltrials are biased by several commonly used EC.EC should be used judiciously and be taken into account in practice guidelines.This burgeoning research area should be further developed. [Storbjörk J. Implications of enrolment eligibility criteria inalcohol treatment outcome research: Generalisability and potential bias in 1- and 6-year outcomes.

  • 28.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Inledning2012In: Samhället, alkoholen och drogerna: Politik, konstruktioner och dilemman / [ed] Jessica Storbjörk, Stockholm: Stockholms universitets förlag, 2012, p. 9-13Chapter in book (Other academic)
    Abstract [sv]

    Inledning till en antologi: Hur kan vi förstå alkoholens och drogernas roll i samhället? Hur definieras problemen, hur hanteras de och vilka konsekvenser får detta? Studier kring dessa frågor ger kunskap om moraliska och politiska dilemman, maktförhållanden, strukturer och förändringsprocesser. Frågorna öppnar upp för en diskussion kring gränsdragningar och spänningar i samhället.

    Boken har en samhällsvetenskaplig utgångspunkt och bidrar till ett kritiskt och reflekterande tänkande kring rusmedelsfrågan, en fråga som är alltför komplex för att endast kläs i medicinska termer, vilket ofta skapar en snäv problembild. Antologin behandlar bl.a. politik, sociala konstruktioner, genus, vård och välfärd. Den ger högskolestuderande en god ingång till och överblick över ämnet. Den riktar sig också till andra intressenter såsom yrkesverksamma inom välfärdssektorn, politiker, tjänstemän, journalister, föreningsaktiva, debattörer och den samhällsintresserade medborgaren.

    Tretton forskare vid Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD), Stockholms universitet, medverkar: Maria Abrahamson, Jan Blomqvist, Jenny Cisneros Örnberg, Hanna Enefalk, Evy Gunnarsson, Nina-Katri Gustafsson, Karin Heimdahl, Mona Livholts, Therese Reitan, Filip Roumeliotis, Jessica Storbjörk, Johan Svensson och Jukka Törrönen. Författarna har sin hemvist inom sociologi, socialt arbete, statsvetenskap, historia, psykologi och folkhälsovetenskap.

  • 29.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    ”Jag har hört att du dött några gånger”: vilka gick mot strömmen och blev socialt integrerade?2015In: Nordic Studies on Alcohol and Drugs, ISSN 1458-6126, Vol. 32, no 2, p. 133-135Article in journal (Other academic)
  • 30.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Kvinnor och män i svensk missbruksbehandling:: en beskrivning av personalen inom Stockholms läns landstings beroendevård och deras syn på missbrukarvården år 20012003Report (Other academic)
  • 31.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Missbruk av genus2013In: Social Qrage, ISSN 1404-997X, no 4, p. 33-33Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Fokus på kvinnors specifika problem och vårdbehov i missbruks- och beroendevården kan bidra till att traditionella könsroller cementeras och att såväl kvinnor som män blir utan viktiga hjälpinsatser.

  • 32.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Märkbar tilltro till missbrukarvårdens potential2007In: Medicinsk access, ISSN 1652-9782, no 7, p. 68-71Article in journal (Other academic)
    Abstract [sv]

    Forskningen visar att missbrukarvården ger relativt dåliga resultat (20-40 procent av dem som vårdas är alkoholfria ett år efter behandling) och har inte förbättrats nämnvärt över tid. Trots de smått nedslående resultaten fortsätter jakten på bättre behandlingsmetoder. Jessica Storbjörk, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD), Stockholms universitet, menar i denna artikel att det är viktigt att ta ett steg tillbaka och fundera på om inriktningen – jakten på evidensbaserade metoder – är den ultimata lösningen.

