Jan Blomqvist

Treated and Untreated Recovery from Alcohol Misuse: Environmental Influences and Perceived Reasons for Change

This Swedish study compared assisted and unassisted subjects with different long-term drinking outcomes with regard to drinking patterns, significant life events, and attributions as to what initiated and maintained recovery. It was found that both recovery, independent of help-seeking status, and help-seeking, independent of long-term outcome, were preceded by prolonged harmful drinking consequences and increasing negative stress. Initial attempts to solve the drinking problem were followed by a significant reduction in life stress, but stable recovery was uniquely associated with stability and/or major improvements in the life context. Unassisted recovery was more often gradual in character and/ or motivated by positive incentives than assisted recovery. Possible clinical and social-political implications are discussed.

Perceptions of addictions as societal problems in Canada, sweden, Finland and st. Petersburg, Russia.

Aims: This study reports on the relative gravity people attribute to various addictive behaviors with respect to other societal concerns in four northern populations with different history, social policy and treatment alternatives for addicted individuals. Methods: Random population surveys were conducted in Canada, Sweden, Finland and St. Petersburg, Russia. In Finland and Sweden, the survey was conducted by mail, in Canada and St. Petersburg by phone. As a part of this survey, the respondents were asked to assess the gravity of various societal problems, some of which involved various addictive behaviors. The data were analyzed by descriptive statistical methods, factor analysis, contextual analysis and multiple regression analysis. Results: Hard drugs, criminality and environmental issues belonged to the topmost problems in all data samples. Overall, Finns and Canadians appeared the least worried about various societal problems, Swedes seemed the most worried and St. Petersburgian views were the most polarized. Two factors were extracted from the combined data. Factor 1 covered criminal behavior and various addictions; it was named Threats to Safety factor. Factor 2 comprised social equality issues. The country context explained 12.5% of the variance of the safety factor and 7.9% of the equality factor. Conclusions: Despite some cultural variation in the gravity assessments, the central core of the social representation of addictive behaviors tends still to be linked with ‘badness’ since they were mainly grouped with various forms of criminal behavior in all these countries.

Maturing Out of Drinking Problems : Perceptions of Natural History as a Function of Severity

This study tested the hypothesis that maturing out descriptions of change were more common among respondents whose drinking problems were less severe prior to reduction and that consequence driven changes were more common among those who had a lifetime diagnosis of alcohol dependence, prior to resolution. As part of a general population telephone survey, former heavy drinkers were asked their reasons for change. These responses were tape-recorded, transcribed and then coded into three categories – consequence driven reasons, drifting out reasons and reflective maturational reasons. As predicted, drifting out reasons were more often provided by those with less severe alcohol use and consequence related reasons appeared associated with respondents who had had more severe alcohol problems. The differing descriptions of pathways to change observed in natural history studies may be the result of research that captures only partial samples of the larger population of former heavy drinkers.

'More cure and less control' or 'more care and lower costs'? Recent changes in services for problem drug users in Stockholm and Sweden

This article deals with the development of drug services in Stockholm, Sweden since the mid-1990s. Initially, data were collected as part of a European Union comparative study of the development of drug services in six major European cities. However, the present article uses these data to analyse to what extent the traditional ‘Swedish model’ of dealing with narcotic drugs can be said to have come to a crossroad. The article describes and analyses changes in drug use, and in the structure, organization and utilization of social services based, as well as healthcare-based drug services in Stockholm during the past decade. As pointed out in the article, the ‘drug-free society’ is still the ultimate goal of Swedish drug policy. However, as the Stockholm example hints, when it comes to the care and treatment of individual drug problems, there seems to be an on-going shift, from in-patient treatment towards measures such as substitution treatment, outpatient care and housing. The article discusses whether these changes signify a softening of Swedens restrictive drug policy, or whether they rather point to a ‘re-medicalization’ of drug services, and shift in focus from ‘cure’ and social re-integration towards a focus on ‘care’ and on attempts to avoid ‘public nuisance’.

Moving away from addiction : forces, processes and context

This special issue of Addiction Research and Theory contains a selection of papers which explore the influences and mechanisms which are involved when people manage to overcome various addictions or ‘‘excessive appetites’’, whether to alcohol, drugs, gambling or other experiences. Some of the papers deal exclusively with people who moved away from their addictions without submitting themselves to be managed by others, whereas others include formal ‘‘treatment’’ among the forces potentially conducive of changing one’s life-style. Taken together, they strongly indicate that the routes both into and out of destructive habitual repetitive behaviours are diverse and many layered, and suggest that our responses to people who find themselves in such difficulties should be similar. In the days when authors such as Les Drew (1968) and Lee Robins et al. (1980) first drew attention to the fact that people quite often find paths out of their addiction without the help of treatment or other formal interventions, these reports were seen as presenting an unwarranted challenge to widely held beliefs and as a threat against strong vested interests in the policy and treatment fields. Since then much water has passed under the bridge. Increasing evidence of the occurrence of so called ‘‘spontaneous recoveries’’ has gathered over time, and by the traditional disease models have been mutated or abandoned to leave room for other perspectives. Today, research and policy is to a large part guided by the new public health paradigm, Addiction Research & Theory, 2002, Vol. 10, No. 2, pp. 115–118

