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  • 1.
    Houborg, Esben
    et al.
    Aarhus University, Denmark.
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Nordgren, Johan
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Bancroft, Morgan
    Aarhus University, Denmark.
    Hesse, Morten
    Aarhus University, Denmark.
    Et sund eller et ocean?: Ligheder og forskelle på stofbrugeres hverdagsliv på de to sider af Øresund2022In: Byen og Rusmidlerne: Oplevelser, konflikter og regulering / [ed] Houborg, Esben; Kammersgaard, Tobias; Bach, Jonas; Bancroft, Morgan, Aarhus: Aarhus Universitetsforlag, 2022Chapter in book (Refereed)
  • 2.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    A comparison of privileged access interviewing and traditional interviewing methods when studying drug users in treatment2016In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 24, no 5, p. 406-415Article in journal (Refereed)
    Abstract [en]

    Aims: Privileged access interviewing (PAI) has traditionally been used to reach illicit drug users and other ‘hidden’ populations. How PAI data compare to other self-reported data have seldom been discussed. We compare data from patients in opioid substitution treatment (OST), gathered through PAI and researcher interviews, respectively, to investigate whether PAIs and researchers are reaching comparable populations, and whether differences in answers are due to the sensitive nature of the questions. Methods: Structured interviews were conducted with 368 patients from nine OST clinics in three Swedish cities. 237 interviews were carried out by researchers, and 131 by nine PAIs (OST patients). Data were analyzed with χ2 test, Fisher’s exact test, t-test and logistic regression analysis. Results: PAIs and researchers recruited comparable populations, with few differences in terms of individual, treatment and social factors. However, self-reported behaviors revealed several significant differences. Alcohol consumption and drinking to intoxication was more commonly reported among patients interviewed through PAI (p < 0.001 and p = 0.001, respectively). Furthermore, the PAI group reported selling medication (p < 0.001 last month, p < 0.001 during treatment episode) and snorting buprenorphine (p = 0.010 last month, p = 0.001 during treatment episode) more frequently. Conclusions: PAI is a useful method in studies of illicit drug use and a valuable complement to more traditional interviewing methods. Specifically as regards revelations of a sensitive or controversial nature, PAI seems to produce different results than researcher interviews, and possibly also more truthful responses. PAI may have considerable potential as a data-gathering method also when studying other, more easily accessible populations.

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  • 3.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Diversion of methadone and buprenorphine by patients in opioidsubstitution treatment in Sweden: prevalence estimates and risk factors2014In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 26, no 2, p. 183-190Article in journal (Refereed)
    Abstract [en]

    Background: Diversion—patients who sell or share their medication—is a hotly debated but rela-tively unresearched phenomenon. We have investigated the prevalence of self-reported diversion ofmethadone and buprenorphine at OST programs in Sweden. We have also examined if demographic,treatment, and social factors can be associated with an increased risk of diversion. Methods: Structured interviews were conducted with 411 patients from eleven OST programs. A standard-ized questionnaire with 106 close- and five open-ended questions were used. 280 interviews were doneon site, by the researchers, while 131 interviews were conducted by specially trained patients throughprivileged access interviewing. The data were analyzed through frequency- and averages-calculations,cross-tabulations, and logistic regression analysis. Results: In total, 24.1% (n = 99) of the patients reported diversion in the past month. 67.6% (n = 277) statedthat they had diverted at some point. The peer interviews showed significantly higher levels of diver-sion (37.4% past month) compared with the researcher interviews (17.2%). Neither demographic factors,dosages, nor collection routines were associated with diversion. The likelihood of diversion was higherfor patients on mono-buprenorphine (OR = 5.64) and buprenorphine–naloxone (OR = 2.10), than amongmethadone patients. Other factors which increased the likelihood of diversion were current illicit druguse (OR = 5.60), having had patients as a primary source of illicit methadone or buprenorphine prior totreatment (OR = 3.39), and mainly socializing with active drug users (OR = 2.12). Conclusion: Self-reported diversion was considerably higher than in previous studies. This is most likelydue to the new methodological strategy we used, but may also partly be explained by low availability ofOST in Sweden, leading to a high demand for the substances by heroin users outside treatment. Effortsto decrease diversion should primarily focus on psychosocial and lifestyle-changing interventions, andexpanded access to treatment, rather than on control measures.

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  • 4.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Diversion of methadone and buprenorphine from opioid substitution treatment: a staff perspective2014In: Journal of Psychoactive Drugs, ISSN 0279-1072, E-ISSN 2159-9777, Vol. 46, no 5, p. 427-435Article in journal (Refereed)
    Abstract [en]

    Opioid substitution treatment (OST) is still controversial, despite positive results. The issue of diversion to the illicit drug market is a cornerstone in the criticism typically voiced against the treatment. Little research is available concerning how professionals who work in OST view the issue of diversion. In this article, we discuss existing ideas and attitudes toward diversion of methadone and buprenorphine among OST staff in Sweden. The article is based on semi-structured interviews with 25 professionals working in eight OST-programs in southern Sweden. Diversion was seen as a deleterious phenomenon by the interviewees. Three problematic aspects were highlighted: Medical risks in the form of overdose fatalities and the recruitment of new opiate/opioid users; negative consequences for the legitimacy of OST; and moral objections, since diversion means that the patients remain in a criminal environment. However, positive aspects were also highlighted. Illicit methadone or buprenorphine is perceived as safer than heroin. In this way, diversion can fulfill a positive function; for instance, if there is a shortage of access to regular treatment. Patients who share their medication with opioid-dependent friends are seen as less culpable than those who sell to anyone for money.

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  • 5.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: Patients who Regularly Sell or Share their Medication2015In: Journal of Addictive Diseases, ISSN 1055-0887, E-ISSN 1545-0848, Vol. 34, no 1, p. 1-17Article in journal (Refereed)
    Abstract [en]

    Diversion-patients who sell or share their medication-is a much debated problem of opioid substitution treatment. We study regular diversion by patients at 11 OST programs in the South of Sweden. Using quantitative and qualitative data, we investigate whether those patients differ from other patients, their motives for and means of diversion, and who the recipients are. Regular diverters are a small, yet heterogeneous group. Continued illicit drug use, however, stand out as a common risk factor. Pecuniary need and a desire to help friends are other important motives. The client base mainly consists of people from the regular diverters' own drug milieus.

  • 6.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Diversion of methadone and buprenorphine from opioid substitution treatment: the importance of patients’ attitudes and norms2015In: Journal of Substance Abuse Treatment, ISSN 0740-5472, E-ISSN 1873-6483, Vol. 54, p. 50-55Article in journal (Refereed)
    Abstract [en]

    Aims Methadone and buprenorphine diversion by patients in opioid substitution treatment (OST) is a poorly understood phenomenon. We study the norms and attitudes on diversion among OST patients, including the role these norms and attitudes play as diversion risk factors. We also study whether perceived quality of care, social bonds to treatment staff, and deterrence can be associated with diversion. Methods Structured interviews were conducted with 411 patients from eleven OST programs. In total, 280 interviews were done on site by the researchers, while 131 interviews were conducted through peer interviewing by specially trained patients. The data was analyzed through frequency- and averages-calculations, cross-tabulations, and logistic regression analysis. Results Most patients consider diversion as mostly positive (83.7%), morally right (76.8%), and without any significant risk of detection (66.9%). Individual differences in norms and risk perceptions may play a role in explaining variations in diversion; patients who consider it right to share medication with friends report higher treatment-episode diversion than other patients (OR 1.455, p = 0.016). Patients who perceive control measures as effective report lower diversion than other patients (OR = 0.655, p = 0.013). Furthermore, data indicate that patients who are satisfied with the care and service are less prone to engage in diversion. Social bonds with treatment staff seem to be less importance. Conclusions The norm system described by patients resemble Bourgois’ ‘moral economy of sharing’ concept—not sharing drugs with friends in withdrawal is considered unethical. Efforts to decrease diversion may focus on lifestyle-changing interventions, and reducing black market demand for illicit medications by expanding access to treatment.

