Tvingad till vård : missbrukares syn på LVM, motivation och egna möjligheter

Compulsory treatment is regulated by the Care of Alcoholics and Drug Abusers Act (LVM; 1988:870), and aims, among other things, at motivating addicts to treatment. Research has, up til now, mostly disregarded the client-perspective on compulsory measures. This dissertation has its starting point in the experiences of 54 alcohol- and drug addicts. The intention is to describe and analyse their view on coercive care and the possibilities to become motivated for change and/or voluntary treatment in such a context. A central question during the interviews (which took place at five different institutions for compulsory commitments) is the addicts´ problem recognition, desire for help and willingness to participate in treatment. These dimensions are also illuminated quantitatively by use of a questionnaire. The results of this questionnaire form the basis of a division of the addicts into three groups with varying de-gree of treatment motivation. Comparisons between the groups are done with reference to the evaluation of present treatment context and of the institutions’ efforts to enhance motivation. In addition to this the groups are compared regarding how they perceive limita-tions in their freedom of action. The results showed that the three groups had different motiva-tional structures. The “least motivated” stated that the addiction was not their major problem and wanted no help with that aspect of their lives. The “middle-group” claimed to have alcohol-/drug problems that, however, were not too serious. They were not sure that the coercive care was adequate for their situation. The “most motivated” said that they had vast problems with their addiction, were help-seeking and satisfied with having the chance to participate in any kind of treatment program at all. Less differences between the groups were noticeable when it came to a direct evaluation of com-pulsory treatment. The majority reported that they, through the co-ercion, had been exposed to violations of their autonomy. Whether motivated for treatment or not, the interviewees were also sceptical about the possibilities of the institutions to enhance motivation among the incarcerated addicts. In the dissertation, addiction and motivation is furthermore dis-cussed from the perspective of rational choice and motivational the-ory. It is concluded that committed addicts think and act strategically in order to maximise their personal use of involuntary incarcerations. It is also asserted that their view on what happens during commit-ment, in some respects, is opposed to the “establishment’s”. For instance, the addicts claim that you don’t become motivated by way of compulsory treatment, while the opposite of their notion form the basis of the legislation