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<p>This dissertation argues for a number of theses related to responsibility, norm psychology, and personhood. Although most of the papers argue for “standalone” theses, in the sense that their truth does not depend the truth of the others, the five papers collectively illustrate a broader view of humans as (a) responsible agents who are (b) self-governing and (c) equipped with a capacity for norms, and whose agency (d) centers on dynamic responsiveness to corrective feedback. Drawing on this broader picture, the dissertation sheds light on ethical questions about our social practices and technologies, as well as descriptive questions about the nature of substance use disorder. </p> <p>Most centrally, the dissertation argues that forward-looking considerations are relevant for responsibility, not merely because the consequences of our responsibility practices are desirable, but primarily because of a connection which I argue exists between relationships, norms, and learning. On the view I defend, an agent is a responsible agent only if she can learn from being held responsible, so as to regulate herself according to norms of which she presently falls short. I argue that, if it were not for the capacity of humans to learn from <i>social corrective feedback</i>, such as normative responses like praise and blame, humans would be unable to participate in norm-governed relationships and communities. It is in virtue of their participation in these relationships and communities that humans are subject to interpersonal norms, such that they can fulfill or violate these norms and be praiseworthy or blameworthy for doing so. So, without the kind of learning that makes participation in these relationships a possibility, humans could never be praiseworthy or blameworthy for anything that they do. </p> <p>The dissertation also argues that human norm psychology has implications for how we should relate to “social robots”—artificial agents designed to participate in relationships with humans. I argue that, like humans, social robots should be equipped with a capacity to recognize and respond to normative feedback. Lastly, the dissertation resists a common narrative about addiction as being a form of akrasia in which agents act against their own better judgment. While this is certainly a central aspect of many cases of addiction, I argue that it fails to appreciate the ways in which addiction sometimes interacts with a person’s identity and goals, especially in cases where the agent believes that the things she values would not be feasible if she did not continue to engage in addictive behavior.</p>

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Alla människor har rätt till en lika vård men studier visar att personer med substansbrukssyndrom befinner sig i en utsatt position i mötet med vården. Substansbruk definieras enligt världsorganisationen WHO som ett sjukdomstillstånd. 275 miljoner människor beskrivs ha ett substansbruk, varav 36 miljoner av dessa människor har ett substansbrukssyndrom. Syftet med denna studie var att sammanställa kunskap om hur personer med substansbrukssyndrom upplever bemötandet och stigmatisering i vården. Metoden som valdes var en systematisk litteraturöversikt av studier med kvalitativ metod med metasyntes som analysmetod. Databaserna PubMed och PsycInfo användes. Efter kvalitetsgranskning inkluderades 16 artiklar. Resultatet av metasyntesen resulterade i tre slutteman:  Att bli särbehandlad och dömd. Att bli ignorerad och misstrodd. Att bli behandlad som en människa och uppleva att man får den vård man är i behov av. Resultatet visade att personer med substansbrukssyndrom upplever både ett negativt och ett positivt bemötande av vården. I resultatet framkom det en upplevd stigmatisering och en känsla av att bli misstrodd av vården, medan andra delar av resultatet visade att patientgruppen erhöll ett tillitsfullt bemötande och blev sedd som en människa bakom sin diagnos. Slutsatserna tyder på vikten av en personcentrerad vård och att ett individuellt bemötande kan vara grunden för att skapa en god vårdrelation för att förbättra vården för patienter med substansbrukssyndrom. Denna studie kan bidra till en ökad förståelse och kunskap om hur personer med substansbrukssyndrom upplever att de blir bemötta av vården. Studien kan få en betydelse för vårdpersonal, men också för patienter och anhöriga, genom att vården kan uppnå ett förbättrat förhållningssätt till denna patientgrupp.

