Abstract The aim of this study is to illustrate how people with drug abuse problems are being depicted in drug courts, by examining the statements of the social welfare board and the individual, and the drug courts evaluation and judgement. These statements are being examined from power theories and a social constructionist perspective. Furthermore, the study aims to examine how these statements relate to each other. The study has a qualitative approach based on a discourse analytical method with following analytical tools; modality, processes, terminology, passive sense and nominalization. Based on the social constructionist perspective, the language in the verdicts is considered as both constructed and constructing. The empirical data consists of two verdicts concerning compulsory drug treatment, acquired from a drug court located in a medium-sized city in Sweden. In conclusion, the parties' statements may include varying degrees of truth and credibility, depending on structure and word choices. Further, different groups, in this case the social welfare board, the drug court (lawyers) and doctors, throughout the study is given the role of so-called privileged speakers with a special interpretative prerogative, whose expertise and opinions are often a kind of unchallenged knowledge. It is also evident how there are power differences even between these groups. I the two analyzed cases, the results show that different parties have the primary interpretative prerogative. Common to both cases is that the person with drug abuse problems are attributed to the least power, credibility and degree of truth, and thus end up at the bottom of this chain. A key finding in the study is that people with drug abuse problems are constructed in different ways in the verdicts, depending on the choice of words, sentence structure and current discourse. The language in the verdicts becomes a power tool that create, recreate and maintain beliefs about the abuser. Compulsory treatment, discourse analysis, social constructionism, power, drug abuser

Studien syftar till att undersöka hur socialsekreterare resonerar kring omhändertagande av gravida missbrukare. I studien undersöks även tillämpning av tvångsvårdslagstiftning i förhållande till gravida missbrukare och socialsekreterares förhållningssätt till etiska aspekter när beslut om tvångsvård av gravida missbrukare tas. Studien är kvalitativ och genomförs med hjälp av intervjuer med socialsekreterare och även med hjälp av officiella dokument från olika myndigheter. I studien används teorier som empowerment och företrädarskap av Ole Petter Askheim (2007) och Malcolm Payne (2008), socialarbetares handlingsutrymme av Karin Svensson m.fl. (2008) och etiska koder i socialt arbete av Erik Blennberger (2006). Teorierna och kopplingar till det sociala arbetets praktik förklarar socialsekreterares förhållningssätt till omhändertagande av gravida missbrukare. Resultatet av studien visar att socialsekreterare förhåller sig till den svenska lagstiftningen. Socialsekreterare betraktar inte graviditet hos missbrukare som en avgörande faktor när de tar beslut om tvångsvård. / The study aims to survey how social workers reflect on involuntary treatment of pregnant addicts. The study also surveys the application of legislation that regulates involuntary treatment in relation to pregnant addicts and social secretaries' approach to ethical aspects when making decisions on compulsory care of pregnant addicts. The study is qualitative and is implemented with the help of interviews with social workers and also with the help of official documents from various authorities. Theories of empowerment and advocacy by Ole Petter Askheim (2007) and Malcolm Payne (2008), social worker's discretion by Karin Svensson et al (2008) and ethical codes related to social work by Erik Blennberger’s (2006) are used. The theories and issues connected to social work practice explain the grounds social secretaries stand on when taking care of such issues as compulsory care of pregnant addicts. The results of the study show that social workers relate to the Swedish legislation. Social workers do not regard pregnancy of addict as the crucial factor when deciding upon compulsory treatment.

