Recognition and Treatment of Problem Substance Use: A Factorial Survey of Social Workers', Nurses' and Doctors' Judgements

The “governing images” associated with the use and misuse of alcohol and drugs have varied across time and space. In Sweden, the 20th century saw a number of such perspectives – including the moral, the medical and the social – alternately dominating or coexisting. This multitude in perspectives is reflected in the organisation of addiction care and treatment, in which the responsibility for defining and finding solutions to addiction problems has of tradition been shared between the social services and the health care, and between the professions that are employed in the two organizations. Recently, a Government Official Report (2011:35) suggested that the responsibility for treatment should be fully transferred to the health care system – a proposal which is not only associated with professional jurisdiction, but which may also have consequences for potential clients in terms of how their problems are defined and what help is offered. With the aim to systematically compare judgements about the recognition and treatment of problematic substance use between social workers (employed in the social services) and nurses and medical doctors (employed in the health care), this study will use data from a factorial survey which was conducted in 2012 among 328 staff at 50 social services units and 24 health care units in Sweden. In line with this quasi-experimental method, each respondent assessed ten vignettes, describing people with randomly varying social characteristics using alcohol, cannabis or cocaine. Multilevel regression analysis will be used in order to investigate similarities and differences in social workers’ and nurses’/ doctors’ judgements about the severity of use and the proper handling of the cases described