Stress is associated with poor mental health, specifically anxiety and depression, and stress and mental health problems are predictors of substance dependence and relapse. Social characteristics, such as racial/ethnic minority status, female gender, and low socioeconomic status, are often associated with increased psychological distress and substance use disorders. Pearlin’s social stress theory postulates that this association is due to increased exposure to stress and subsequent experiences of distress related to social disadvantage and decreased access to resources for coping with stress. This project uses a social stress theoretical perspective to examine predictors of substance use after treatment entry and follow-up addiction severity in a large sample of Kentucky substance abuse treatment participants (N = 1123). A conceptual model is tested to determine if social characteristics along with psychological distress, perceived stress, and economic hardship are predictors of substance use and follow-up addiction severity. In addition, since recovery support, efficacy, and self-control have been previously identified as mediators in the stress and relapse processes these factors were included as mediators in the model tested. The conceptual model was tested with three outcome variables, substance use between baseline and 12-month follow-up, follow-up alcohol addiction severity, and follow-up drug addiction severity. Bivariate and multivariate analyses, including logistic regression and ordinary least squares regression, were used to test conceptual models with the full sample and also with a subsample with baseline substance use indicative of potential substance dependence. Findings indicated that significance of predictors varied depending on outcome variable, although recovery support, efficacy, and self-control were significant predictors of all three dependent variables. Findings for each outcome variable are discussed, as well as limitations of the present study, implications for social work practice, and implications for future research.

The purpose of this study was to understand how social workers experienced working with Addiction Severity Index (ASI) in relation to the goal set by the National Board of Health and Welfare. The method is spread nationwide and therefore it is of great importance to examine how the social workers themselves experience the demands and the resources surrounding ASI. We choose to do a qualitative study interviewing eight social workers at six different occasions. The result was analyzed using Max Weber’s ideal type bureaucracy and Michael Lipsky’s thesis on street-level bureaucrats. We found that the social workers consider the method useful when used from without their own purposes. The standards set by the National Board of Health and Welfare was considered hard to achieve because of the complexity of the method. Among other things the valuation done by both social worker and client was regarded as tough and therefore the results of the interview are at risk of not becoming reliable. We found that the outcome of the interview depends on the performer.

<p>The purpose of this study was to <em>understand</em> how social workers experienced working with Addiction Severity Index (ASI) in relation to the goal set by the National Board of Health and Welfare. The method is spread nationwide and therefore it is of great importance to examine how the social workers themselves experience the demands and the resources surrounding ASI. We choose to do a qualitative study interviewing eight social workers at six different occasions. The result was analyzed using Max Weber’s ideal type bureaucracy and Michael Lipsky’s thesis on street-level bureaucrats. We found that the social workers consider the method useful when used from without their own purposes. The standards set by the National Board of Health and Welfare was considered hard to achieve because of the complexity of the method. Among other things the valuation done by both social worker and client was regarded as tough and therefore the results of the interview are at risk of not becoming reliable. We found that the outcome of the interview depends on the performer.</p>