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  • 7.
    Johnson, Björn
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Non-prescribed use of methadone and buprenorphine prior to opioid substitution treatment: lifetime prevalence, motives, and drug sources among people with opioid dependence in five Swedish cities2019In: Harm Reduction Journal, E-ISSN 1477-7517, Vol. 16, no 31, article id UNSP 31Article in journal (Refereed)
    Abstract [en]

    Background: Opioid substitution treatment (OST) with methadone or buprenorphine is the most effective means of treating opioid dependence. If these substances are used by people who are not undergoing OST, they can however carry serious risks. This article examines the lifetime prevalence, motives, and drug sources for such use, as well as geographical differences in these variables. Methods: Structured interviews were conducted with 411 patients from 11 OST clinics in five Swedish cities. The researchers carried out 280 interviews on-site, while 131 interviews were conducted by specially trained patients through privileged access interviewing. Data were analyzed by frequency and average calculations, cross-tabulations, and χ2 tests. Results: The lifetime prevalence of non-prescribed use was 87.8% for methadone, 80.5% for buprenorphine, and 50.6% for buprenorphine/naloxone. Pseudo-therapeutic motives—avoiding withdrawal symptoms, staying clean from heroin, detoxification, or taking care of one’s own OST—were commonly cited as driving the use, while using the drugs for euphoric purposes was a less common motive. Most respondents had bought or received the substances from patients in OST, but dealers were also a significant source of non-prescribed methadone and buprenorphine. Geographical differences of use, motives, and sources suggest that prescription practices in OST have a great impact on which substances are used outside of the treatment. Conclusions: Experiences of non-prescribed use of methadone and buprenorphine are extremely common among those in OST in southern Sweden. As the use is typically driven by pseudo-therapeutic motives, increased access to OST might decrease the illicit demand for these substances. Buprenorphine/naloxone has a lower abuse potential than buprenorphine and should therefore be prioritized as the prescribed drug. Supervised dosage and other control measures are important provisions in the prevention of drug diversion and non-prescribed use among people not undergoing OST.

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  • 8.
    Johnson, Björn
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Bengt
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Alkohol- och narkotikaproblem2017Book (Other academic)
    Abstract [sv]

    Över en miljon människor i Sverige har ett riskbruk, missbruk eller beroende av alkohol eller narkotika. Alkohol- och narkotikaproblem berör ofta även anhöriga, vänner och arbetskamrater. För att kunna förstå, förebygga och behandla sådana problem krävs kunskap. I denna grundläggande lärobok presenteras aktuell, forsknings-baserad kunskap på ett pedagogiskt och lättillgängligt sätt. Boken är unik i den bemärkelsen att den tar ett helhetsgrepp på alkohol- och narkotikaområdet. Författarna belyser och problema-tiserar drogernas effekter och skadeverkningar, tar upp hur drog-problem kan förklaras med hjälp av teorier och begrepp från olika vetenskapsområden samt beskriver de sociala och hälso mässiga konsekvenser som problematisk droganvändning kan innebära för den enskilde. Boken innehåller även en gedigen redogörelse för samhällets olika insatser på området – alkohol- och narkotikakontroll, prevention, utredning, vård- och behandling samt skadebegränsning. Ett viktigt inslag i boken är intervjuer med yrkesutövare och en brukarföreträdare, som berättar om sina egna erfarenheter av att arbeta med frågor som rör bruk, missbruk och beroende. Alkohol- och narkotikaproblem vänder sig till personer som studerar till socionom, psykolog, sjuksköterska, läkare, polis eller behandlings-assistent samt till dem som redan arbetar inom något av dessa yrken. Personer som själva har eller har haft drogproblem är också en viktig målgrupp, liksom deras anhöriga. Men boken kan även läsas av personer med ett mer allmänt intresse av alkohol- och narkotikafrågor.

  • 9.
    Johnson, Björn
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Bengt
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Parents as victims of property crime committed by their adult children with drug problems: Results from a self-report study2018In: International Review of Victimology, ISSN 0269-7580, E-ISSN 2047-9433, Vol. 24, no 3, p. 329-346Article in journal (Refereed)
    Abstract [en]

    Parents who are subjected to crime by adult children with drug problems have been neglected in victimological research. We have examined how common it is for parents to fall victim to theft and burglary committed by their children and how the risk varies depending on the parents’ and children’s circumstances. A self-report questionnaire on victimisation was distributed to parents of adult children with drug problems (n=687). The data were collected by means of a postal survey sent to members of the Swedish organisation Parents Against Drugs (Föräldraföreningen mot narkotika) (n=411) and through an online questionnaire that was disseminated on social media and among treatment facilities and other support associations for family members (n=276). Half (50.7%) of the parents declared that they had at one point or another been victims of theft or burglary committed by their children. The level was higher among older parents, among those whose children had more severe drug problems and among parents of children with attention deficit hyperactivity disorder. Of the respondents, 9.9% had been exposed to property crime during the past year. The level was higher among parents of children who were currently taking drugs, among parents of younger children and among parents whose children were living at home. Parents of adult children with drug problems run a high risk of being subjected to property crime by their children. The risk appears to be mostly related to the children’s drug problems and certain other circumstances pertaining to the children. Further research is needed on the extent and nature of this type of crime and about risk prevention for the parents.

  • 10.
    Johnson, Björn
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Bengt
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Physical Violence and Property Damage towards Parents, Committed by Adult Children with Drug Problems2022In: Journal of family Violence, ISSN 0885-7482, E-ISSN 1573-2851, Vol. 37, p. 165-180Article in journal (Refereed)
    Abstract [en]

    Drug use has previously been identified as a risk factor for child-to-parent abuse. We examine how common it is for parents to be exposed to physical violence and property damage by adult children with drug problems, and whether such victimization varies based on factors related to the parents and the adult children, respectively. A self-report questionnaire on victimization was completed by 687 parents of adult children with drug problems. The data were collected via a postal questionnaire to members of the Parents Against Drugs association and a web-based questionnaire to persons recruited via social media, treatment centers and other associations for families of drug users. The proportion of parents who reported having been exposed to physical violence was 19% ever, 6% during the past year. The proportion who had been exposed to property damage was 40% ever, 10% during the past year. Exposure during the past year was higher among parents whose children were currently experiencing drug problems. Mental health problems in the children were associated with higher levels of parental victimization, particularly in the form of physical violence. Parental victimization was also associated with the children being younger and still living at home. Exposure to property damage was higher among parents of male children. Adult children's drug problems are of significance for parental victimization; they do not however appear to constitute a major risk factor but rather one risk factor among several others. Exposure to physical violence is clearly related to the presence of mental health problems in the children.

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  • 11.
    Liahaugen Flensburg, Olivia
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Nordgren, Johan
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Bengt
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    "Something wasn't right"-parents of children with drug problems looking back at how the troubles first began2022In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 29, no 3, p. 255-264Article in journal (Refereed)
    Abstract [en]

    In this study we analyze how parents of adult children with drug use problems view the initial stages of identifying their children's troubles as a severe drug problem. We focus on the parents' accounts of the discovery process by identifying significant events in the parents' narratives through 'the micro-politics of trouble'. The study is based on an analysis of 32 semi-structured interviews with parents of adult children (aged 18+) with drug problems. Four themes emerged from the parents' narratives: (1) the first signs of a problem, (2) drug problem or teenage defiance? (3) the awakening, (4) a passing phase. The different themes show how the parents' interpretations of the situation influence their definitions and thus their actions. Early signs and indicators of something being wrong do not initially result in parents framing the situation as problematic as they are perceived as everyday concerns and dealt with as such. Our focus on the initial phase of the problem definition process and how this affects the parents may provide a better understanding of the parents' situation and needs for support. This may be of use to professionals in the fields of social work and drug treatment who meet these parents and may have a role to play in the development of support measures that can improve their situation.