Bakgrund: I dagens samhälle drabbas många personer av psykisk ohälsa och varje dag tvångsvårdas ungefär 3000 personer i Sverige med stöd av lagen om psykiatrisk tvångsvård eller lagen om rättspsykiatrisk tvångsvård. Att vårdas mot sin vilja kan beskrivas som en väldigt besvärlig upplevelse där patienten ofta förlorar sin självbestämmanderätt och integritet. Syfte: Syftet med denna litteraturstudie var att beskriva patienters upplevelser av tvångsvård inom slutenvården. Metod: I denna litteraturstudie har åtta kvalitativa artiklar analyserats med hjälp av innehållsanalys. Databaserna som användes vid artikelsökningarna var: CINAHL, PubMed och PsycInfo. Resultat: Resultatet visar att upplevelsen av tvångsvården ger flera olika känslor och reaktioner. Förlust av den personliga autonomin och integriteten upplevdes av flera patienter. Personal som missbrukade sin maktposition gjorde att relationen blev sämre. Att bli bemött med respekt och när personalen tog sig tid för samtal var uppskattat upplevelsen blev mer positiv. Konklusion: Litteraturstudiens resultat visade de flesta patienter upplevde tvångsvården som något negativt och att det finns flera brister finns inom tvångsvården. För att kunna ge bättre vård är det viktigt att utbilda vårdpersonalen inom ämnet. Även fortsätt forskning om hur patienter upplever tvångsvård är viktigt för ökad förståelse. / Background: In today’s society many people are suffering from mental illness and every day about 3000 persons are exposed to compulsory treatment in Sweden under the law on compulsory psychiatric treatment or the law on forensic compulsory treatment. Being nursed against their own will can be described as a very difficult experience, where patients’ often loses their autonomy and integrity. Aim: The purpose of this study was to describe patients’ experiences of involuntary inpatient care. Method: In this literature study eight qualitative articles where analyzed using content analysis. The databases used for the article search was: CINAHL, PubMed and PsycInfo. Results: The result shows that the experience of compulsory care provides several different emotions and reactions. Loss of personal autonomy and integrity were experienced by many patients. Staff who abused their position of power made the relationship worse. To be treated with respect and when the staff had time to talk was appreciated and the experience became more positive. Conclusion: The results of the literature study showed that most of the patients experienced compulsory treatment as something negative. In order to provide better care, it’s important to give the medical staff education about the subject. There are also several shortcomings in the compulsory treatment. Although further research on how patients experience involuntary treatment is important for better understanding.

The thesis presents a case study of New Zealand's Alcoholism and Drug Addiction Act 1966 - a civil commitment law used to detain alcoholics and drug addicts for up to two years in state-certified residential treatment facilities. The thesis positions itself as a call for legislative reform. The central argument is that the Act is an anachronistic and potentially draconian piece of social legislation which has no place on the modern-day New Zealand statute book. In the first part of the thesis, Chapter 1 introduces the research, outlines the structure and methodology of the thesis, and locates the study within a wider tradition of scholarship on the management of people with alcohol problems. Chapter 2 summarises the analytical framework that is used to evaluate the Act, attaching particular importance to both the philosophical traditions and the practical strategies of harm minimisation and therapeutic jurisprudence. Chapter 3 gives a positivist reading of the legislation : outlining the evolution of the Act, essaying its major provisions, and noting the efforts that have been made to refine or reform the statute since it was passed in the mid-1960s. Chapter 4 draws on the limited amount of data available to describe how the Act is currently operating 'on the ground'. In the second part of the thesis, the Alcoholism and Drug Addiction Act is put into a comparative context by describing examples of similar-type statutes that exist in two other jurisdictions. Chapter 5 focuses on the New South Wales Inebriates Act 1912; Chapter 6 focuses on the Swedish Act on Care of Addicts in Certain Cases 1989. The final part of the thesis builds a case for reform of the Alcoholism and Drug Addiction Act. Chapter 7 identifies various practical and clinical problems with the Act, which mean that the statute does not work in instrumental terms. It is submitted that the Act cannot be said to make better provision for the care and treatment of alcoholics. Chapter 8 highlights several legal and philosophical difficulties with the Act, which mean that the legislation does not work in value terms. It is submitted that the Act is offensive to the right to refuse treatment and fundamentally conflicts with the principles of individual autonomy and informed consent. Chapter 9 proposes three options for reforming the Act, expressing a preference for the outright repeal of the statute. Finally, Chapter 10 draws conclusions from the preceding discussion, and speculates on the likelihood that the recommended reforms will be implemented.

