Controlling Drug Users: Forms of Power and Behavioural Regulation in Drug Treatment Services

Bacon, Matthew; Seddon, Toby

doi:10.1093/bjc/azz055

Cited by 6 publications

(14 citation statements)

References 25 publications

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“…People who need substantial change and development to manage their everyday lives and overcome the psychosocial consequences of SUD, often require specialised inpatient treatment [ 24 , 25 , 26 , 27 ]. People with SUD have long been the subject of controlling measures in society in general, and in SUD treatment in particular [ 28 , 29 ], and the environment at the services to which people refer to undergo vast change processes, such as inpatient SUD treatment, is tightly controlled [ 30 ]. The treatment practice and the service staff that undertake it perform an essential function in, and exert a profound influence on, inpatients’ everyday lives and their change processes [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Work-Related Satisfaction among Clinicians Working at Inpatient Treatment Facilities for Substance Use Disorder: The Role of Recovery Orientation

Johannessen

Nordfjærn

Geirdal

2021

IJERPH

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Several psychosocial factors have been suggested as facilitators of change among inpatients treated for substance use disorder (SUD). Research suggests that staff members are also influenced by the practice in which they are involved, and by contextual psychosocial factors at their treatment facilities. This cross-sectional questionnaire survey study was conducted to investigate the role of recovery-orientated interventions in describing work-related satisfaction among clinicians at inpatient SUD treatment facilities. The respondents (n = 407) rated items indicating work-related satisfaction and the degree of recovery orientation at their treatment facilities. The main findings of two block regression analyses indicated that clinicians’ work-related satisfaction was positively influenced by inpatients’ opportunities to pursue their goals and choices, and negatively influenced by inpatient involvement. The change in clinicians’ work-related satisfaction could not be described by the degree of individually tailored and varied interventions at the treatment facility. Clinicians should be supported and involved in the process of implementing measures to increase inpatient involvement in the treatment programmes, and treatment measures that enable inpatients to pursue their goals and choices should be enhanced. The findings of this and previous studies indicate that a recovery-oriented framework promotes clinicians’ work-related satisfaction and has an enabling influence on both inpatients and clinicians.

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Section: Introductionmentioning

confidence: 99%

Work-Related Satisfaction among Clinicians Working at Inpatient Treatment Facilities for Substance Use Disorder: The Role of Recovery Orientation

Johannessen

Nordfjærn

Geirdal

2021

IJERPH

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“…As a result of the strict regulatory framework surrounding OST, the work of OST professionals requires an ability to combine both control and supportive functions. A number of studies have examined OST clinics’ perceptions with regard to this duality (see, e.g., Bacon & Seddon, 2020 ; Lilly et al, 1999 ; Petersson, 2013a , 2013b ). Lilly et al (1999) have argued that there is a tension between the roles of being “gatekeepers” for methadone, and counsellors, since there is some level of conflict between the two.…”

Section: Control and Power Imbalance In Ostmentioning

confidence: 99%

“…However, staff reported wanting to develop working methods that were able to integrate these two areas of responsibility. A study by Bacon and Seddon (2020) examined how control was exercised in substance use treatment, both in OST and in non-pharmaceutical treatment provision. For OST staff, there is an element of control in the treatment, and a clear power imbalance between staff and patients.…”

Section: Control and Power Imbalance In Ostmentioning

confidence: 99%

“…For OST staff, there is an element of control in the treatment, and a clear power imbalance between staff and patients. Decisions relating to the provision of and restrictions regarding methadone emerged in the study as a particularly potent means of exercising power, e.g., withholding methadone in the case of lateness or intoxication ( Bacon & Seddon, 2020 ). Petersson (2013b) also notes the unequal power relations between patients and treatment staff in a Swedish study of patient and staff experiences of everyday practice at OST clinics.…”

Section: Control and Power Imbalance In Ostmentioning

confidence: 99%

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A transition of power in opioid substitution treatment: Clinic managers' views on the consequences of a patient choice reform