Bakgrund Socialtjänsten saknar register för uppföljning av kvalitet. Utan kunskap om vilka insatser som socialtjänsten ger   riskerar personer att blir utan effektiva insatser eller utsätts för insatser som kan vara till mer skada än nytta. Syfte Förbättrad livssituation för individer i socialtjänstens missbruks- och beroendevård genom  systematisk uppföljning. Öka användningen av Addiction Severity Index- (ASI) för att följa och utveckla socialtjänstens insatser. Identifiera faktorer som bidrar till eller försvåra användandet av ASI. Metod Programteorin innehållande fem förbättringsområden togs fram. Förbättringsarbetet följdes upp genom genomförda ASI-intervjuer. Förbättringsarbetet studerades med mixad metod. Kvantitativ data med tidsserieanalys och kvalitativ data  med tematisk analys. Resultaten har analyserats genom Modell för implementering i olika kontexter. Resultat Användning av ASI-intervjuer ökade men nådde ej målen. Studien av förbättringsarbetet ger få svar på vad som påverkar användningen av ASI. Starkare koppling av faktorer med negativ inverkan på ASI-användningen än positiva inverkan. Slutsatser Förbättringsarbete  på flera områden gav ökad ASI-användning. Förbättringsarbete kan bedrivas samtidigt i ett läns kommuner. Det finns intresse för förenklade ASI-intervjuer men försöket gav ej underlag att dra slutsatser. Studien visar  faktorer som påverkar användningen av ASI men att det krävs fördjupningar för att generaliserbara slutsatser. / BackgroundSocial services do not have registers for monitoring quality. Without knowledge of what interventions the social services provide already exposed groups risk missing follow-up and improvement of care and support. Purpose Improved life situation for individuals in social services addiction care through systematic follow-up. Increase the use of Addiction Severity Index (ASI) to monitor and improve social services. Identify factors that contribute to or hamper the use of ASI. Method A program theory was developed. The improvement work was studied with a mixed method. Quantitative data with time series analysis and qualitative data with thematic analysis. Results was analysed through Model for implementation in different contexts. Results The use of ASI interviews increased but did not reach the targets. The study of the improvement gives few answers to what affects the use of ASI. Stronger coupling of factors with a negative impact on ASI usage than positive impact. Conclusion Improvement in multiple areas increased use of ASI. Improvement can be carried out simultaneously in 13 municipalities in a county. There is interest in simplified ASI interviews, but the trial did not provide evidence to draw conclusions. The study shows factors that affect the use of ASI, but that there is a need for more studies to generalize conclusions.

<p><strong>ABSTRACT</strong></p><p>Standardized assessment instruments have increasingly come to be used in social work. Although national studies of ASI and DOK's reliability and validity has only been examined to a limited extent. In order to improve knowledge of assessment instruments conditions, relevance and scope, this present literature study highlights the background and the application of the interview methods ASI and DOK, used in swedish abuse and dependent care. In answering the survey questions, a qualitative content analytical method has been used. ASI and DOK are multidimensional interviews which take into account that several areas affecting the client's treatment outcome. Assessment instruments differ in respect of use, approach to the assessment of client needs and help troubled, the basis for the interview estimates and its rating scales. International research shows that the ASI and DOK include a number of methodological problems that affect the reliability and validity in self-reported data. Assessment instruments different question areas, however, lacks a theoretical framework that allows any assumptions about the causal relationships between key areas of life and substance abuse problems. In accordance with a social constructionism perspective, ASI and DOK's usability are time and culture bound and must therefore be seen as methods that are in a constant process of change to generate as reliable knowledge as possible.</p><p><strong>Keywords: </strong>assessment instrument, social work, Addiction Severity Index, ASI, documentation system, DOC, structured interviews, addiction, substance abuse.</p>

ABSTRACT Standardized assessment instruments have increasingly come to be used in social work. Although national studies of ASI and DOK's reliability and validity has only been examined to a limited extent. In order to improve knowledge of assessment instruments conditions, relevance and scope, this present literature study highlights the background and the application of the interview methods ASI and DOK, used in swedish abuse and dependent care. In answering the survey questions, a qualitative content analytical method has been used. ASI and DOK are multidimensional interviews which take into account that several areas affecting the client's treatment outcome. Assessment instruments differ in respect of use, approach to the assessment of client needs and help troubled, the basis for the interview estimates and its rating scales. International research shows that the ASI and DOK include a number of methodological problems that affect the reliability and validity in self-reported data. Assessment instruments different question areas, however, lacks a theoretical framework that allows any assumptions about the causal relationships between key areas of life and substance abuse problems. In accordance with a social constructionism perspective, ASI and DOK's usability are time and culture bound and must therefore be seen as methods that are in a constant process of change to generate as reliable knowledge as possible. Keywords: assessment instrument, social work, Addiction Severity Index, ASI, documentation system, DOC, structured interviews, addiction, substance abuse.