I granskning av personer med missbruksproblematik finns det en risk att de bedöms utifrån samhällets normer samt föreställningar om kategorierna missbrukare, kvinna och man. Även att de förstås som annorlunda i relation till vad som är “normalt” och förväntat utifrån respektive kategori. Strukturalistisk forskning på området visar på en bred kunskap om samhällets föreställningar i relation till kategorierna missbrukare, kvinna och man samt att dessa är skapade i samhället och påverkar välfärdsstatens myndigheter och instanser. Dock saknas fokus på hur dessa föreställningar och kategorier som ett social konstruerat fenomen påverkar arbetet i förvaltningsrätten. Uppsatsen handlar om synen på personer med missbruksproblematik samt hur de begripliggörs i förvaltningsrättens domar. Materialet har analyserats med tematisk analys och för att få djupare förståelse analyserades materialet även utifrån Howard Beckers avvikarteori och Judith Butlers genusteori. Av resultat och analys av uppsatsen framkommer det att förvaltningsrätten och socialnämnden begripliggör personer med missbruksproblematik på ett nedsättande vis, i relation till samhällets normer och vissa egenskaper och livssituationer ges betydelse snarare än andra. Personerna förstås som misslyckade medborgare, dåliga föräldrar och oförståndiga och i detta skapas de till att endast vara klienter i behov av hjälp. Resultatet synliggör att förvaltningsrätten och socialnämnden är en del i ett avvikarskapande som möjliggör tvingande insatser.

Bakgrund: Tidigare forskning visade att patienter som tvångsvårdats beskrev att det var problematiskt när andra bestämde åt dem och när personal inte tog sig tid att lyssna och prata. Enligt Lag om psykiatrisk tvångsvård (SFS 1991:1128) ska tvångsåtgärder utföras med största möjliga hänsyn till patienten. Sjuksköterskor har beskrivit sig kunna känna skuld efter att ha utsatt patienter för tvångsåtgärder och vissa menade att det ibland inte fanns några alternativ till att utföra tvångsåtgärder. Syfte: Att beskriva patientens upplevelse utav tvångsvård och tvångsåtgärder. Metod: En litteraturstudie med kvalitativ inriktning. Studien är baserad på elva vetenskapliga artiklar som är publicerade mellan år 2000-2012 och genomförda i Australien, Finland, Kanada, Nederländerna, Norge, Storbritannien och Sverige. Dessa artiklar har analyserats och därefter har subkategorier och huvudkategorier urskiljts. Resultat: Personal upplevdes som ignorant och respektlös och patienter efterlyste genuin omtanke. Maktutövningar framkom och resulterade i att patienter upplevde sig förlora kontrollen. Vidare framkom det att patienter upplevde en bristande kommunikation där de varken blev hörda på eller hade en fullgod kontakt med personalen. Patienter upplevde sig inte heller bli tillräckligt delaktiga och informerade gällande deras vård. Samtidigt visade det sig också att vården kan erbjuda en känsla av säkerhet och gott omhändertagande. Patienternas upplevelser resulterade i fyra huvudkategorier samt sex subkategorier. Diskussion: Tännsjös definition av begreppet autonomi valdes till teoretisk utgångspunkt och användes för att genomföra en diskussion av resultatet. Information, beslutstagande och personalens makt är några utav de ämnen som diskuterats. / Background: Previous studies have shown that patients who were involuntarily treated described the care as problematic when others were taking decisions for them and the staff didn’t listen or talked to them. According to The Law of psychiatric Compulsory Care of 1991, coercive measures should be used with the highest regard considering the patient. Nurses can feel guilty about exposing the patient to coercive measures and some believed that there are no alternatives to it. Aim: To describe the patient’s experience of compulsory treatment and coercive measures. Methods: A literature review with a qualitative approach. Eleven scientific articles, published between the years 2000-2012, were used in the study. The studies were carried out in Australia, Finland, Canada, The Netherlands, Norway, Great Britain and Sweden. The studies were analyzed and the result was categorized. Results: Staff was described as ignorant and disrespectful and the patients wanted genuine regard. Staff exercised power which, for the patients, resulted in an experienced loss of control. Patients reported failure in communication, information, participation and were not having an adequate contact with the staff. Meanwhile some patients narrated that their care was good and offered them a sense of security. The patients’ experiences resulted in four main categories and six sub categories. Discussions: The definition of autonomy, by Tännsjö, was chosen to be the theoretical framework and was used in the discussion. Information, decision-making and the power of the staff were some of the topics which were discussed.