Perceptions of addiction and recovery in Sweden: The influence of respondent characteristics

Respondents to a representative population survey were asked to rate four psychoactive substances (tobacco, alcohol, cannabis and ‘hard’ drugs) with regard to their severity to society and addictiveness, as well as the options for recovery, with and without treatment, from an addiction to the same substances. This article explores if and how these ratings differ with regard to respondents’ socio-demographic characteristics, their own and close persons’ substance use experiences, and, their attitudes towards people with substance use problems. Data were analysed using descriptive statistics and logistic or linear regressions. Although the main difference goes between respondents’ perceptions of various substances and addictions, the results also point to some interesting differences with regard to respondents’ experiences and characteristics. Thus for example, women and respondents with no personal substance use experiences, tend to play up the severity and addictiveness of most substances, and to play down the options for untreated recovery from an addiction, whereas current risk users tend to take an opposite view. Main interpretations are that there is a general tendency to exaggerate the hazards of and risks with habits that are perceived as unfamiliar and alien, that current risk users at the same time dwell on a ‘false hope’ of being able to quit, and that women are, for various reasons, more inclined than men to worry about their own substance use habits, as well as those in their close environment. Potential implications, for further research as well as for policy and prevention, are discussed.

Characteristics of former heavy drinkers : results from a natural history of drinking general population survey

This study explored the factors associated with reduction from heavy drinking among three groups: current abstinent, moderate, and reduced drinkers. A random-digit-dialing telephone survey was conducted of 3,006 respondents in Ontario, Canada. Of these, 470 respondents (46% female) met criteria as former heavy drinkers (99 abstinent; 237 moderate; 134 reduced but not moderate drinkers). Quantitative and qualitative questions were used to explore current and past drinking, use of treatment, and reasons for change. Qualitative items were tape-recorded and transcribed. Respondents in the abstinent group had more severe problems prior to resolution as compared with those in the moderate group. Reduced drinkers displayed a prior alcohol severity at a level between these two other groups. The most common reasons for change in all groups were new responsibilities, maturation, and health concerns. This study serves as a useful adjunct to other natural-history research, exploring the reasons for change in a representative sample of former heavy drinkers.

How should substance use problems be handled? Popular views in Sweden, Finland, and Canada

Purpose – Although the way in which, for example, substance use problems are conceived and reacted to (by experts and treatment professionals but also by the environment), can have vast consequence ...

Self-Change from Alcohol and Drug Abuse: Often-Cited Classics

As maintained by Toulmin [1], a certain event or condition can appear as a phenomenon — something that is problematic and needs explaining — only against the background of some inferred’ state of natural order’. This proposition is worth bearing in mind when revisiting and trying to summarize the key findings and major implications of some of the studies that have historically been most often cited in the debate over the existence, incidence, and character of self-change from addictive behavior. Admittedly, the selection of studies for the following brief review has by necessity been somewhat arbitrary. Nonetheless, it is evident that the vast majority of what may be termed the ‘classics’ in this field originated in the USA, in the 1960s and 1970s. To some extent this may be explained by the dominance, in a global perspective, of American alcohol and drug research at the time. However, the attention paid to these studies and the controversy raised by the issue of self-change may also be reflective of a cultural setting particularly conducive to making this topic stand out. Through the influence of the alcohol movement, the popular ‘disease model’ of drinking problems had by the early 1960s become an almost uncontested foundation for alcohol research as well as policy in the USA [2]. According to this model, alcoholism is an irreversible and inexorably progressive process, due to some inborn characteristics in certain people. Similarly, but for different reasons, narcotic drugs (i.e. at the time, opium and its derivatives) were assumed to have chemical properties making them capable of enslaving users, more or less instantly and for life.

“Yes, I've Received Treatment”: What Does This Mean in the Context of Epidemiological Surveys for Alcohol Problems?:

Aim: To assess what it means when respondents say they have received treatment on population surveys. Method: Former heavy drinkers recruited through a random digit dialing telephone survey were asked about the type, time, and amount of treatment they had received. Results: When respondents indicated that they had received treatment, it appeared that they had a specific treatment in mind, that they completed the treatment program, and that, for the majority, treatment occurred at roughly the same time as their successful change from heavy drinking. The congruence between age of change and age of treatment use appeared greater among respondents with abstinent versus reduced-drinking recoveries.