  • 33.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    On the significance of social control: Treatment-entry pressures, self-choice and alcohol and drug dependence criteria one year after treatment2012In: International Journal of Social Welfare, ISSN 1369-6866, E-ISSN 1468-2397, Vol. 21, no 2, p. 160-173Article in journal (Refereed)
    Abstract [en]

    This article explores howself-choice and treatment-entry pressuresare associated with one-year treatment outcome (dependencesymptoms, 0–6, 12 months) among alcohol and drugmisusers, respectively. Informal pressures (from family andfriends), formal pressures (related to work, healthcare, socialservices, social allowances, child custody) and legal pressures(related to the police, criminal justice system, compulsorytreatment) were analysed.A sample (N = 1,210) representativeof the addiction treatment system of Stockholm County wasinterviewed when starting a new treatment episode and afterone year. Regression analyses indicated that self-choice andpressures are associated with outcome among alcohol misusersbut not among drug misusers when controlling for backgroundfactors and severity. Self-choice (without pressures) correlatedwith a good outcome (a lower number of dependence criteria).Pressures were generally associated with poorer outcome.Alcohol misusers who had experienced threats regarding childcustody did better in comparison with those not experiencingsuch pressure. The difference in results by drug type andimplications were discussed.

  • 34.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    One model to rule them all? Governing images in the shadow of the disease model of addiction2018In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 37, no 6, p. 726-728Article in journal (Other academic)
    Abstract [en]

    Treatment providers demonstrate a quite strong support for a disease model of addiction, particularly so in the United States. However, conceptions vary and the problems may be perceived as primarily a disease, moral or social problems, or a combination of these (Barnett et al. in press). This commentary discusses the ongoing and dynamic process of defining addiction problems and notes that non-medical perspectives often appear in the shadow of and tend to oppose the disease model that stands quite inviolable – i.e., like the One Ring to rule them all by citing The Lord of the Rings. Recent changes in the Swedish Addiction treatment system, well known for its social perspective on the nature and handling of addiction problems, are highlighted to demonstrate that the world may be changing, or not. It is argued that there cannot be just one model. 

  • 35.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Oraker till att inte söka vård: En studie i Stockholms läns beroendevård2003In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 20, no 2-3, p. 113-127Article in journal (Refereed)
    Abstract [en]

    This article is part of a larger treatment system study entitled Women and Men in Swedish Alcohol and Drug Treatment carried out in Stockholm County. The goal is to analyse and describe the reasons people have for not entering the healthbased addiction treatment system in Stockholm County. The following questions were raised: What reasons for not seeking treatment did the patients have prior to treatment entry? What are the differences between females and males and alcohol and drug abusers with regard to reasons for not seeking help? The material analysed consists of 942 face-toface interviews with patients entering alcohol and drug treatment units. The analysis is based on nine items about various things that might get in the way of people getting help for an alcohol or drug problem. The majority of the patients (90 %) endorsed at least one of the statements. The three most prevalent reasons for not entering treatment among the patients were that they did not want to stop drinking or using drugs; they were concerned about what others would think; and thought they could handle their problem themselves. Approximately half of the respondents agreed with each of these items. Forty-four per cent did not think their problem was that serious, and therefore had not sought treatment earlier. Treatment scepticism constituted a barrier for 36 per cent of the respondents that did not think treatment would help them. Responsibilities at work are not considered an important barrier to entering treatment as only 22 per cent agreed with this statement. However, when focusing on those who had a job nearly 45 per cent of the respondents agreed with the statement. Thirty-one per cent of the respondents did not enter treatment since they felt they had too many responsibilities at home. Only 7 per cent indicated the reason for not seeking treatment as there was nobody to take care of their children (among those who had children). A present threat to abusers with children seems to be fear of losing custody of their children. Nearly 30 per cent considered this a reason for not entering treatment. The females support five out of nine statements to a significantly greater extent than the men do and also support three of the four remaining statements to a greater extent than the males, although not to a significant degree. There is no doubt that women experience more home- and childrelated barriers to entering treatment. The only difference between alcohol and drug abusers was that alcohol abusers reported unwillingness to stop usage more frequently as a reason for not entering treatment than the drug abusers.

