The aim of the study was to analyze addiction care staff (N=447) perceptions of needs for psychosocial and medical treatment, and possibilities for self-change in relation to fictitious cases. By means of a factorial survey and multilevel analysis, the importance of user, respondent and work characteristics were estimated, with a particular focus on the comparison between healthcare staff and social services staff. Healthcare staff were more skeptical than social services staff towards self-change and assessed the need for medical treatment to be greater. Despite the ongoing medicalisation of Swedish addiction care, psychosocial interventions were still seen as a central part of treatment by both groups. The importance of user characteristics for the assessments was surprisingly similar across the two groups of staff, suggesting that staff perceptions are analogous to the governing images of substance use and treatment needs that prevail in society.