The aim of this paper is to show how staff in the Stockholm County treatment system view the responsibility of the individual in connection to alcohol and drug dependency and the nature of alcohol and drug problems, shown in a self-administered questionnaire. The empirical data is analysed with the help of the theoretical model developed by Brickman et al. (1982) and the analysis is also a test of this theoretical model.The results show that staff view the clients as partially responsible for becoming alcohol or drug dependent and fully responsible for resolving the problem -a somewhat moral view. Staff also comply with the disease concept and the idea of alcohol and drug problems as mainly social problems. They do not agree to the same extent to their clients being weak-willed. Support can be found both for a moral, medical and social view among staff.

The Treatment‐systems Research on European Addiction Treatment study (TREAT‐project) is a longitudinal multicenter study on predominantly opioid‐dependent patients and their health‐care system in six European cities. As part of the examination of the drug services, this study evaluates level of burnout, coping strategies, perceived self‐efficacy and job satisfaction among health‐care workers treating opioid addicts. Employees were recruited from organizations in Athens, London, Padua, Stockholm, Zurich and Essen. The Maslach burnout inventory, Brief COPE, general self‐efficacy questionnaire and a job satisfaction scale were filled in by about 383 drug service workers. One‐third of the staff suffer from severe burnout. London and Stockholm colleagues are significantly more burdened than Zurich personnel where job satisfaction is highest. No cross‐national differences could be detected concerning coping styles or level of perceived self‐efficacy. Burnout is positively correlated to passive coping strategies and negatively linked to self‐efficacy and job satisfaction. Males experience more depersonalization. Organizational features such as the entry‐threshold level of the institution or out‐ vs. inpatient setting are relevant for coping strategies and job satisfaction. These and other findings are discussed in relation to preliminary data from the TREAT‐project on characteristics of opioid addicted patients and other specific features of the drug treatment system. Copyright © 2009 John Wiley & Sons, Ltd.

In the year 2000, 804 adults were in coercive care for a maximum of 6 months under the Swedish Act on Care of Addicts in Certain Cases, which has both paternalistic and utilitarian motives. The extensive rights of the state to intervene in the private lives of its citizens seem to have a solid support in society. The article describes the present system and offers some explanations for its acceptance by looking at history. The fact that compulsory decisions have been made within the social administration has meant that such measures grew with the welfare system and could benefit from its goodwill. The medical profession provided motivation for preventive compulsory measures for social or individual reasons and gave hope for a cure. The crucial involvement of laypersons and non-governmental organisations in decision-making and provision of compulsory treatment has given compulsory treatment a high political legitimacy. Compulsion became ‘internalised’ in the Swedish society. The economic and political liberalisation of today may pose a threat to the Swedish compulsory treatment of substance misusers.

The focus on difference between men and women has been important in the development of gender-specific treatment for alcohol and drug problems. The aim of this article is to examine the views of alcohol and drug treatment staff on differences between men and women in treatment and compare men and women in treatment on issues related to staff attitudes. One data set consists of questionnaires sent to staff working with alcohol and drug problems in Stockholm County (n = 918). Another data set consists of interviews with women and men in treatment for alcohol and drug problems in Stockholm (n = 1865). The results show that staff experience differences between men and women both in their problems and in how they should be treated. Some of these differences are supported by the comparison of women and men in the client-data, but mostly the differences are relatively small or even non-existent.

The Swedish handling of drug users includes compulsory treatment (CT) for up to 6 months. Social services play a key role in the decisions about when and for whom CT is used. In this paper the aim is to get an understanding of how social workers reason about the use of CT through looking at the goals they set for their clients and how they are to be reached. Why they reason the way they do is a central question in the analysis as well as in the long term understanding of why Sweden uses CT. The social worker comments are contrasted against three principles central to modern society; the principle of liberty emphazising the autonomy of the individual, the egalitarian principle of social justice linked to paternalism and the utilitarian principle focused on maximizing happiness. The data used in this analysis comes from interviews with social workers and observations of meetings with clients as well as other professionals in 6 municipalities in Sweden. Central goals for the social workers are that the client takes responsibility for her/his life (autonomy) and total rehabilitation (abstinence). However, their possibilities of reaching these goals are limited, and therefore they have modified them (a bearable life for the old and total rehabilitation for the young clients). The means to achieve these goals are ambitious treatment for the young and low threshold interventions for the old, in theory excluding CT for both groups. However, obstacles are identified also for these goals which allows for CT to be an alternative. Financial issues and expectations on social services also play a part in the understanding. Further the analysis shows the importance of the egalitarian principle and a strong paternalism, which minimizes the role of the liberty principle.