Problem representations in Swedish youth substance use treatment: staff views on what is treatable and less treatable

Abstract

Swedish youth substance use problems are mainly treated at so-called Maria clinics, multidisciplinary units employing both medical and psychosocial staff. Interventions include assessments of substance use and health, urine testing, counselling and education about drug harms. The study analyzes how treatment staff represent youth problems in interviews so that they align with such interventions. We draw on Carol Bacchi’s (2009) post-structuralist “What’s the problem represented to be” (WPR) approach to policy analysis. It assumes that “problems” should be approached analytically as posterior rather than anterior to solutions; that they are calibrated in discourse and practice to fit with certain interventions. This is important since problematizations can ultimately authorize policy targets, determine resource allocation and steer who gets what help. We thus assert that staff discussions about patient groups and working methods include legitimization of why some, but not other, youth substance use problems are considered apt for Maria clinic treatment. Twenty interviews with professionals who work with youth substance use treatment in the Stockholm region were conducted. The results show that the participants primarily evoked patients with demarcated drug problems, who became motivated to treatment, submitted to adult monitoring and learned to care for their health and everyday routines. Three examples of other youth problems that were represented as less aligned with this treatment are also illustrated; adolescents with severe comorbidity, criminal identities and irrelevant support needs. The analysis highlights how the Maria clinic treatment appeared to be geared towards adolescents who can be effectively treated, responsibilized and deterred from substance use. We discuss whether adolescents who were considered less relevant for this treatment, namely those described as particularly unhealthy, rebellious or chaotic, are more adequate targets of intervention than the occasional cannabis users who receive a lot of attention in Swedish policy and practice.