The aim of this dissertation is to examine empirically what Evidence-based practice (EBP) and its standardized procedures become when put into practice in social work. EBP builds on the idea that professional practice should be based on systematic and reliable knowledge of the interventions and instruments used in this work. This implies a standardization of both research and practice that has been highly contested. Inspired by works within science and technology studies (STS), this dissertation analyses the actual content of the standardized procedures and their uses in social work practice. The dissertation examines a ‘critical case’, a substance abuse social services agency that has worked extensively for several years at implementing EBP, and consists of four papers focusing on three standardized procedures used by the agency in order to enact EBP: 1) the Addiction severity index (ASI) assessment instrument; 2) the psychosocial intervention Motivational interviewing, and 3) the decision-making model Critical appraisal (CA). Ethnographic methods were employed to study the agency’s concrete uses of the standardized procedures in daily practice. MI was also followed in the research literature as it became established as an ‘evidence-based’ intervention. Fundamentally, the development of the standards of EBP can be a messy and paradoxical process. In the stabilization of MI, its differences and ‘fluidity’ have eventually been made to disappear and left a stable ‘evidence-based’ object. Findings from the ethnographic studies show that EBP, as enacted in the agency’s daily practice, is a bureaucratic project where the agency’s managers have decided on and control the use of a set of standards. Thus, what constitutes relevant evidence is based not on professional discussion within the agency but is ultimately determined by the managers. In practice, the standards introduce new logics that cause tensions within the agency, tensions which the social workers are left to handle. Main conflicts concern how the client work is ordered and contradictory organizational rationales. The three standards are used to varying extent, which can be understood by examining what they seek to standardize and how they are put to work. CA was not used at all, mainly due to its design. Disregarding organizational rationales that are unavoidable within the social services, it could not be adapted to the agency’s work. With ASI and MI the situation was different, mostly because of their organizational adaptability. ASI could be implemented in several phases of the agency’s work flow resulting in adjustments of both the instrument and the work flow. As a ‘fluid intervention’, MI was constrained by, but also adjustable to the organization. It was thus possible for both ASI and MI to transform and be transformed by pre-existing practices, in effect creating new practices. A major conclusion is that EBP and its standardized procedures is a more dynamic and multifaceted process than previously acknowledged in social work. Rather than a deterministic one-way path, there are different kinds, degrees, and mutual transformations of standardization processes, which must be appreciated in research and in practical efforts to implement EBP. Given the importance of the organization in professional social work, there is a need to move away from individualistic conceptions of EBP and to consider what evidence use might mean from an organizational perspective. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Manuscript.</p>

<p> </p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><p><!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-name:"Normal\,Normal1\,Normal11\,Normal111\,Normal1111\, webb2"; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 70.85pt 70.85pt 70.85pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --></p><!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} --><p> </p><!--[endif]--><p>Vilka bedömningsinstrument som används inom missbruks- och beroendevården och hur Sveriges kommuner använder instrumenten är ett outforskat område. Socialstyrelsen publicerade år 2007 nationella riktlinjer för missbruks- och beroendevård där man förespråkar användandet av bedömningsinstrument. Studien har granskat i vilken utsträckning och i vilket syfte bedömningsinstrument används och hur förutsättningarna ser ut för användningen av bedömningsinstrument inom socialtjänstens arbete med missbruks- och beroendevård. Hur frekvent är användningen av bedömningsinstrument och vilka för- och nackdelar framkommer i bruket av dessa? Uppsatsen har en kvantitativansats med kvalitativa inslag och utgår från telefonintervjuer med tio respondenter. Dessa arbetar som handläggare inom missbruks- och beroendevården för vuxna och har tillgång till bedömningsinstrument. Studien visade att åtta av tio arbetsplatser (80 %) som har tillgång till olika bedömningsinstrument använder dem. Främsta syftet är att tydliggöra klientens problematik, se insatsbehovet, få ett helhetsperspektiv och att skapa ett aktivt deltagande från klienten. Förutsättningarna för att använda bedömningsinstrument finns i form av utbildning och stöd från organisationen, men det saknas tid, kunskap och utrustning för att använda dessa fullt ut. Den statliga intentionen med en evidensbaserad praktik är att skapa en evidensbaserad kunskapsbank. Trots detta visar undersökningen att utvärdering och statistik är två eftersatta områden gällande hanteringen av bedömningsinstrument.</p> / <p><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-name:"Normal\,Normal1\,Normal11\,Normal111\,Normal1111\, webb2"; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 70.85pt 70.85pt 70.85pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} --> <!--[endif]--></p><p>What assessment instruments used in drug and dependent care, and the extent to which the Swedish municipalities are using these instruments is an unexplored area. Socialstyrelsen published in 2007, national guidelines for drug and dependent care which advocates the use of assessment instruments. The study aim is to examine the extent to which, for what purpose and how conditions look for the use of assessment instruments in the social service work with drug and dependent care. How frequent is the use of assessment instruments and the advantages and disadvantages apparent in the use of these? The essay has a rate of quantitative and qualitative elements based on telephone interviews with ten respondents. Those working as administrators in the drug and dependent care for adults and have access to assessment instruments. The results showed that eight out of ten sites (80%) use different assessment instruments. Main purpose is to clarify the client's problem, see the effort need, have a global perspective and to create the active participation of the client. The conditions for the use of assessment instruments are in the form of training and support from the organization, but the absence still time, knowledge and equipment to use them fully. The government intends to evidence-based practice is to create an evidence-based knowledge. Although this study shows that the evaluation and statistics are two areas in the existing management of the assessment instrument.<strong></strong></p><p> </p>

