In the study ''Women and Men in Swedish Alcohol and Drug Treatment,'' it is possible to compare alcohol consumption and problems among respondents in the general population with those in clients entering alcohol treatment. The differences between these groups have led researchers to talk about the ''two worlds'' of alcohol problems -in general and in clinical populations. The aim of this article is to study the relative strength of factors in predicting entering and the clinical population. The studied factors are demographics and marginalization; volume and frequency of drinking; alcohol dependence; social response to drinking (suggestions to cut down or seek treatment by informal actors, e.g. family and friends, and formal actors such as employer, the social services or judicial system); and treatment history. The client sample includes 1202 clients (71% men) interviewed face-to-face when entering inpatient and outpatient treatment facilities in Stockholm. In the general population survey, 3557 persons aged 18-75 years were interviewed. The two samples differ significantly. As expected, clients were older, more marginalized and reported more severe alcohol problems, and many reported previous treatment experiences and social responses. Logistic regression analyses show that previous treatment, unemployment/institutionalization and having an unstable living situation are the strongest predictors of who is in treatment, followed by age, alcohol dependence and frequency of drinking. Formal pressures to cut down or seek treatment are also important and males are more likely to be in treatment. The results support a notion of the treatment system as a place for handling marginalized people, beyond and beside their extent of drinking.

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.

Jessica storbJörkGender differences in substance use, problems, social situation and treatment experiences among clients entering addiction treatment in stockholm

Objective:Researchers generally assume that addiction treatment systems can be viewed as entities and planned with the citizens’ best interests in mind. We argue that another steering principle, the market logic, has permeated many Western World treatment systems but is neglected in research. We demonstrate how it may affect system-level planning, service provision, and the service users.Method:We draw on an ongoing Swedish study, with some Nordic references, using several data sources: (1) public statistics on treatment expenditures and purchases; (2) interviews with service users (n = 36) and their service providers (n = 23) on different market features; (3) an observation of a large public procurement process concluding framework agreements based on competitive tendering; (4) interviews with officials involved with steering of the system and procurement (n = 16); (5) a workshop on procurement in the Nordic countries (n = 11 participants); and (6) 77 interviews with professionals, managers, and elected representatives.Results:We outline seven propositions that call for further research attention: public procurement, as regulated in the European Union, is not suitable for addiction treatment; marketization challenges democracy, equity, needs assessment, and treatment planning; marketization causes new accountability problems and idle monitoring; marketization causes fragmentation and obstructs coordination and continuity of care; marketization causes unification of services and favors big bureaucratically sophisticated providers; treatment professionals’ values are downplayed when a mistrust-based market logic replaces a trust- and needs-based logic; and marketization marginalizes treatment professionals and service users by limiting discretion.Conclusions:Findings point toward the importance of acknowledging and mitigating market principles in treatment systems to safeguard needs assessments and planning that serve the interests of the service users and the public.Objectif :Les chercheurs supposent en général que les systèmes de traitement des dépendances peuvent être considérés comme des entités et que les soins sont planifiés en prenant en compte le plus grand intérêt des citoyens. Nous soutenons qu’un autre principe directeur, la logique de marché, s’est infiltré dans plusieurs systèmes de traitement en occident, mais qu’il a été négligé dans la recherche. Nous en démontrons les impacts sur l’organisation du système de soins, la prestation de services ainsi que les utilisateurs de services.Méthode :Nous nous appuyons sur une étude suédoise en cours ainsi que sur quelques références scandinaves, en utilisant plusieurs sources de données : (a) des statistiques publiques sur les achats et les dépenses liées aux traitements; (b) des entrevues avec des utilisateurs de services (n = 36) et les professionnels qui leur ont procuré des services (n = 23) à propos des différentes caractéristiques du marché; (c) l’observation d’un vaste processus public d’acquisition conduisant à des accords-cadres fondés sur des appels ...

Given its traditions of universal welfarism and social democ- This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.