Hildegunn Sagvaag

Addiction, families and treatment: A critical realist search for theories that can improve practice

Abstract The stress–strain-coping-support (SSCS) model and the social-ecological (SE) model were analysed in a search for theories that can serve as a foundation for improving the assistance and support provided to families affected by addiction and alcohol and drug (AOD) problems. The basis for the analyses was a critical realist one, viewing addiction as a multilayered and necessarily laminated phenomenon. The two models approach two different layers of reality: the SSCS model highlights the importance of dealing with mechanisms at the psychological level for affected family members, while the SE model emphasizes the importance of intervening in relationships and systems at the social level of reality. Both models are highlighted as essential for dealing with the complexity of the phenomenon of addiction in families: the SSCS model by providing agency for a neglected group of affected family members and developing a method to address their needs, and the SE model by advocating the relative position of social solutions in the field of AOD treatment and developing a framework for conducting joint sessions and family therapy. Both models and their respective practical guidelines for interventions could work in a complementary way in a clinical setting, as useful tools in different types of case and at different stages of treatment – combining the level and emergence in the interaction between agency and structure – for the betterment of families and individuals.

Who initiates and organises situations for work-related alcohol use? The WIRUS culture study

Aims: Alcohol is one of the leading causes of ill health and premature death in the world. Several studies indicate that working life might influence employees’ alcohol consumption and drinking patterns. The aim of this study was to explore work-related drinking situations, with a special focus on answering who initiates and organises these situations. Methods: Data were collected through semi-structured group interviews in six Norwegian companies from the private (n=4) and public sectors (n=2), employing a total of 3850 employees. The informants (n=43) were representatives from management and local unions, safety officers, advisers from the social insurance office and human-resource personnel, health, safety and environment personnel, and members from the occupational environment committee. Both qualitative and quantitative content analyses were applied in the analyses of the material. Results: Three different initiators and organisers were discovered: the employer, employees and external organisers. External organisers included customers, suppliers, collaborators, sponsors, subcontractors, different unions and employers’ organisations. The employer organised more than half of the situations; external organisers were responsible for more than a quarter. The differences between companies were mostly due to the extent of external organisers. Conclusions: The employer initiates and organises most situations for work-related alcohol use. However, exposure to such situations seems to depend on how many external relations the company has. These aspects should be taken into account when workplace health-promotion initiatives are planned.

The influence of alcohol consumption on sickness presenteeism and impaired daily activities. The WIRUS screening study

Background Alcohol use is a global health issue and may influence activity performance in a variety of domains, including the occupational and domestic spheres. The aim of the study was to examine the influence of annual drinking frequency and binge drinking (≥6 units at one occasion) on activity impairments both at work (sickness presenteeism) and outside the workplace. Methods Employees (n = 3278), recruited from 14 Norwegian private and public companies, responded to a questionnaire containing questions from the Alcohol Use Disorders Identification Test (AUDIT) and the Workplace Productivity and Activity Impairment questionnaire (WPAI). Results Multiple hierarchical regression analyses revealed that binge drinking was associated with both sickness presenteeism and impaired daily activities, even after controlling for gender, age, educational level, living status and employment sector. Annual drinking frequency was associated with impaired daily activities, but not sickness presenteeism. Conclusions Binge drinking seems to have a stronger influence on activity performance both at work and outside the workplace than drinking frequency. Interventions targeting alcohol consumption should benefit from focusing on binge drinking behavior.

Women, work and wine

Aims There are many grey zones between work and leisure time, where colleagues drink together. Managers are more often involved in grey-zone situations than other employees, and the managerial arena is dominated by men. What is the significance of female managers’ visibility in their understanding of their own consumption of alcohol? What leads female managersto moderate their work-related alcohol consumption? Data and Methods To capture the female managers’ perspectives, we conducted 13 in-depth interviews. The female managers represented various kinds of work within care or nursing, media or publishing, public administration and commodity trading. Results The female managers’ reflections and experiences of consuming alcohol in grey zones explain how their heightened visibility as women leads them to moderate their alcohol consumption. Three themes were especially salient: (1) need to be in control, (2) concern about stigmatisation, and (3) life stages marked with caring tasks. Conclusions The results show the importance of external factors in work-related drinking. Womens visibility is significant in relation to cultural dimensions, moderating work-related drinking even when women are managers. The women place demands upon themselves based on their own conceptions of others’ expectations of female managers.