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  • 12.
    Liahaugen Flensburg, Olivia
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Väfors Fritz, Marie
    Malmö University, Faculty of Health and Society (HS), Department of Criminology (KR).
    Parents of adult children with drug addiction dealing with shame and courtesy stigma2023In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 30, no 6, p. 563-572Article in journal (Refereed)
    Abstract [en]

    The study aims to provide insight into the lives of parents to adult children with drug addiction. We focus on how the parents' social life and interactions were affected by feelings of guilt and shame, and how they dealt with the stigma that often accompanies drug addiction. 32 semi-structured interviews were conducted with parents (age 46-70) of adult children (age 18-47) with drug addiction in Sweden. Three themes emerged (1) Experiences of guilt, shame, and courtesy stigma, (2) Impact on social life and relationships and, (3) Strategies to reduce guilt and shame. Guilt, shame, and courtesy stigma complicated and restricted the parents' social interactions. Many parents applied a selective openness, carried experiences of alienation and in some cases isolated themselves. At the same time, several parents described that they were open about their child's addiction in certain contexts. For some parents, this meant a relief from guilt and shame and an opportunity for increased social interaction. Both informal and professional support for family members of individuals with drug addiction is vital to reduce experiences of guilt, shame, and courtesy stigma.

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  • 13.
    Nordgren, Johan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    ‘A free position in midfield' – a qualitative study of faith-based social work with people who use drugs in Sweden2023In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Many faith-based organisations (FBOs) provide social work services to marginalised groups in need of care such as people who use drugs (PWUD), but little is known about how diaconal or faith-based social work with PWUD is carried out and how staff view their work. The aim of this study was to explore how social work with PWUD within FBOs in Sweden is conducted. This study is based on semi-structured qualitative interviews with 14 employees at a range of churches in Sweden. The empirical material was analysed with qualitative textual analysis. FBO staff channeled a personal calling to offer services through their organisations and found PWUD be in need mainly of emergency support. Staff engaged in boundary work such as differentiating between activities conducted at the church premises or on the streets. Staff accompanied clients to meetings with publicly funded welfare services to the benefit of the clients, and they appreciated their free role compared to social services staff. FBOs mainly act as stabilisers in relation to official public welfare services. The role of prophetic diaconal work aiming at social justice was limited and clients’ emergency needs were in focus, which indicates that FBOs in Sweden mainly complement welfare state services.

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  • 14.
    Nordgren, Johan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Risk environments of people who use drugs during the Covid-19 pandemic: the view of social workers and health care professionals in Sweden2022In: Drugs: education prevention and policy, ISSN 0968-7637, E-ISSN 1465-3370, Vol. 29, no 3, p. 297-307Article in journal (Refereed)
    Abstract [en]

    Although research is emerging on how the Covid-19 pandemic has affected people who use drugs (PWUD), there is a lack of studies focusing on professionals' views on Covid-19 related risks and consequences for this group. The aim of this study was to analyze how social workers and health care professionals in the city of Malmö, Sweden viewed the effects of the Covid-19 pandemic on PWUD risk environments. We used a mixed methods approach including an online survey with social workers and three qualitative focus group sessions with social workers and health care professionals working with PWUD. The professionals defined PWUD as an especially vulnerable group that had difficulty protecting themselves from contracting Covid-19, and who risked severe consequences if infected. They described risks relating to lifestyle and marginalization, limited health literacy, and health-related problems. Reported consequences of the pandemic included reduced access to treatment and support, social isolation, anxiety, and increased drug use. Factors at both micro and meso levels of risk environments seemed to contribute to a particular vulnerability for PWUD during the Covid-19 pandemic. It is important to learn from this development in order to provide better support to at-risk groups in future crises.

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  • 15.
    Nordgren, Johan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Social work with people who use drugs during the Covid-19 pandemic: A mixed methods study2022In: Nordic Social Work Research, ISSN 2156-857X, E-ISSN 2156-8588, p. 1-14Article in journal (Refereed)
    Abstract [en]

    Measures to control the spread of Covid-19 are challenging social work practice in terms of difficulties to deliver services to vulnerable groups. The aim of this study was to investigate how the Covid-19 pandemic affected social work with people who use drugs regarding ways of working, quality of work, accessibility, and staff motivation. A mixed methods approach was used which included an online survey (n = 81), and three qualitative focus group sessions with social workers in the field of addiction. We analysed the quantitative data through frequency calculations, cross tabulations and Pearson’s χ2 test, and the qualitative data with qualitative textual analysis. The demand for physical distancing challenged important principles of social work such as social closeness, trust and accessibility, and led to a difficult work environment and fewer opportunities to conduct high quality social work, as well as a reduced likelihood of vulnerable clients receiving adequate assistance. Altered practices concerning client meetings negatively affected assessments, working alliances as well as motivation and energy in social work practice. Social workers on the frontline became the ‘last outpost’ when other services shut down, and ‘digital bridges’ between clients and other social workers. Social workers faced a difficult trade-off between protecting themselves and clients from the risk of infection and providing support to a vulnerable group. There were also examples of new practices and lessons learned, for example, the introduction of ‘walks and talks’ with clients and an increased knowledge of how and when to use digital tools for communication.

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  • 16.
    Nordgren, Johan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Stallwitz, Anke
    Department of Social Work, Protestant University of Applied Sciences Freiburg.
    Police officers’ attitudes and practices toward harm reduction services in Sweden: a qualitative study2022In: International journal of drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 104, p. 1-8, article id 103672Article in journal (Refereed)
    Abstract [en]

    Background

    Since the 1980s, Swedish drug policy has combined a restrictive zero tolerance approach with the vision of a “drug-free society”. However, in recent years, access to harm reduction services has increased through local initiatives and new national guidelines. The possible success of these services may be affected in part by police drug law enforcement. The aim of this study was to explore how Swedish police officers act toward and view harm reduction services in a national drug policy setting of zero tolerance toward drug use.

    Methods

    Applying a qualitative research design, we conducted 19 in-depth interviews with police officers who worked with drug law enforcement in Malmö. We conducted a qualitative textual analysis of the data.

    Results

    Officers largely supported harm reduction services and refrained from overtly enforcing drug laws in their vicinity. Officers engaged in boundary work that assigned the responsibility of care of marginalized people who use drugs (PWUD) to the health care system, while including policing of drug market problems, young PWUD and dealers in their own jurisdiction. Opioid substitution treatment was seen as positive, although diversion of medicines was pointed out as a problem. Needle exchange programs were seen as offering important public health services and a no-go zone for the police. Several officers wanted to carry naloxone on duty but requested more information about its use.

    Conclusion

    The general support among police officers for harm reduction services is an indication of a changing drug policy landscape in Sweden. Drug policy should take police officers’ views into consideration and there is a need for collaboration between police and harm reduction services. Further research should focus on how the police conduct boundary work since police actions may impact on the success of harm reduction services.

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  • 17.
    Nordgren, Johan
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Svensson, Bengt
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Say No and Close the Door?: Codependency Troubles among Parents of Adult Children with Drug Problems in Sweden2020In: Journal of Family Issues, ISSN 0192-513X, E-ISSN 1552-5481, Vol. 41, no 5, p. 567-588Article in journal (Refereed)
    Abstract [en]

    Codependency is a term used to describe a range of behaviors among persons who are affected by the problematic drug use of family members. This article analyzes how 32 Swedish parents of adult children with drug problems talked about and understood codependency. The sociology of trouble was used as a theoretical framework and three significant themes were identified in the interviews. The parents spoke about how they defined codependency troubles, how they discovered codependency, and how they set boundaries for their children. The parents talked about their situations as highly distressing, and third-party troubleshooters defined their troubles and problems as codependency. The parents generally rejected the advice to “close the door” on their children and engaged in a range of remedial actions. The analytical focus of this study on the identification, definition, and remedial actions of parents gives valuable insights into family disruptions related to drug problems.