Statistik från Socialstyrelsen visar att den 1 november 2016 tvångsvårdades 384 personer med missbruksproblematik i Sverige. Mellan år 2000–2009 dokumenterades 150 graviditeter och åtta förmodade graviditeter som resulterade i 94 barn som föddes av kvinnor som fick vård enligt LVM. Dessa barn föddes i högre andel prematurt jämfört med resten av befolkningen samt hade lägre födelsevikt. I Sverige finns det idag inget lagstöd för att vårda en gravid kvinna med missbruksproblematik till skydd för det ofödda barnet. Det beräknas att det föds 1,6 barn per 1000 med den svåraste formen av skador till följd av moderns alkoholintag, fetalt alkoholsyndrom. Studiens syfte är därför att med en kvalitativ metod undersöka hur åtta yrkesverksamma socialarbetare i Sverige upplever arbetet med gravida kvinnor med missbruksproblematik samt hur de uppfattar skyddet för ett ofött barn. Studien har sedan analyserats utifrån de teoretiska begreppen makt och handlingsutrymme samt svenska lagar, riktlinjer och konventionen om barns rättigheter. Resultatet visar att samtliga informanter känner frustration över att inte kunna ta hänsyn till barnets välbefinnande förrän efter det fötts och att de anser att det hade varit till fördel för både barnen och till viss del de gravida om lagen ändrades. / Statistics from the National Board of Health and Welfare declares that on November 1, 2016, 384 people with drug addiction were receiving compulsory treatment in Sweden. Between the years of 2000 and 2009, 150 pregnancies and 8 presumed pregnancies which resulted in 94 children born of women receiving care under the LVM were documented. These children were born prematurely and had lower weight at birth compared to the rest of the population. In Sweden, there is no legal ways to grant a pregnant woman with substance abuse compulsory treatment for the protection of the unborn child. It is estimated that 1.6 children out of 1,000 are born with the most severe form of injuries due to the mother's alcohol intake, which is fetal alcohol syndrome. The purpose of this study is to by a qualitative approach examine how eight working social workers in Sweden experience their work with pregnant women with substance abuse and how they perceive the protection of an unborn child. The answers has then been analyzed on the basis of the theoretical concepts of power and scope, as well as Swedish laws, guidelines and the convention on the rights of the child. The result shows that all informants feel frustrated by not being able to take into account the child's wellbeing until after birth and that they think a change in Swedish law would have been beneficial for both the children and the pregnant women.