  • 36.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Samhället, alkoholen och drogerna: Politik, konstruktioner och dilemman2012Collection (editor) (Other academic)
    Abstract [sv]

    Antologi.

    Hur kan vi förstå alkoholens och drogernas roll i samhället? Hur definieras problemen, hur hanteras de och vilka konsekvenser får detta? Studier kring dessa frågor ger kunskap om moraliska och politiska dilemman, maktförhållanden, strukturer och förändringsprocesser. Frågorna öppnar upp för en diskussion kring gränsdragningar och spänningar i samhället. Boken har en samhällsvetenskaplig utgångspunkt och bidrar till ett kritiskt och reflekterande tänkande kring rusmedelsfrågan, en fråga som är alltför komplex för att endast kläs i medicinska termer, vilket ofta skapar en snäv problembild. Antologin behandlar bl.a. politik, sociala konstruktioner, genus, vård och välfärd. Den ger högskolestuderande en god ingång till och överblick över ämnet. Den riktar sig också till andra intressenter såsom yrkesverksamma inom välfärdssektorn, politiker, tjänstemän, journalister, föreningsaktiva, debattörer och den samhällsintresserade medborgaren.

    Tretton forskare vid Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD), Stockholms universitet, medverkar: Maria Abrahamson, Jan Blomqvist, Jenny Cisneros Örnberg, Hanna Enefalk, Evy Gunnarsson, Nina-Katri Gustafsson, Karin Heimdahl, Mona Livholts, Therese Reitan, Filip Roumeliotis, Jessica Storbjörk, Johan Svensson och Jukka Törrönen. Författarna har sin hemvist inom sociologi, socialt arbete, statsvetenskap, historia, psykologi och folkhälsovetenskap.

    Se http://www.suforlag.se/1100/1100.asp?id=4112

  • 37.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Skyldigheterna bakom rättigheterna i svensk välfärdslagstiftning2012In: Samhället, alkoholen och drogerna: Politik, konstruktioner och dilemman / [ed] Jessica Storbjörk, Stockholm: Stockholms universitets förlag, 2012, p. 184-215Chapter in book (Other academic)
    Abstract [sv]

    I det här kapitlet diskuterar jag de lagstiftade rättigheter vi medborgare har inom välfärdsområdet. Ur dessa kan vi utläsa vilka skyldigheter vi också har och vad som därigenom karaktäriserar de ”normala” liv vi förväntas eftersträva.Kapitlet berättar om Lasse, en så kallad ”tung missbrukare”. Jag presenterarcentrala delar av den välfärdslagstiftning som människor i Lasses situation ofta berörs av. Vilka rättigheter har Lasse? Vilka villkor och krav på motprestationer kan välfärdsinstitutionerna, enligt gällande lagar och förordningar,ställa på honom? Och vad säger det om vad som förväntas av oss alla i Sverige? Välfärdslagarna utgör ett spänningsfält mellan statens och den enskildes intressen och kan sägas ange den överenskomna och normerande gränsen mellan de beteenden och livsval som av lagstiftaren betraktas som eftersträvansvärda och de som inte gör det. Kapitlet visar att lagarna uppmanaross att ta ansvar, göra rätt för oss, vara skötsamma, aktiva, motiverade att göra något åt våra problem och att solidariskt ta hand om varandra. Välfärdslagarnahar utöver en hjälpande funktion (individskydd) också en disciplinerandefunktion (samhällsskydd). Vi kontrolleras i det här fallet inte genom straffrätten utan genom begränsade och villkorade rättigheter.