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  • 18.
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Hiv- och hepatitprevention på institution: utvärdering av ett peer-baserat utbildningsprojekt med syfte att öka kunskapen om blodsmittor hos klienter och personel på SiS-institutioner2012Report (Other academic)
    Abstract [en]

    Title: HIV and Hepatitis Prevention in Compulsory Care Institutions. Evaluation of a Peer-based Education Project aimed at increasing the Knowledge of Blood-borne Infectious Diseases for Clients and Staff at Institutions connected to Sweden’s National Board of Institutional Care (NBoIC). Aim: This report aims at describing the project “Hiv på institution” (HIV at Institutions), specifically focusing on the educational model, and the execution and results of the project. Another object of the report is to evaluate the goal fulfillment of the project, while also advising on potential continuous educational measures. Method: The report is primarily based on the results of three surveys conducted in the second and third years of the project. The description of the education method and the execution of the project is based on interviews with and written reports from the educators, in addition to participant observation. Results: The results show that clients at NBoIC institutions constitute to a high-risk group in terms of blood-borne infections, due to the fact that a large number of clients have experience of injection drug use, and a majority of them exhibit a high degree of sexual risk-taking. The fact that at least a quarter of the clients have a Hepatitis C infection, in conjunction with their high-risk behavior, furthermore indicates that clients at NBoIC institutions constitute a well-defined risk group in terms of transmitting blood-borne infections to others. Staff, as well as clients, generally exhibited not only an inadequate knowledge of transmission routes for HIV and different forms of Hepatitis, but also about the opportunities for inoculation and treatment of these infectious diseases. In particular, male clients, clients born outside of Sweden, and younger (below the age of 18) clients exhibited insufficient knowledge in this area. At the follow-up, the clients who had taken part in awareness training, generally displayed a significantly higher level of knowledge of blood-borne infections and transmission routes in comparison to clients who had not taken part significant differences). Nearly all participants stated that they, as a result of the awareness training day, had increased their knowledge of HIV and various forms of Hepatitis. A substantial majority of the participants also claimed that the awareness training, to a high or very high degree had increased their knowledge of transmission routes for HIV and Hepatitis (A, B, C), including how to avoid getting infected. The peer-based education model received positive response. Over 90 per cent of the participants rated the awareness training events as good or very good on the whole, and the same high percentage expressed themselves happy or very happy with the way the information was delivered (the method). The educators own experiences of blood-borne infections and addiction, as well as their personal life stories, were described by the participants as particularly valuable. In particular the fact that the educators were drawing on personal experiences added to their legitimacy and credibility, in the eyes of the participants, and meant that the lectures became more "personal", "vibrant", “engaging” and “gripping.” Furthermore, many participants voiced the opinion that these life stories play an important role by creating an increased understanding of and empathy with people in difficult circumstances of life, while also giving hope by showing that it is possible to recover from addiction, and that it is possible to live a good life despite an HIV or Hepatitis infection. Implications: Clients at NBoIC institutions constitute an important target group for measures aimed at preventing blood-borne infectious diseases. Peer-based awareness training appears to be a good model to reach members of this group and to increase their knowledge of transmission risks. However, the degree to which this increased knowledge de facto results in an improved risk behavior is uncertain. Consequently, in order to ensure a decrease in the transmission of infections, other interventions are required, as well as further studies directly aimed at mapping behavioral changes within primary groups at risk of blood-borne infections.

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  • 19.
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Humanitet måste gå före ideologi: om överdosprojektet i Malmö2013In: Med narkotikan som följeslagare / [ed] Björn Johnson, Philip Lalander, Malmö högskola, Fakulteten för hälsa och samhälle , 2013, p. 32-40Chapter in book (Other academic)
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  • 20.
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS).
    Injektionsmissbrukande kvinnors inkomstkällor och anskaffning av droger2009In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 26, no 5, p. 365-383Article in journal (Refereed)
    Abstract [en]

    Injection drug using women and the means by which they support their drug use AIMS AND METHODS The purpose of the present paper is to investigate the ways in which women who inject heroin or amphetamines procure drugs and finance their drug use. The results are based on standardised interviews conducted at the needle exchange programme in Malmö between 1 July 2005 and 30 September 2006. In total, 188 out of the 232 women who visited the programme during this period were interviewed. RESULTS A vast majority of the women (93%) buy most of the drugs they use themselves. Among the women interviewed, the most common sources of income were; social benefits (45%), dealing (23%), prostitution (22%), theft (21%) and paid work (16%). A majority of the women (53%) reported use of both formal and informal incomes to finance their drug use over the last two weeks, just over a third of the women (36%) reported only formal incomes, and a small minority (12%) reported only informal incomes. A majority of the women also reported to have been provided with drugs by others. In most cases, the provider was a man (p>.01). Women with heroin as their principal drug more frequently reported multiple sources of income (p>.01), income through prostitution (p>.001), dealing (p>.01) or theft (p>.05), whereas women with amphetamines as their principal drug more frequently reported income through paid work (p>.05) or pensions (p>.01). CONCLUSIONS Few women correspond to the stereotypical image of the homeless and outcast street addict who supports her drug habit mainly through prostitution and illegal activities or by contacts with male addicts. The majority of the women in this study have a relatively stable housing situation, the vast majority (93%) are active actors on the drug market who buy most of the drugs they use themselves, and most of the women use incomes from both formal/legal and informal/illegal sources. For most of the women, drugs provided by others only constituted a complement to those obtained by the women themselves. A few women, however, who did not report any personal income, seem to be highly dependent on others to secure a safe supply of drugs. Some women also reported that they had had to perform sexual services in order to get access to drugs from male suppliers. For women with heroin as their principal drug, it seemed much more difficult to finance their drug use by legal incomes only. KEYWORDS Women, injection drug use, heroin, amphetamines, needle exchange programme, income, drug economy.

  • 21.
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS).
    Mot en mer kunskapsbaserad öppenvård för unga med missbruk: slutrapport för ett trestadsprojekt kring kunskapsutveckling, erfarenhetsutbyte och systematisk dokumentation2011Report (Other academic)
    Abstract [sv]

