Moral concerns - Treatment staff and user perspectives on alcohol and drug problems

Sammanfattning: Constructions of alcohol and drug problems, as well as of treatment, show a great variation that can be understood from the perspective of societal needs to categorize individuals as deviant. The thesis deals with contemporary perspectives, among staff in treatment of alcohol and drug problems and a group of drug users, on alcohol and drug problems and how these problems should be handled in the public sphere. The thesis consists of four papers covering: (1) views of treatment staff on alcohol and drug problems, (2) views of treatment staff on gender issues, (3) views of treatment staff on priorities of client groups and (4) views on the “user” from the point of a union for drug users. The first three papers use questionnaire-data from a treatment systems study in Stockholm County. The first and third papers deal with questions directed to treatment staff whereas the second paper besides staff data analyses data from interviews with 1865 individuals entering treatment for alcohol and drug problems. The fourth paper is a discourse analysis of texts written by the Swedish users union.The results shows that staff see alcohol and drug problems as social problems, diseases and moral problems. Staff also perceive men and women in treatment as different, both in terms of their problems and their treatment. These experienced differences were supported by comparisons between men and women in treatment in a few cases, but mostly differences were not that great or did not appear at all. When staff were asked to make priorities between groups of clients they seem to take past actions of the clients into account rather than using the egalitarian reasoning regulating priorities in official documents. Taking past actions into account indicates a moral approach to alcohol and drug problems. The analysis of the Swedish users union also points at a moral perspective on drug problems in the dominating drug policy discourse, pronounced in the opposition of the union. In this opposition the union constructs the user as a “consumer”, as “weak”, “sick” and “innocent”. The union shows signs of a human rights perspective, a public health perspective and a disease perspective as well as a direct opposition to the perspective of the user as a criminal.Seen together the papers show the importance of categorizing subjects for and in treatment as well as the constructed nature of alcohol and drug problems. A moral perspective seems to be the base for many categorizations (distinguishing between normal and deviant as well as between more and less culpable “troubled persons”) and is not as clearly in conflict with medical and social perspectives as one might expect. The thesis also indicates a strengthened medical approach with connections to individualisation of problems and market orientation. To classify a certain group of individuals as deviants is important for our construction of normality and inclusiveness, whether the deviance is in terms of illness or moral failure. Treatment of deviance can be seen as a manifestation and reproduction of this categorization and research on treatment and deviance plays an important part in this process.