  • 38.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stakeholders’ arguments for and against moving Swedish substance abuse treatment to the health care system: How a fat reform proposal became a thin government bill2014In: Nordic Studies on Alcohol and Drugs, ISSN 1458-6126, Vol. 31, no 1, p. 81-110Article in journal (Refereed)
    Abstract [en]

    BACKGROUND - Far-reaching changes in the Swedish substance abuse treatment system (SAT) were proposed by a state-commissioned inquiry in 2011. The proposal implied a break with the social tradition of SAT. It was suggested that the treatment responsibility should be transferred from the municipal social services to the regional-level health care system; and that compulsory treatment in its present form (assessed by/paid for by social services, run by the state) should be abolished and become incorporated into coercive psychiatric care provided by health care. A lively debate arose, and the vast majority of stakeholders sought to articulate their arguments. AIM - The study analysed the development of Swedish SAT by examining the policy process from reform proposal to government bill in 2013. METHOD - Content analysis was used to analyse written comments on the proposal submitted to the Ministry of Health and Social Affairs by close to 200 stakeholders. The goal was to empirically chart and examine the arguments for and against as well as advocates and opponents of the reform. With the government bill at hand, we retrospectively sorted out the winning arguments in the now highly contested SAT field and which actors were able to influence the process. CONCLUSIONS - The article discloses that the mixed response and rather critical voices in most groups, including social/medical professions and government bureaucracy, helped block the responsibility shifts, and that reformations of subsystems like SAT are difficult to carry out as freestanding projects within larger systems of social and health care.

  • 39.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The interplay between perceived self-choice and reported informal, formal and legal pressures in treatment entry2006In: Contemporary Drug Problems, ISSN 0091-4509, E-ISSN 2163-1808, Vol. 33, no 4, p. 611-643Article in journal (Refereed)
    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.

  • 40.
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Vem tvångsvårdas?: Utmärkande drag för tvångsvårdade respektive frivilligt vårdade personer med alkohol- och narkotikaporlbem2010In: Nordisk Alkohol- og narkotikatidsskrift (NAT), ISSN 1455-0725, E-ISSN 1458-6126, Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, Vol. 27, no 1, p. 19-46Article in journal (Refereed)
    Abstract [en]

    The article studies what characterized thosecommitted to compulsory treatment (CT)according to the Care of Alcoholics, Drugabusers and Abusers of Volatile Solvents(Special Provision) Act as compared to thosein voluntary treatment in Stockholm County2001–2002. The aim is to analyze who is inCT by studying which client characteristics(sex, age, drug of choice, consumption, routeof administration, social situation, physicalhealth, incl. municipality) are associatedwith CT. Responses from 361 CT-clients whowere interviewed with DOK (Documentationof Clients) are compared to comparableresponses from 1772 clients in voluntarytreatment from the study Women and Menin Swedish Alcohol and Drug Treatment.Bivariate and multivariate analyses showthat the two groups differ significantly inmany respects. Clients in CT are younger,report more frequent consumption of theirmain drug of choice and an inferior socialsituation (housing, livelihood). An analysisof interaction terms shows that old alcoholmisusers are less likely to be in CT thanyoung drug misusers. Women are not morelikely to be in CT than men. However, CT wasmore often used for women, but not for men,with children under the age of 18 or whowere living with another misuser.

  • 41.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Antonsson, Erik
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The Swedish Addiction Treatment System: Government, Steering and Organisation. Technical Report2019Report (Other academic)
    Abstract [en]

    Welfare systems in Sweden and internationally have gone through major changes regarding modes of operation and means of government in New Public Management (NPM) reforms, which have sought to balance autonomy and control. There is a lively debate about NPM, but research is scarce. NPM indicates improved performances but also unintended consequences and inconsistencies concerning ideas, demands on the services and performance incentives – such as tensions between medical and social professional autonomy and knowledge on the one hand and administrative control, auditing and a growing bureaucracy (e.g., procurement, inspections, documentation) on the other. The research project used addiction treatment with different organisations and professions as a case for studying the impact of NPM on the daily work in regional health care and municipal social services organisations.