    Föreliggande rapport beskriver ett trestadsprojekt kring öppenvård för unga med missbruk i Stockholm, Göteborg och Malmö. Projektet har sin upprinnelse i att flera nya specialiserade öppenvårdsmottagningar för unga med missbruk startats under början av 2000 talet. Det övergripande syftet med projektet har varit att öka kunskapen kring mottagningarna och deras besökare samt låta representanter från de olika öppenvårdsmottagningarna arbeta med gemensamt intressanta utvecklingsfrågor. Totalt har sju mottagningar deltagit i projektet. Från Stockholm har Maria Ungdomsenhet och PUMAN deltagit, från Göteborg Mini Maria Hisingen, Mini Maria Nordost, Mini Maria Väster och Mini Maria Centrum och från Malmö, Maria Malmö. Representanter från respektive mottagning har utgjort den projektgrupp som genomfört arbetet i trestadsprojektet. Projektet har framförallt bestått av tre delar: En inledande jämförande studie, ett långsiktigt gemensamt arbete med erfarenhetsutbyte och kunskapsutveckling samt ett arbete med att ta fram och implementera ett nytt gemensamt dokumentationssystem anpassat till mottagningarnas verksamhet. Den jämförande studien syftade till att beskriva och jämföra de deltagande mottagningarna vad gäller både organisering, metoder, insatser och målgrupp. Det som framförallt förenade mottagningarna vid inledningen av trestadsprojektet var att samtliga vände sig till ungdomar/unga vuxna som missbrukar alkohol/narkotika eller som riskerar att hamna i ett missbruk. Samtliga mottagningar er- bjöd också råd, stöd och behandlingsinsatser i form av öppenvård. Gemensamt för mottagningarna har också varit ett omfattande familje- och nätverksinriktat arbete, ett uppsökande arbete i syfte att nå ungdomen i ett tidigt skede samt en målsättning om att tillhandahålla ett brett utbud av både medicinska och sociala insatser. Inledningsvis fanns dock stora skillnader mellan mottagningarna vad gäller t ex organisering och huvudmannaskap, personalsammansättning, arbetsmetoder, dokumentationsarbete samt utbud av insatser. Under projektets gång har mottagningarna framförallt utvecklats i liknande riktning. Den jämförande studien innebar också en första gemensam kartläggning av mottagningarnas besökare. Sammanfattningsvis kan konstateras att det är en mycket bred grupp besökare som vänder sig till de sju mottagningarna, både vad gäller ålder, bakgrund, problem och behov. Mottagningarna möter allt från 13-14 åringar som kommer med sina föräldrar efter sin första berusning, till ungdomar och unga vuxna med ett etablerat narkotikamissbruk, omfattande kriminalitet och/eller stora psykiska problem. Även om vissa variationer förekommer mellan mottagningarnas besökare så finns samma breda grupp representerad på samtliga mottagningar. De ungdomar som kommer till mottagningarna har generellt en betydligt större problematik i jämförelse med samma åldersgrupp i normalbefolkningen medan de framförallt har stora likheter med ungdomar placerade på SiS- institutioner. Under hela projekttiden har det skett ett erfarenhetsutbyte mellan de deltagande mottagningarna. Tanken med detta utbyte har framförallt varit att ge deltagarna en möjlighet att dela idéer och erfarenheter kring arbetssätt och metoder samt beskriva och diskutera problem och framgångar inom verksamheterna. Ett mål med arbetet har varit en kunskapsutveckling vilken kan leda till ett utvecklingsarbete på de olika mottagningarna. Inom ramen för erfarenhetsutbytet har det även genomförts föreläsningar och presentationer kring möjliga modeller för att arbeta med utvärdering och metod- och verksamhetsutveckling. Det har också genomförts ett pilotprojekt med skattingsskalorna ORS (Outcome Rating Scale) och SRS (Session Rating Scale). Tanken med projektet var att testa om dessa skalor kunde vara ett bra instrument för behandlaren att få kontinuerlig feedback från klienten kring behandlingsrelationen och relevansen av behandlingsinnehållet. Erfarenheterna av projektet var framförallt positiva och idag använder flera av mottagningarna ORS/SRS i det dagliga arbetet. Erfarenhetsutbytet upplevdes generellt som mycket positivt och givande av projektdeltagarna. Framförallt upplevdes det som givande att få träffa behandlare från andra mottagningar som arbetar utifrån en liknande situation. Detta menar man har inneburit nya idéer kring och nya perspektiv på sitt arbete samt att man fått hjälp med en kritisk blick på den egna mottagningen. Deltagarna beskriver också hur man genom erfarenhetsutbytet erhållit en ökad kunskap kring modeller för metod- och verksamhetsutveckling. Den tredje delen i trestadsprojektet har utgjorts av arbetet med att utveckla och implementera dokumentationssystemet UngDOK. Dokumentationsarbete beskrevs tidigt som ett problemområde på mottagningarna och personalen uppfattar frågan kring systematisk dokumentation som ett svårt dilemma. Å ena sidan ses en utförlig och systematisk dokumentation som en viktig förutsättning för att säkerställa verksamhetens kvalitet och utveckling. Å andra sidan anses ett omfattande och strukturerat dokumentationsarbete kunna ta för stort utrymme i verksamheten, riskera att ”skrämma bort” vissa besökare eller påverka behandlingsarbetet negativt. Vid inledningen av trestadsprojektet fanns stora skillnader i hur man arbetade med dokumentation på mottagningarna, där vissa arbetade med etablerade system och där andra helt saknade ett systematiskt dokumentationsarbete. På samtliga mottagningar fanns ett missnöje med den dokumentation som genomfördes. En genomgång av redan befintliga dokumentationssystem visade att inget av dessa system var optimalt för mottagningarna. Det beslutades därför att ett nytt gemensamt dokumentationssystem skulle skapas, vilket skulle svara mot mottagningarnas förutsättningar och behov. Projektgruppen har till stor del själva drivit arbetet med att utveckla ett nytt system. Synpunkter på formulär och frågeområden har dock kontinuerligt inhämtats från klienter, personal och chefer på de olika mottagningarna. Projektgruppen har också tagit hjälp av forskare och experter inom dokumentationsområdet. Arbetet ledde fram till det nya dokumentationssystemet UngDOK, vilket idag används på samtliga mottagningar. UngDOK kan enkelt beskrivas som ett dokumentationssystem för öppenvårdsmottagningar som möter unga med missbruk. Intervjuformulären är relativt kortfattade och frågorna är anpassade för en ung målgrupp. Målsättningen är att formulären skall skapa ett underlag för en bred belysning av besökarnas livssituation, resurser, problem och behov samt ge en bild av de insatser som besökaren erhållit under behandlingskontakten. Systemet kan användas som ett stöd i behandlingsarbetet, som underlag för uppföljning, enklare utvärdering och verksamhetsutveckling samt för regionala och nationella kartläggningar och jämförelser. Vid starten av trestadsprojektet var den generella kunskapen kring specialiserade öppenvårdsmottagningar och deras besökare, insatser och resultat mycket knapp och möjligheten till en kunskapsutveckling begränsad. Projektdeltagarna upplevde också flera problem och brister i mottagningarnas arbete. Dels saknades ett systematiskt och gemensamt dokumentationsarbete, dels saknade man på mottagningarna till stor del kunskap kring metoder för utvecklings- och utvärderingsarbete. Det saknades också forum för erfarenhetsutbyte och professionell dialog kring det praktiska arbetet. Flera av de problemområden som uppmärksammats vid inledningen av trestadsprojektet har behandlats under projektets gång och en hel del har hänt sedan trestadsprojektet inleddes för drygt sex år sedan. Även om ett stort arbete kvarstår talar mycket för en tydlig rörelse mot en mer kunskapsbaserad öppenvård för unga med missbruk, där trestadsprojektet har haft en viss betydelse. Genom utvecklingen av UngDOK har mottagningarna nu ett systematiskt dokumentationsarbete och en gemensam forskningsdatabas. Detta innebär en tillgång till data som kan användas för flera olika syften, på flera olika nivåer. Genom erfarenhetsutbytet har deltagarna byggt upp ett professionellt nätverk och ett forum för dialog. Erfarenhetsutbytet har också inneburit en ökad kunskap hos deltagarna 12 13 kring metoder för utvecklingsarbete. Trestadsprojektet har således inneburit en möjlighet både till en större generell kunskap kring öppenvård för unga med missbruk och till en mer kunskapsbaserad praktik.

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  • 22.
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Taking Care of Business in a Male - Dominated Drug Economy: Income Strategies, Risks, and Opportunities of Women Who Use Drugs2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 882128Article in journal (Refereed)
    Abstract [en]

    Background: Street level drug economies are often described as hierarchical and gender-segregated arenas where men hold high positions and control the supply of drugs, and where women are confined to marginal and low-level positions. Few studies have explored income strategies, risks and opportunities of women who use drugs within drug economies in the Nordic countries.

    Objective: The aim of this study was to analyze women's stories about "taking care of business"-making money and securing drugs-in a local drug economy. The study focuses on the women's gender enactments, the strategies they use to achieve success, and the barriers and risks they face in their everyday endeavors.