Andersson

2022

Nordic Studies on Alcohol and Drugs

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Objectives: Opioid substitution treatment (OST) is often described as a strict and highly regulated treatment method, in which patients have limited influence over their treatment. In 2014, a reform was introduced by the regional council of Skåne in southern Sweden, which allowed OST patients to choose their treatment provider, thus transferring power from care providers to patients. The aim of this study was to examine what this increase in patient influence has meant for the clinics that provide OST in Skåne, and how these clinics have dealt with the new competitive situation that has arisen following the introduction of the reform. Methods: The study is based on two waves of semi-structured interviews with clinic managers at all OST clinics in Skåne. Results: The clinic managers described the increase in patient influence as a positive change, which had led to the patients being treated with more respect. The competition among clinics was expressed, among other things, in the form of differing views on the prescription of benzodiazepines, which initially gave rise to dissatisfaction among clinics with a more restrictive approach to such prescriptions. The reform did not lead to any clear diversity between clinics, apart from different approaches to the prescription of benzodiazepines. The incentive for competition-based diversity is, however, limited by the strict national regulatory system and by the reimbursement system, which restricts the ways in which clinics can conduct treatment activities. Conclusion: OST-clinic managers were largely positive about the increased patient empowerment and the shift in power balance associated with the patient choice reform. The introduction of the reform did not lead to any clear diversity between treatment providers, apart from differing views on the prescription of benzodiazepines, which by some managers was regarded as unfair competition.

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“…In particular, Bourgois (2000) illustrates the debilitating effects of OST documenting negative impacts on self-esteem and the collapse of relationships among OST clients. Making reference to indicators of socioeconomic disadvantage, such as the high rates of unemployment and low income commonly associated with the drug treatment population (Jones et al 2007), Bacon and Seddon (2019) also suggest that drug treatment has become another tool to regulate the poor. Moreover, OST has been criticised for "parking" patients by inner city pharmacists that are tasked with supervising consumption (Bryan 2013).…”

Section: Situating the Treatment Experiences Of Ous: Negative Portrayals And Contempt Within Drug Treatment Policymentioning

confidence: 99%

A history of abuse: Documenting the harms experienced by the “Trainspotting generation”

Weston

2021

OSLS

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The story of the past 40 years has been the relentless hollowing-out of industrial Britain leading to long-term unemployment and discarded generations that have been excluded socially and economically (Pearson 1987a, 1987b, Buchanan and Young 2000). In an attempt to block out these harsh social and economic realities of their lives, the youth of the 80s and 90s turned to heroin (Buchanan and Wyke 1987). By adopting a social harm approach to the analysis of semi-structured interviews with twelve opiate users (OUs), I argue that the problems often associated with drug use – experiences of stigmatisation, unemployment, and physical and mental health – might be best understood as harms resulting from a reductionist discourse that misrepresents drugs and drug users as a threat to society and focuses treatment on reducing the risks that OUs pose rather than enhancing the social resources necessary for human flourishing. La historia de los últimos 40 años ha sido el incesante desmantelamiento de la Gran Bretaña industrial hacia el desempleo de larga duración y las generaciones descartadas que han sido excluidas social y económicamente (Pearson 1987a, 1987b, Buchanan y Young 2000). En un intento de bloquear estas duras realidades sociales y económicas de sus vidas, los jóvenes de los 80 y los 90 recurrieron a la heroína (Buchanan y Wyke 1987). A partir de un abordaje de daño social para el análisis de entrevistas semiestructuradas con doce usuarios de opiáceos, aduzco que los problemas comúnmente asociados al consumo de drogas –experiencias de estigmatización, desempleo, y salud física y mental– podrían entenderse mejor como daños resultantes de un discurso reduccionista que representa erróneamente las drogas y a sus consumidores como una amenaza a la sociedad, y enfoca el tratamiento como una reducción de los daños que suponen los consumidores de opiáceos en lugar de enfocarlo en los recursos sociales que se necesitan para la prosperidad humana.

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Controlling Drug Users: Forms of Power and Behavioural Regulation in Drug Treatment Services

Cited by 6 publications

References 25 publications

Work-Related Satisfaction among Clinicians Working at Inpatient Treatment Facilities for Substance Use Disorder: The Role of Recovery Orientation

Work-Related Satisfaction among Clinicians Working at Inpatient Treatment Facilities for Substance Use Disorder: The Role of Recovery Orientation

A transition of power in opioid substitution treatment: Clinic managers' views on the consequences of a patient choice reform

A history of abuse: Documenting the harms experienced by the “Trainspotting generation”

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