    We charted the broad steering and organisation of addiction treatment. We analysed the extent to which tendencies of NPM have conveyed advantages or created conflicting logics by comparing addiction treatment in three regions and six municipalities with varying degrees of NPM. The study used official statistics, documents, interviews and a web survey. A total of 85 interviews were made with 93 individual state, regional and local policy-makers and officials (including the previously unstudied procurers) and public and private care providers (managers and treatment professionals) in 2017–2018. The interviews formed the basis for a web survey among professionals in Sweden in 2019. Purchasing addiction services was further examined by observing a large procurement process, by organising a workshop with Nordic procurement experts, and by interviewing civil servants in Finland, Denmark and Norway.

    The study shows how addiction treatment is governed and organised, highlighting developments over time with special emphasis on various NPM features. The interviews addressed advantages and tensions in the daily work and if and how professionals seek to adapt to new, perhaps inconsistent, demands. The web survey allows for comparisons across organisations and professional groups. This technical report presents the background and aims of the study and describes in detail the Swedish study setting, and the study design, methods and data sources used.

  • 42.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Christophs, Irja
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Milander Yazdanpanah, Sarah
    A study of service user involvement in practice in the Swedish substance abuse treatment system: Methods, participants, and outcomes2016Report (Other academic)
    Abstract [en]

    Demands for service user involvement has a long history in the general health and welfare sectors in Sweden, but user involvement has been lagging behind as concerns substance abuse treatment. “The position of the service user in substance treatment: A study of user involvement in practice” therefore sought to analyze perceptions of user involvement and the extent to which alcohol and drug users in this treatment sector can influence the choice of intervention in their own case. The study included both the perspectives of the service users and their professional service providers. The relationship between user involvement, satisfaction, and outcomes were explored, as well as potential differences in perceptions and experiences between various service user groups and service providers. The study applied a qualitative research approach by interviewing 36 service users and 23 service providers (pairs of service users and providers), and following them up three months later.

    The primary goal of the present technical report was to provide a quantitative exploration of research participant characteristics, user involvement and treatment satisfaction by different groups, including outcomes. The report uses tabular formats as well as several summaries of interview accounts. The report also outlines our theoretical point of departure and detailed information concerning the research methods and methodological considerations.

    [A Swedish summary is available in the report]

  • 43.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Garfield, Joshua B. B.
    Larner, Andrew
    Implications of Eligibility Criteria on the Generalizability of Alcohol and Drug Treatment Outcome Research: A Study of Real-World Treatment Seekers in Sweden and in Australia2017In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 52, no 4, p. 439-450Article in journal (Refereed)
    Abstract [en]

    Background: Clinical studies of alcohol and drug treatment outcomes frequently apply participant eligibility criteria (EC), which may exclude real-world treatment seekers, impairing the representativeness of studied samples. Some research exists on the impact of EC on alcohol treatment seekers. Little is known about drug treatment and country differences. Objectives: We tested and compared the degree to which commonly used EC exclude real-world treatment seekers with problem alcohol and drug use in Sweden and Australia, and compared the impact of EC on outcomes. Methods: Two large naturalistic and comparative service user samples were used. Respondents were recruited in Stockholm County (n = 1,865; data collection 2000–2002), and Victoria and Western Australia (n = 796; in 2012–2013). Follow-up interviews were conducted after 1 year. Cross-tabulations, Chi-square (χ2) tests and logistic regressions were used. Results: Percentages of the samples excluded by individual EC ranged from 5% (lack of education/literacy) to 70% (social instability) among Swedish alcohol cases and from 2% (low alcohol problem severity) to 69% (psychiatric medication) among Australian counterparts; and from 2% (age 60+ years) to 82% (social instability) among Swedish drug cases and from 1% (age 60+ years) to 67% (psychiatric medication) among Australian counterparts. Country differences and differences across substances appeared independent of country effect. Co-morbid psychiatric medication, noncompliance, poly drug use, and low education EC caused positive 1-year outcome bias; whereas female sex and old age introduced negative outcome bias. Conclusions/Importance: Commonly used EC exclude large proportions of treatment seekers. This may impair generalizability of clinical research, and the effects of many EC differ by country and drug type.