<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--><!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-name:"Normal\,Normal1\,Normal11\,Normal111\,Normal1111\, webb2"; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 70.85pt 70.85pt 70.85pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} -->  <!--[endif]-->Vilka bedömningsinstrument som används inom missbruks- och beroendevården och hur Sveriges kommuner använder instrumenten är ett outforskat område. Socialstyrelsen publicerade år 2007 nationella riktlinjer för missbruks- och beroendevård där man förespråkar användandet av bedömningsinstrument. Studien har granskat i vilken utsträckning och i vilket syfte bedömningsinstrument används och hur förutsättningarna ser ut för användningen av bedömningsinstrument inom socialtjänstens arbete med missbruks- och beroendevård. Hur frekvent är användningen av bedömningsinstrument och vilka för- och nackdelar framkommer i bruket av dessa? Uppsatsen har en kvantitativansats med kvalitativa inslag och utgår från telefonintervjuer med tio respondenter. Dessa arbetar som handläggare inom missbruks- och beroendevården för vuxna och har tillgång till bedömningsinstrument. Studien visade att åtta av tio arbetsplatser (80 %) som har tillgång till olika bedömningsinstrument använder dem. Främsta syftet är att tydliggöra klientens problematik, se insatsbehovet, få ett helhetsperspektiv och att skapa ett aktivt deltagande från klienten. Förutsättningarna för att använda bedömningsinstrument finns i form av utbildning och stöd från organisationen, men det saknas tid, kunskap och utrustning för att använda dessa fullt ut. Den statliga intentionen med en evidensbaserad praktik är att skapa en evidensbaserad kunskapsbank. Trots detta visar undersökningen att utvärdering och statistik är två eftersatta områden gällande hanteringen av bedömningsinstrument. / <!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:HyphenationZone>21</w:HyphenationZone> <w:PunctuationKerning /> <w:ValidateAgainstSchemas /> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables /> <w:SnapToGridInCell /> <w:WrapTextWithPunct /> <w:UseAsianBreakRules /> <w:DontGrowAutofit /> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> </w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="156"> </w:LatentStyles> </xml><![endif]--> <!-- /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-name:"Normal\,Normal1\,Normal11\,Normal111\,Normal1111\, webb2"; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";} @page Section1 {size:612.0pt 792.0pt; margin:70.85pt 70.85pt 70.85pt 70.85pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> <!--[if gte mso 10]> <mce:style><! /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal tabell"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} --> <!--[endif]--> What assessment instruments used in drug and dependent care, and the extent to which the Swedish municipalities are using these instruments is an unexplored area. Socialstyrelsen published in 2007, national guidelines for drug and dependent care which advocates the use of assessment instruments. The study aim is to examine the extent to which, for what purpose and how conditions look for the use of assessment instruments in the social service work with drug and dependent care. How frequent is the use of assessment instruments and the advantages and disadvantages apparent in the use of these? The essay has a rate of quantitative and qualitative elements based on telephone interviews with ten respondents. Those working as administrators in the drug and dependent care for adults and have access to assessment instruments. The results showed that eight out of ten sites (80%) use different assessment instruments. Main purpose is to clarify the client's problem, see the effort need, have a global perspective and to create the active participation of the client. The conditions for the use of assessment instruments are in the form of training and support from the organization, but the absence still time, knowledge and equipment to use them fully. The government intends to evidence-based practice is to create an evidence-based knowledge. Although this study shows that the evaluation and statistics are two areas in the existing management of the assessment instrument.

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