    Methods: This article draws on informal conversations and in-depth qualitative interviews with 27 female drug users in Malmö, Sweden during periods of fieldwork between 2009 and 2012.

    Results: The interviewed women had established themselves as entrepreneurs in the local drug economy, working hard for their money. However, only a few held middle or high positions, and all women described encountering gendered obstacles and risks in their efforts to take care of business. The patriarchal and sexualized nature of the drug economy meant special prerequisites for the women's income strategies and gender enactments. Three main income strategies were distinguished in the women's stories: (1) using femininity and sexuality, (2) proving tough and dangerous by using street masculinity, and (3) establishing trust, being professional, and keeping a low profile. These strategies involved different advantages and disadvantages, as well as different types of risk.

    Conclusions: The results show that it is possible for women to achieve success in male-dominated drug economies, but that this is associated with major challenges. Gendered social hierarchies, structures and norms seem to influence the women's gender enactments, opportunities and risks. However, factors such as type of drug use, degree of drug dependence and social position, was also decisive for their possibility of taking care of business. This points to the importance of combining a focus on gender with a focus on other determants of power relations and vulnerabilities, when studying the everyday lives of people who use drugs.

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  • 23.
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS).
    Unga missbrukare i Stockholm, Göteborg och Malmö - En deskriptiv och jämförande studie av sex öppenvårdsmottagningar och deras besökare2008Report (Other academic)
  • 24.
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Wasted, overdosed, or beyond saving - to act or not to act?: Heroin users' views, assessments, and responses to witnessed overdoses in Malmö, Sweden2015In: International journal on drug policy, ISSN 0955-3959, E-ISSN 1873-4758, Vol. 26, no 1, p. 92-99Article in journal (Refereed)
    Abstract [en]

    Background: Overdose is a significant cause of death among heroin users. Frequently, other heroin users are present when an overdose occurs, which means the victim's life could be saved. There is a lack of studies that, based on heroin users own stories, examine their views, assessments, and responses to witnessed overdoses. Methods: The study is based on qualitative interviews with thirty-five heroin users who witnessed someone else's overdose. Results: The heroin users generally had a positive attitude towards assisting peers who had overdosed. A number of factors and circumstances, however, contribute to witnesses often experiencing resistance to or ambivalence about responding. The witness's own high, the difficulty in assessing the seriousness of the situation, an unwillingness to disturb someone else's high, uncertainty about the motive behind the overdose and whether the victim does or does not want assistance as well as fear of police involvement, were common factors that acted as barriers to adequate responses in overdose situations. Conclusion: The fact that being high makes it difficult to respond to overdoses, using traditional methods, argues for simpler and more effective response techniques. This can include intranasal naloxone programs for heroin users. The findings regarding the uncertainty about the intention of the overdose victim and the sensitivity to the experience of a good high argue for more up-front communication and discussion amongst using peers so that they can make their intentions clear to each other. Issues like this can be addressed in overdose education interventions. Overdose prevention measures also need to address the fact that fear of the police acts as a barrier to call emergency services. (C) 2014 Elsevier B.V. All rights reserved.

  • 25.
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Överdoser, försörjningsstrategier och riskhantering: livsvillkor för personer som injicerar narkotika2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    People who inject illegal drugs constitute a vulnerable group in society. Their vulnerability can partly be explained by the negative consequences of the drug use itself and the particular risks associated with injecting, but also by society’s negative view of, and harsh attitude towards, drug users. Injection drug use is a relatively understudied topic in Sweden. The overall aim of this dissertation is to examine life circumstances of people who inject heroin or amphetamines. The dissertation is based on two research projects at Malmö University and includes interviews with a total of over two hundred visitors at the needle exchange program in Malmö as well as focus group discussions with twenty-seven heroin users in treatment. The first project focus on women who use the needle exchange program and on their social situation, income strategies, experience of treatment and care, as well as on their wishes for further societal assistance. The results present a picture of a very heterogeneous group of women, in which most differ from the stereotypical image of the female injection drug user as homeless, destitute, marginalized, and primarily dependent on men or prostitution for their livelihood and access to drugs. Most women were active in the drug economy, they obtained most of the drugs they used on their own, and they supported their drug purchases through both formal and informal sources of income. A small group, mainly women who primarily use heroin, described a very vulnerable and marginalized existence with insecure housing and incomes restricted to dealing, stealing or sex-work. The vast majority of the interviewed women did wish for some sort of societal support in order to change their situation. Most requests involved substance abuse treatment. More than anything, heroin users wished for better access to opioid substitution treatment. Many women also wanted access to women-only treatment facilities. Not all women, though, saw their drug use as problematic or intended to stop using illegal drugs. Some saw society’s poor treatment of drug users and the “repressive” drug policy as a greater problem than the drug use itself. The second research project focus on heroin overdoses. The aim of the project was to gain further knowledge on why overdoses occur, a greater understanding of how heroin users interpret and handle the overdoses of others, as well as to discuss potential interventions to reduce the number of overdose deaths in Sweden. The results showed that the interviewed heroin users generally had good knowledge about overdose risks. Different circumstances, however, caused restricted possibilities to avoid overdose risks or meant that risks were seen as minor compared to the potential gains of drug use. The desire for a powerful high, experience of severe withdrawal symptoms, an unsafe environment, mental ill health, and an “unbearable life situation”, were examples of factors associated with an increased risk of overdoses. Those heroin users who had been present at someone else’s overdose generally had a positive attitude towards assisting the victim, and their actions were often life-saving. However, a number of factors such as the witness’s own intoxication or lack of knowledge of lifesaving measures, as well as fear of police involvement in some cases, led to inadequate responses to overdoses. The interviewees’ accounts point to the need for a more diverse and accessible drug abuse and addiction treatment model but also to the need for interventions that aim to reduce vulnerability and improve life circumstances and health for persons who, for various reasons, continue to use illegal drugs. The results also reveal the need for interventions that improve heroin users’ possibilities for safer drug use, as well as the importance of increasing their potential for helping other heroin users who overdose.

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  • 26.
    Richert, Torkel
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Överdosprevention: en övergripande strategi2017In: Dogmer som dödar: vägval för svensk narkotikapolitik / [ed] Niklas Eklund, Mikaela Hildebrand, Verbal , 2017, p. 254-278Chapter in book (Other academic)
  • 27.
    Richert, Torkel
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Anderberg, Mats
    Dahlberg, Mikael
    Mental health problems among young people in substance abuse treatment in Sweden2020In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 15, no 1, article id 43Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Young people with substance use problems face a high risk of co-occurring mental health problems, something that may involve a more difficult life situation, social problems as well as worse treatment outcomes. The aim of this study is to analyse self-reported mental health problems among young people receiving outpatient treatment for substance use problems in Sweden. We explore what types of mental health problems are more or less predominant, and whether there are significant differences between boys and girls. In addition, we analyse how various mental health problems covary with indicators of substance abuse severity.

    METHODS: The study is based on structured interviews with 1970 young people enrolled at outpatient clinics in 11 Swedish cities. The data was analysed through frequency- and averages-calculations, Chi-square tests and multivariate logistic regression analyses.

    RESULTS: Self-reported mental health problems were common among the young people in the study. A relatively large percentage of the total group (34-54%) reported problems such as concentration difficulties, sleeping difficulties, anxiety and depression. At the same time, many of the young people did not report any symptoms and only a small group, about 20%, reported diagnosed mental health disorders. The results show substantial gender differences, with girls reporting significantly higher levels of mental health problems. Multivariate logistic regression analyses demonstrated significant associations between severity of drug use problems and anxiety, concentration difficulties, aggression, hallucinations and mental stress caused by experiences of trauma.