  • 44.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Room, Robin
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). University of Melbourne, Australia; AER Centre for Alcohol Policy Research, Australia.
    The two worlds of alcohol problems: Who is in treatment and who is not?2008In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 16, no 1, p. 67-84Article in journal (Refereed)
    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.

  • 45.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Samuelsson, Eva
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences.
    Brukarinflytande på vårdmarknaden: en paradox i missbruks- och beroendevården?2018In: Socialtjänstmarknaden: om marknadsorientering och konkurrensutsättning av individ- och familjeomsorgen / [ed] Marie Sallnäs, Stefan Wiklund, Stockholm: Liber, 2018, p. 85-115Chapter in book (Other academic)
    Abstract [en]

    The chapter deals with service user involvement in addiction treatment and discusses potential conflicts between user involvement and New Public Management (NPM). The chapter addresses how different NPM features – such as public procurement, framework agreements, freedom of choice and performance-based payment models – impact service user and staff discretion as well as service users’ views of their possibility to influence their care in an NPM-inspired treatment system.

  • 46.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    The new privatized market: A question of ideology or pragmatism within the Swedish addiction treatment system?2019In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 53, no 5, p. 776-792Article in journal (Refereed)
    Abstract [en]

    Given its traditions of universal welfarism and social democracy, Sweden had already scored unexpectedly high on New Public Management by the 1980s. Health and welfare services remain primarily tax‐funded, but the production of care is increasingly transferred to a competitive quasi-market. To what extent can this development be understood in terms of right‐wing governments, and to what extent in terms of other, socioeconomic and pragmatic factors? We examined this question through official statistics on providers of institutional addiction care since 1976, and through the total expenditure and purchases by local‐level municipal social services of interventions for substance users in Sweden in 1999, 2004, 2009, and 2014. We have analyzed the distribution across publicand private providers within the addiction treatment system, and whether national developments and local differences across the 290 municipalities—which bear the major treatment responsibility—can be understood in terms of local‐level political majority, population size, and local wealth. The share of purchased services has remained stable, but the treatment system shows increasing financial turnover and an increasing share of for‐profit providers among producers of purchased care, especially in outpatient treatment. While venture capital enterprises emerged as a new actor, non‐governmental organizations lost out in importance. Bourgeois government correlated with larger shares of purchasing and purchases from for‐profit providers. However, purchasing on a market dominated by for‐profit providers has also become the “new normal”, regardless of ideology, and recent years have shown a reversed effect of left‐wing municipalities purchasing more services than right‐wing governments. Pragmatic reasons also influence local‐level purchasing.

  • 47.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Stenius, Kerstin
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). National Institute for Health and Welfare, Finland.
    Why Research Should Pay Attention to Effects of Marketization of Addiction Treatment Systems2019In: Journal of Studies on Alcohol and Drugs, ISSN 1937-1888, E-ISSN 1938-4114, no Supplement 18, p. 31-39Article in journal (Refereed)
    Abstract [en]

    Objective:

    Researchers generally assume that addiction treatment systems can be viewed as entities and planned with the citizens’ best interests in mind. We argue that another steering principle, the market logic, has permeated many Western World treatment systems but is neglected in research. We demonstrate how it may affect system-level planning, service provision, and the service users.

    Method:

    We draw on an ongoing Swedish study, with some Nordic references, using several data sources: (1) public statistics on treatment expenditures and purchases; (2) interviews with service users (n = 36) and their service providers (n = 23) on different market features; (3) an observation of a large public procurement process concluding framework agreements based on competitive tendering; (4) interviews with officials involved with steering of the system and procurement (n = 16); (5) a workshop on procurement in the Nordic countries (n = 11 participants); and (6)77 interviews with professionals, managers, and elected representatives.