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The pandemic of alcohol and drug abuse continues to ravage families, communities and societies placing many households, even communities, under siege. For persons living in an addictive home it is like living in a whirlwind where a family member’s substance use disorder (SUD) turns homes into sporadic unpredictable and out-of-control environments. The partner or concerned significant other (CSO) of the partner with the SUD becomes so engrossed in the latter, that they sacrifice their own time, needs, energies and resources to manage the whirlwind, even adopting maladaptive coping skills to survive. When partners with SUDs begin treatment, its modalities primarily focus on treating the partner with the SUD. The non-abusing CSO-partner is mostly conceptualised as an adjunct treatment collaborator for partners with a SUD and therefore instrumental to a successful treatment outcome. The CSO-partner’s own needs for professional treatment go unattended while they themselves seldom receive specialised treatment to heal and recover from the many and varied scars caused by the whirlwind of a partner’s SUD. They are thus deprived of a service to which they are entitled in their own right. This explains a lacuna in home-grown treatment which falls within the ambit of social work for a CSO-partner. Utilising a qualitative research approach, and the collective instrumental case study and phenomenological research designs complemented by an explorative, descriptive and contextual strategy of inquiry, I explored the experiences, challenges and coping strategies of CSOs living with a partner with a SUD with the view of informing guidelines for social work intervention from 12 CSO-partners and their partners with a SUD. These guidelines were informed by their suggestions for social work support. To live with a partner with a SUD was for all the CSO-participants an overall negative and stressful experience in which they felt isolated and trapped. Feelings of anger and frustration; sadness; embarrassment; shame, humiliation; despair, and hopelessness were experienced causing some of them to emotionally disengage from their partners. Their partners’ SUD-related behaviour had a negative effect on them; their relationships and the relationships with their children. The partner’s argumentative attitudes; intimate partner violence; lack of responsibility; erratic, reckless behaviour, manipulation and threatening relapse were highlighted as some of the challenges experienced. A mix of coping strategies that can be categorised as both adaptive and maladaptive, or enabling behaviours, were employed to mitigate and manage the challenges experienced. The CSO-participants also employed external sources of motivation to convince or force their partners to enter treatment. Admitting to the fact that their SUD’s had affected the CSO-partners negatively, both the partners with the SUDs and their CSO-partners offered suggestions for social work support for the CSOs of partners with a SUD. Topics to be covered during social work interventions to support to CSOs included providing information about drugs and its effects; setting of boundaries and personal safety; rebuilding self-esteem; anger-management; relapse management; and parenting and marriage counselling. Ways in which to provide such social work intervention and support suggested was through couple counselling; family counselling and support groups, and a tailor-made programme catering specifically for the CSO-partners. Based on the research findings, guidelines were formulated as recommendations for social work intervention directed at social work practice. Additional recommendations for education and training; continuous professional development, and ideas for future research were also suggested. / Social Work / D. Phil. (Social Work)

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Problématique. L’importance de la qualité de la relation entre de jeunes adultes présentant un trouble concomitant de santé mentale et lié aux substances et leurs intervenants pour la santé de ces jeunes est bien documentée. Or, ce phénomène complexe a surtout été étudié dans une perspective individuelle plutôt que systémique alors que plusieurs des résultats d’études antérieures soutiennent le caractère systémique de cette relation. But. Cette étude vise à mieux comprendre, selon une perspective systémique, le phénomène complexe de la relation entre les jeunes adultes atteints d'un trouble concomitant de santé mentale et lié aux substances et les intervenants. Méthode. Une revue intégrative basée sur un cadre théorique systémique a été effectuée. Six bases de données ont été consultées, une recherche de littérature grise et une vérification des références ont bonifié le processus. Résultats. Sur un total de 532 écrits recensés, 44 ont été inclus. L’analyse thématique a fait ressortir deux thèmes, soit a) le système de santé : un environnement contraignant et b) la relation au coeur des soins. Le premier thème décrit le contexte de la relation alors que le deuxième concerne l’influence des soins prodigués, de la confiance réciproque et du caractère hiérarchique de la relation sur la qualité de cette relation. Conclusion. Cette étude corrobore le rôle conjoint joué par le jeune et l’intervenant dans le développement et le maintien de leur relation. Elle peut donc constituer d’assise pour le développement d’interventions infirmières mettant à l’avant plan la relation selon une perspective systémique. / Problem. Importance of a quality relationship between young adults living with dual diagnosis and their health care providers is well documented. However, this complex phenomenon was mostly studied with an individual perspective instead of systemic perspective even if the results addressed the systemic nature of this relationship. Objective. This study aims to better understand the relationship between young adults living with dual diagnosis and their health care providers with a systemic perspective. Method. An integrative review framed by a systemic approach was completed. Six data bases were consulted, manual research in grey literature and references screening enhanced the process. Results. On a total of 500 studies and 32 reports identified, 44 were included in the review. Thematic data analysis was realized, and two themes were identified: (a) the health care system: a constraining environment and (b) the relationship: at the heart of care. The first theme describes the context of the relationship, and the second theme addresses the influence of cares, mutual confidence, and hierarchic relationship on the quality of this relationship. Conclusion. This study supports the joint role played by both young adult and health care provider on the development and the maintenance of their relationship. This integrative review can represent the foundation of future nursing interventions that brought the relationship to the forefront of nursing cares with a systemic approach.