Personality rights are fundamental human rights which are the subject of much attention also during the provision of health care. A patient has right, above all, to data protection in his medical documentation, medical facilities have an obligation to maintain confidentiality on matters relating to the patient?s state of health. All therapeutic actions can be carried out only with the consent of a patient. However, the personality rights can be limited in order to protect public health. Legislation can impose a whole range of obligations and duties to patients and medical facilities in order to protect public health. The thesis summarizes fundamental legislation and regulations of the above mentioned issue. It describes a possibility to break the confidentiality in order to protect public health, a regulation of imposition of compulsory medical treatment and anti-epidemiological measures. The thesis briefly informs about company preventive care and related limited choice of a physician and a medical facility. The objective of the thesis was to find out the views of general public of limitations of personality rights in order to protect public health. For the practical part the method of quantitative research was chosen, the technique of a questionnaire. The research was conducted from January 2011 to March 2011 in the region of České Budějovice. The research group included 460 respondents, 405 respondents filled in the questionnaires properly and these were included in the research. To achieve the research objectives, three hypotheses were set. Hypotheses 1 and 3 were proven on the basis of obtained and statistically evaluated data. Hypothesis 2 was not proven. The research results demonstrated especially differences in respondents´ views of a possibility to refuse obligatory vaccinations.

The aim of this study have been to examine how lagen (1988:870) om vård av missbrukare i vissa fall [LVM] (involuntary treatment for addicts) is constructed in Swedish news press and what discourses are being produced regarding LVM and involuntary treatment. Out of the 195 articles that fit the search criteria, extending a period of ten years, 36 were selected and analyzed, using a critical discourse analysis according to the three-dimensional model proposed by Fairclough. The theoretical perspective derives from the hypothesis of social constructionism. This study shows that LVM is subject to a silent assumption of an economic constraints discourse that´s being produced in news press, regarding the shortage of funds in public sector. In turn, this discourse also exhibits close relationship with the greater addiction discourse, which deems drug- and alcohol abuse as sickness, or disease. Furthermore, a set of minor discourses are identified, that to some degree stems from the economic constraints discourse. The media depiction presents an ongoing medicalization process that in social practice results in a higher death rate among drug abusers. The notion that medicinal treatment of addiction is more cost effective than LVM, nonetheless spurs society in adding evermore medicinal treatment of addicts. / <p>VT, 2016</p>

<p>Compulsory treatment is regulated by the Care of Alcoholics and Drug Abusers Act (LVM; 1988:870), and aims, among other things, at motivating addicts to treatment. Research has, up til now, mostly disregarded the client-perspective on compulsory measures. This dissertation has its starting point in the experiences of 54 alcohol- and drug addicts. The intention is to describe and analyse their view on coercive care and the possibilities to become motivated for change and/or voluntary treatment in such a context.</p><p>A central question during the interviews (which took place at five different institutions for compulsory commitments) is the addicts´ problem recognition, desire for help and willingness to participate in treatment. These dimensions are also illuminated quantitatively by use of a questionnaire. The results of this questionnaire form the basis of a division of the addicts into three groups with varying de-gree of treatment motivation. Comparisons between the groups are done with reference to the evaluation of present treatment context and of the institutions’ efforts to enhance motivation. In addition to this the groups are compared regarding how they perceive limita-tions in their freedom of action.</p><p>The results showed that the three groups had different motiva-tional structures. The “least motivated” stated that the addiction was not their major problem and wanted no help with that aspect of their lives. The “middle-group” claimed to have alcohol-/drug problems that, however, were not too serious. They were not sure that the coercive care was adequate for their situation. The “most motivated” said that they had vast problems with their addiction, were help-seeking and satisfied with having the chance to participate in any kind of treatment program at all. Less differences between the groups were noticeable when it came to a direct evaluation of com-pulsory treatment. The majority reported that they, through the co-ercion, had been exposed to violations of their autonomy. Whether motivated for treatment or not, the interviewees were also sceptical about the possibilities of the institutions to enhance motivation among the incarcerated addicts.</p><p>In the dissertation, addiction and motivation is furthermore dis-cussed from the perspective of rational choice and motivational the-ory. It is concluded that committed addicts think and act strategically in order to maximise their personal use of involuntary incarcerations. It is also asserted that their view on what happens during commit-ment, in some respects, is opposed to the “establishment’s”. For instance, the addicts claim that you don’t become motivated by way of compulsory treatment, while the opposite of their notion form the basis of the legislation.</p>