    Results:

    We outline seven propositions that call for further research attention: public procurement, as regulated in the European Union, is not suitable for addiction treatment; marketization challenges democracy, equity, needs assessment, and treatment planning; marketization causes new accountability problems and idle monitoring; marketization causes fragmentation and obstructs coordination and continuity of care; marketization causes unification of services and favors big bureaucratically sophisticated providers; treatment professionals’ values are downplayed when a mistrust-based market logic replaces a trust- and needs-based logic; and marketization marginalizes treatment professionals and service users by limiting discretion.

    Conclusions:

    Findings point toward the importance of acknowledging and mitigating market principles in treatment systems to safeguard needs assessments and planning that serve the interests of the service users and the public.

  • 48.
    Storbjörk, Jessica
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Ullman, Sara
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    A prospective study of mortality up to eight years after starting treatment for alcohol and drug problems in Stockholm county: 2000-20082012In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 20, no 5, p. 402-413Article in journal (Refereed)
    Abstract [en]

    Background and aim: Research indicates an association between substance use and premature death and that misuse of illicit drugs is more closely linked to mortality than alcohol misuse. Given that these studies often are based on homogeneous treatment populations, we sought to analyse long-term mortality among both alcohol and drug misusers in a representative treatment system sample by examining: (1) excess death ratios (SMR, standardised mortality ratio) in comparison with the general population and (2) risk factors for mortality within the sample. Method: Prospective study (N = 1659; 28% women) interviewed when starting treatment in Stockholm County, 2000-2002, and followed-up with regard to mortality up to 8 years after baseline. Analyses were based on death certificates and intake interview data (demographics, social situation/support, ICD-10 alcohol/drug dependence, treatment experiences). The strength of the study is the prospective design, that we have been able to link mortality to interview data, and to reach a heterogeneous treatment population. Results: (1) SMR was 5.7 (no sex difference). (2) Logistic regression showed that being older, male, retired and having reported living with a substance misuser were identified as risk factors for mortality within the sample. Housing organised by authorities and no dependence on alcohol/drugs were protective factors. The mortality risk did not differ between alcohol and drug-dependent cases. Neither was homelessness, living situation (3 years) nor education predictive of mortality. Conclusions: No difference regarding mortality risk between treated alcohol and drug-dependent patients in Sweden is found when controlling for age.

  • 49. Trocchio, Sarah
    et al.
    Chassler, Deborah
    Storbjörk, Jessica
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD).
    Delucchi, Kevin
    Witbrodt, Jane
    Lundgren, Lena
    The Association Between Self-Reported Mental Health Status and Alcohol and Drug Abstinence 5 Years Post-Assessment for an Addiction Disorder in U.S. and Swedish Samples2013In: Journal of Addictive Diseases, ISSN 1055-0887, E-ISSN 1545-0848, Vol. 32, no 2, p. 180-193Article in journal (Refereed)
    Abstract [en]

    This study compared whether self-reported mental health status was associated with likelihood of being abstinent from alcohol and drugs five years after baseline assessment for an addiction disorder in two representative samples; one from Sweden (n = 469) and one from the US (n = 667). Self-reported mental health status was measured through the ASI score of mental health symptoms and history of inpatient and/or outpatient treatment. Through logistic regression modeling the study controlled for demographic characteristics including age, gender, employment status and social network connection with individuals who do not use alcohol/drugs. For both the US and Swedish samples employment status and having a social network that does not use alcohol and drugs were associated with being likely to be abstinent from alcohol and drugs five years after initial assessment. For the US sample only, individuals who reported symptoms of anxiety were 50% more likely not to be abstinent from alcohol and drugs at follow-up. For the Swedish sample, current mental health status was not significantly associated with abstinence. However, reporting a lifetime history of inpatient psychiatric treatment at the baseline assessment was significantly associated with not being abstinent at 5 years post assessment; those with a lifetime history of inpatient mental health treatment were 47% less likely to report abstinence. While specific variables differ across Sweden and the US, psychiatric comorbid status, employment and social network are each associated with drug and alcohol abstinence cross-nationally.

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