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.
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.
The welfare state has been found to be highly resilient and protected from retrenchment by institutional and popular support. However, marketization with restructuration of publicly funded health and ...welfare services is changing the composition of service providers in the Nordic welfare model, heavily relying upon public provision. Sweden has been the Nordic country most favourable for the establishment of for-profit private welfare providers. The present article uses the case of residential substance use treatment (SUT) to outline and elaborate upon the mix of public, for-profit and non-profit private providers in Denmark, Finland, Norway and Sweden in 2019–2020. The comparison takes its point of departure in Sweden, which, as expected, presented the biggest and most profit-oriented SUT market. The other countries presented smaller markets, measured by the number of units. Denmark and Norway had the highest presence of NGOs, while Norway stood out with a high share of public provision and few for-profit units. The article identified the market-friendly Sweden, ambivalent Finland, stable, market-regulating Denmark and stable, welfare-corporatist Norway, and investigated the country-specific factors potentially influencing the different developments. Implications for the future development of SUT within the Nordic welfare state were discussed.
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 public and 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.
Introduction and Aims
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 issues when evidence‐based treatment guidelines, crystallised from outcome research, influence treatment provision. This study reports on the effects of EC on generalisability and short‐ and long‐term outcomes among real‐world treatment‐seekers.
Design and Methods
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 have been excluded by each EC and the extent to which EC bias the 1 and 6‐year alcohol outcomes.
Results
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‐compliant service users caused an upwards bias that would considerably boost estimates of treatment effectiveness. Other bias effects were smaller. Six‐year effects were generally higher than for 1 year.
Discussion and Conclusions
Outcome studies that exclude complex and non‐compliant cases are not representative of real‐world service users, and thus effectiveness estimates from clinical trials 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 in alcohol treatment outcome research: Generalisability and potential bias in 1‐ and 6‐year outcomes. Drug Alcohol Rev 2014;33:604–11
Aim:
In increasingly market-oriented welfare regimes, public procurement is one of the most important instruments for 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.
This overview reviews the establishment and evolution of the Centre for Social Research on Alcohol and Drugs (SoRAD). It outlines its current organisation and updated research direction, and ...discusses SoRAD’s future challenges and opportunities. SoRAD was established at Stockholm University to strengthen and support Swedish social science research on alcohol and drugs. It became active in 1999, and quickly grew in research efforts and reputation, while experiencing setbacks around 2006 and 2017. In 2018 SoRAD merged with the Centre for Health Equity Studies (CHESS), to form a new Department of Public Health Sciences. In its new suit, SoRAD acts as a research centre within the teaching department. The research activities on alcohol and other drugs and gambling behaviour and problems may be categorised into four main areas: social epidemiology; subcultures and social worlds of use and heavy use; policy formation, implementation and societal responses; and societal and other collective definitions of problems and solutions. The new arrangements, with an increased staff pool and close interplay with higher education, provide a more stable and long-term platform for achieving the main mission of promoting and developing social science research on addictive substances and behaviours and related problems.
One in a series of commentaries discussing a paper published in the same journal issue by Stan Einstein, 'Peer Workers/Health Counselors: A New Label for a Labeled Population -- A Work-in-Progress ...which may not Progress'. Adapted from the source document.
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