    CONCLUSIONS: Treatment needs are diverse within this group of young people who use drugs. Since girls report higher levels of all mental health problems, and a larger burden of psychosocial risk factors than boys, they are likely to require more comprehensive treatment interventions. The link between more severe drug problems and mental health problems points to the importance of exploring this relationship in treatment. A multidisciplinary approach, in which co-occurring problems can be addressed simultaneously, may be the best treatment form for many young people with drug problems.

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  • 28.
    Richert, Torkel
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Brukares erfarenheter av och syn på sin behandling: en intervjustudie med 411 LARO-patienter i fem städer2014Report (Other academic)
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  • 29.
    Richert, Torkel
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Illicit use of methadone and buprenorphine among adolescents and young adults in Sweden2013In: Harm Reduction Journal, E-ISSN 1477-7517, Vol. 10, no 27, article id 27Article in journal (Refereed)
    Abstract [en]

    Background Illicit use of methadone and buprenorphine has been described as a growing problem in Sweden in recent years, and has been associated with an increased drug-related mortality. Critics claim that the substances have become popular among adolescents and that they function as a gateway to heroin use. The aim of this study is to investigate, firstly, the extent to which illicit use of methadone and buprenorphine occurs among adolescents and young adults in Sweden, and secondly, at what stage in a user's drug career these substances tend to appear. Methods The study is based on surveys and structured interviews on drug use among various populations of young people, in addition to qualitative interviews with 86 informants who, in their professional capacity, encounter adolescents or young adults who are using illicit drugs. Results Illicit use of methadone and buprenorphine is rare among young people in Sweden. According to high school surveys, less than 0.1% have tried these substances. Among young drug users in general, few have tried the substances, and there is nothing to indicate that they act as gateway drugs. Among adolescents and young adults with severe drug problems, however, the illicit use of methadone and buprenorphine is more common (54% in a compulsory care sample). These substances normally enter the drug career late, and few use them as their main drug of choice. Other prescription drugs, like benzodiazepines and tramadol, are used by adolescents to a far greater extent. Diversion and illicit use of methadone and buprenorphine is not seen as a serious problem by the professionals interviewed. A general view is that the substances are mainly used by people with a heroin or polydrug addiction, often for "self-medication" purposes. However, several informants express concern that methadone and buprenorphine may cause fatalities among young drug users without an opioid tolerance. Conclusions Illicit use of methadone and buprenorphine among young drug users is not a widespread problem in Sweden. Harm-reduction measures should target drug users with more severe problems, among whom illicit use of methadone and buprenorphine is more common and pose a medical risk. Illicit use of other prescription drugs, which are less controlled and more widely used by young people, is an important issue for further research.

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  • 30.
    Richert, Torkel
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnson, Björn
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Long-term self-treatment with methadone or buprenorphine as a response to barriers to opioid substitution treatment: the case of Sweden2015In: Harm Reduction Journal, E-ISSN 1477-7517, Vol. 12, no 37, p. 1-14, article id 12Article in journal (Refereed)
    Abstract [en]

    Background It is well known that illicit use of methadone and buprenorphine is common among people with an opioid dependence. Less notice has been taken of the fact that these substances are also used for extended periods of self-treatment, as a way of handling barriers to OST. In this study, motives for self-treatment are investigated, as well as attitudes and perceived barriers to OST among drug users with an opioid dependence in Sweden. Method The study is based on qualitative research interviews with 27 opioid users who have treated themselves with methadone or buprenorphine for a period of at least three months. Results The duration of self-treatment among the interviewees varied from 5 months to 7 years. Self-treatment often began as a result of a wish to change their life situation or to cut back on heroin, in conjunction with perceived barriers to OST. These barriers consisted of (1) difficulties in gaining access to OST due to strict inclusion criteria, limited access to treatment or a bureaucratic and arduous assessment process, (2) difficulties remaining in treatment, and (3) ambivalence toward or reluctance to seek OST, primarily due to a fear of stigmatization or disciplinary action. Self-treatment was described as an attractive alternative to OST, as a stepping stone to OST, and as a way of handling waiting lists, or as a saving resource in case of involuntary discharge. Conclusion Illicit use of methadone and buprenorphine involve risks but may also have important roles to play for users who are unwilling or not given the opportunity to enter OST. A restrictive and strict rehabilitation-oriented treatment model may force many to manage their own treatment. More generous inclusion criteria, a less complex admission process, fewer involuntary discharges, and less paternalistic treatment may lead to increasing numbers seeking OST. Control measures are necessary to prevent diversion and harmful drug use but must be designed in such a way that they impose as few restrictions as possible on the daily life of patients.

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  • 31.
    Richert, Torkel
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Svensson, Bengt
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Being a Parent to an Adult Child With Drug Problems: Negative Impacts on Life Situation, Health, and Emotions2018In: Journal of Family Issues, ISSN 0192-513X, E-ISSN 1552-5481, Vol. 39, no 8, p. 2311-2335Article in journal (Refereed)
    Abstract [en]

    This study is about the vulnerability of parents to adult children with drug problems. The study is based on a self-reporting questionnaire (n = 687) distributed to parents in Sweden via family member organizations, treatment centers, and online communities. Most parents reported extensive negative consequences on relationships, social life, and mental health due to their children’s drug problems. Most parents also experienced strong feelings of powerlessness, grief, guilt, and shame. Many parents reported a negative impact on their economy and work ability. In general, fathers claimed to feel less of a negative impact than mothers. A more severe drug problem and life situation for the child was associated with a greater negative impact for the parents. Many parents experienced difficulties in securing adequate help both for their child and for themselves. The study shows the need for increased support efforts for this parent group.

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  • 32.
    Richert, Torkel
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Månsson, Sven-Axel
    Malmö högskola, Faculty of Health and Society (HS).
    Laanemets, Leili
    Malmö högskola, Faculty of Health and Society (HS).
    Kvinnor som injicerar heroin respektive amfetamin: skillnader i social situation, erfarenhet av behandling och önskemål om hjälp2011In: Socialvetenskaplig tidskrift, ISSN 1104-1420, E-ISSN 2003-5624, Vol. 18, no 2, p. 144-164Article in journal (Refereed)
    Abstract [en]

    Women Who Inject Heroin or Amphetamines - Differences in Life Situation, History of Treatment and Request for Help The purpose of the present paper is to investigate differences between women who inject heroin and women who inject amphetamines, particularly as regards their life situation, treatment history and current request for help. The results are based on standardized interviews with 188 women at the needle exchange program in Malmö. A larger proportion of amphetamine users had stable housing combined with exclusively legal/formal sources of incomes (wage labour, pension, social benefits), whereas a larger proportion of heroin users had unstable housing combined with illegal/informal sources of income (prostitution, dealing, theft). This implicates that amphetamine users, in general, are more socially included whereas heroin users are more marginalized. Women with heroin as their principal drug reported to a higher extent, experiences of all types of treatment, lifetime history of treatment, treatment at several different occasions and contact with the social services and outreach groups during the last year. Several factors where significantly related to a request for help, whereas heroin as principal drug was the single factor showing a significant relation to request for help in a multivariate logistic regression equation. The differences between the two groups as regards their history of treatment and present requests for help may have several explanations. One probable explanation has to do with different levels of abuse and dependence in the two groups, where heroin users, due to a higher level of dependence, have a greater demand for care and treatment. A second explanation concerns differences in treatment supplies available for the two groups. To this day there is no evidence-based treatment for amphetamine abuse. Treatment options for heroin abuse, on the other hand, are well documented and well recognized and heroin users are a prioritized group for interventions within the Swedish care system.