The First Six Years of Building and Implementing a Return-to-Work Service for Patients with Acquired Brain Injury. The Rapid-Return-to-Work-Cohort-Study

Background and objective Despite large activity worldwide in building and implementing new return-to-work (RTW) services, few studies have focused on how such implementation processes develop. The aim of this study was to examine the development in patient and service characteristics the first six years of implementing a RTW service for persons with acquired brain injury (ABI). Methods The study was designed as a cohort study (n=189). Data were collected by questionnaires, filled out by the service providers. The material was divided into, and analyzed with, two implementation phases. Non-parametrical statistical methods and hierarchical regression analyses were applied on the material. Results The number of patients increased significantly, and the patient group became more homogeneous. Both the duration of the service, and the number of consultations and group session days were significantly reduced. Conclusion The patient group became more homogenous, but also significantly larger during the first six years of building the RTW service. At the same time, the duration of the service decreased. This study therefore questions if there is a lack of consensus on the intensity of work rehabilitation for this group.

Empowerment and pathologization: A case study in Norwegian mental health and substance abuse services

Service user involvement in service development and research is an international goal. However, research illuminating the patient stakeholder role is limited.

“A Problem Like This Is Not Owned by an Individual”: Affected Family Members Negotiating Positions in Alcohol and Other Drug Treatment

The main aim of this article is to explore the dynamics of encounters between treatment institutions and families dealing with substance use. What kind of possibilities do such encounters offer, and what kind of processes do they facilitate? Based on interviews with 10 families recruited from three alcohol and other drug treatment centers in Norway, positioning theory is used as an analytical tool to address the dynamics and negotiation (1) between service providers and families when it comes to the possibilities for treatment and support and (2) between family members during the course of treatment. Three main storylines are analyzed in interviews with families about encounters with treatment: (1) the medical storyline, (2) storylines of autonomy, and (3) storylines of connection. These storylines positioned affected family members, respectively, as outsiders, as in need of help in their own right, and as part of an affected family. The medical storyline is revealed as being insufficient to deal with the problems associated with substance use—it needs to be extended by family-involving storylines facilitating processes of reintegration and repositioning within families.

Stuck in limbo: illicit drug users’ experiences with opioid maintenance treatment and the relation to recovery

Objective The objective of this article is to gain insight into how individuals who frequent open illicit drug scenes experience opioid maintenance treatment (OMT) and investigate how this appears to affect their recovery processes. Method By means of the ethnographic method, one of the researchers spent time in an open illicit drug scene over a 1-year span, and gathered data on individuals who frequent the scene on a regular basis, and their experiences with OMT. The data are based on field notes and audiotaped interviews. Findings Four themes emerged as relevant for the participants’ experiences with OMT: 1) the loss of hope, 2) trapped in OMT, 3) substitution treatment is not enough, and 4) stigmatization of identity. Conclusion The participants found the OMT to be overruling and degrading. Several of the individuals from the illicit drug scene are part of the OMT programme, but as the treatment does not remove painful emotions, they supplement OMT with illegal substances, violate the OMT regulations, and run the risk of being excluded from the programme. In fear of losing the replacement opioid, they conceal parts of the addiction they seek treatment for and end up lying and cheating instead of exploring strategies for reducing and managing the addiction. The patients’ relation to the OMT personnel is negatively affected by the need to hide a large portion of their issues. The result is a feeling of hopelessness, increased stigmatization, lack of control and being trapped between two worlds—in limbo, an intermediate state which interferes with the recovery process.