The social ecology of alcohol and drug treatment : Client experiences in context

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