  • 33.
    Richert, Torkel
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Stallwitz, Anke
    Department of Social Work, Protestant University of Applied Sciences Freiburg, Freiburg, Germany.
    Nordgren, Johan
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Harm reduction social work with people who use drugs: a qualitative interview study with social workers in harm reduction services in Sweden2023In: Harm Reduction Journal, E-ISSN 1477-7517, Vol. 20, no 1, article id 146Article in journal (Refereed)
    Abstract [en]

    Background: Social work with people who use drugs (PWUD) has traditionally focused on abstinence and rehabilitation. In recent years, harm reduction has gained an increasingly more important role in social work with PWUD, and social workers are key professionals in many harm reduction services. This study investigates how social workers in harm reduction services for PWUD in Sweden understand the concept of harm reduction and how it relates to goals of rehabilitation, and how they assess and deal with dilemmas and challenges in everyday work.

    Methods: The study is based on interviews with 22 social workers in harm reduction services for PWUD in the Scania region of Sweden. A thematic analysis in three steps was used in coding and processing the data.

    Results: The social workers pointed to similar values between social work and harm reduction and argued for combining the two fields to improve services for PWUD. Three overarching principles for Harm Reduction Social Work (HRSW) were developed based on the social workers accounts: (1) Harm reduction is a prerequisite for rather than a counterpoint to rehabilitation and recovery, (2) motivational work must be non-mandatory and based on the client's goals, (3) a holistic perspective is crucial for Harm Reduction Social Work. Challenges in doing HRSW concerned restrictive laws, policies, and guidelines, resistance from managers, difficulties in setting boundaries between client autonomy and life-saving interventions, and the risk of normalizing high-risk behaviors.

    Conclusions: We use the concept of Harm Reduction Social Work to show how social work with PWUD can have a primary focus on reducing harm and risks, while at the same time it involves a holistic perspective that facilitates motivation and change. The suggested principles of HRSW can provide guidance in practical social work with vulnerable PWUD. Social workers can have important roles in most harm reduction settings and may act to enable recovery.

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  • 34.
    Richert, Torkel
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Svensson, Bengt
    Malmö högskola, Faculty of Health and Society (HS).
    Gambling with life - injection drug use, risk taking and overdoses2008In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, no 5, 2008Article in journal (Refereed)
    Abstract [en]

    Aims: This article describes experiences of overdose among a group of long time heroin users. The main aim is to seek understanding for circumstances, motives and actions concerning the phenomena overdose. Methods: The data was collected through focus-groups and in depth interviews during the period September 2006- January 2008. A total of 52 participants took part in the study. Results: The participants were aware of many of the common risk factors for overdoses. In spite of this most participants had vast experience of overdoses. Most overdoses did occur as a result of a conscious risk taking behavior. A number of different circumstances and motives meant that risks for overdoses were ignored or that risks were considered to be subordinate to the expected benefits of risk taking. The search for the “ultimate rush”, severe abstinence, anxiety and depression, feelings of indifference and despondency, an unsafe and stressful environment are example of factors that led to a decrease in risk thinking and/or an increase of risk taking. Conclusions: Heroine overdoses can not fully be understood only by defining different isolated risk factors. There is also a need to explore the awareness of these risks among heroin users, how users comprehend and value these risks and what circumstances and which emotions and motives influence risk taking action that can lead to overdose. Key words: Overdose, heroin, injection drug use, risk taking, motives, occupational hazard, focus-groups, in-depth interviews, Sweden

  • 35.
    Richert, Torkel
    et al.
    Malmö högskola, Faculty of Health and Society (HS).
    Svensson, Bengt
    Malmö högskola, Faculty of Health and Society (HS).
    Med livet som insats: injektionsmissbruk, risktagande och överdoser2008In: Nordisk alkohol & narkotikatidskrift, Vol. 25, p. 355-376Article in journal (Other academic)
  • 36.
    Richert, Torkel
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention. Malmö University.
    Svensson, Bengt
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention. Malmö University.
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention. Malmö University.
    Experiences of Swedish Parents Seeking Social Services Support for Their Adult Children With Drug Addiction2021In: Journal of the Society for Social Work and Research, ISSN 2334-2315, Vol. 12, no 4, p. 677-704Article in journal (Refereed)
    Abstract [en]

    Objective: Family members of a person with drug addiction often experience negative impacts on their lives and face barriers to seeking professional support. More knowledge is needed about such barriers so they can be reduced. This article examines the help-seeking experiences of parents of adult children with drug addiction, a group that has received little attention in research. Method: We conducted in-depth interviews with 32 parents of adult children with drug addiction in Sweden. Results: Parents described problems in encounters with social services and barriers to adequate support for their children. On a psychological level, they described feelings of shame and guilt, negative views of social services, and fear of stigma and loss of control that were barriers to seeking professional support. On an interpersonal level, barriers to help were connected to problems in the interaction among parents, children, and social services. On a structural level, barriers pertain to deficiencies in the availability and quality of support measures, inadequate cooperation between authorities, and a shift in responsibility from the state to the individual and the family. Conclusions: Parents of children with drug addiction are a vulnerable group that often experience problems in their contacts with authorities. A more collaborative approach by social services may abate parents’ self-blame and concern and may strengthen their role in their children’s treatment process.

  • 37.
    Stallwitz, Anke
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Department of Social Work, Protestant University of Applied Sciences Freiburg, Freiburg, Germany;Department of Social Work, Malmö University, Malmö, Sweden.
    Nordgren, Johan
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    ‘Not having a real life’: psychosocial functions of using and selling drugs among young Afghan men who came to Sweden as unaccompanied minors2023In: Journal of ethnic and migration studies, ISSN 1369-183X, E-ISSN 1469-9451, p. 1-21Article in journal (Refereed)
    Abstract [en]

    Unaccompanied minors (UM) entering Europe face significant psychosocial challenges. Uncertain residence situations, marginalization during the asylum process, and low levels of support increase their risk of developing mental health and drug use issues. However, little is known about drug involvement (using and dealing) in this group. This is the first study to investigate drug involvement among young adults who entered Europe as UM from their subjective perspectives. We conducted qualitative interviews with 11 Afghan men who came to Sweden as UM in 2015/2016 and had experience of using and/or selling drugs, and analyzed the transcripts based on grounded theory. Drug initiation usually occurred after arrival in Sweden and was related to peer influence. Using and selling fulfilled specific psychosocial functions including self-medication and money-making. ‘Not having a real life’ (being excluded from school, employment, and many social activities) emerged as a central motive for drug involvement. By using or selling drugs, feelings of social belonging and control over one's own life could be experienced. Long, uncertain asylum processes and social exclusion exacerbate the risk of UM and former UM using or selling drugs. Policy and intervention measures must focus on providing this group with support, social inclusion, and meaningful activities.

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  • 38.
    Svensson, Bengt
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Richert, Torkel
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Johnson, Björn
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Faculty of Health and Society (HS), People, Places and Prevention.
    Parents’ experiences of abuse by their adult children with drug problems2020In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 37, no 1, p. 69-85Article in journal (Refereed)
    Abstract [en]

    Aims: To examine parents’ experiences of abuse directed at them by their adult children with drug problems. Material and Method: The material consists of 32 qualitative interviews on child-to-parent abuse with 24 mothers and eight fathers. The interviewees had experienced verbal abuse (insults), emotional abuse (threats), financial abuse (damage to property and possessions) and physical abuse (physical violence). Findings: In the parents’ narratives, the parent-child interaction is dominated by the child’s destructive drug use, which the parents are trying to stop. This gives rise to conflicts and ambivalence. The parents’ accounts seem to function as explaining and justifying their children’s disruptive behavior in view of the drug use. The fact that an external factor - drugs - is blamed seems to make it easier to repair the parent-child bonds. The parents differentiate between the child who is sober and the child who is under the influence of drugs, that is, between the genuine child and the fake, unreal child. The sober child is a person that the parent likes and makes an effort for. The child who is on drugs is erratic, at times aggressive and self-destructive. Conclusions: The interviewed parents’ well-being is perceived as directly related to how their children’s lives turn out. The single most important factor in improving the parents’ situation is to find a way for their adult child to live their lives without drug problems.

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