Substance use disorders (SUDs) are a serious public health concern contributing to health risks for individuals and communities. Recovery capital are client strengths associated with SUD recovery. Employment represents recovery capital associated with positive SUD treatment outcomes. However, the relationship between employment mechanisms and SUDs are not well understood. The present study investigates how specific employment variables at SUD treatment intake predict (a) successful treatment completion, (b) abstinence at six-month treatment follow-up, (c) reduced use at six-month treatment follow-up. Additionally, employment variable change is explored. A retrospective, cross-sectional investigation with logistic regression modeling to predict substance use at six-months post SUD treatment follow-up was used. Clients in the study period (1999-2016, N = 8,925) were a mean age of 31.7 (SD=11.8), mostly male (67.2%), and primarily White (86.6%). Results demonstrated that employment variables at intake predicted greater successful treatment completion, Wald χ2[36]=185.3, p<0.0001. However, greater employment strengths were predictive of maintained use at six-month follow-up rather than abstinence or reduced use. Further investigation showed, the best predictors of post-treatment recovery were months employed change (AOR=1.53, 95% CI=1.34-1.75) and days missed from work change (AOR=2.43, 95% CI=2.00-2.96). Counseling psychologists can help to improve substance use outcomes and the quality of life for those in SUD treatment by becoming involved in intervention design, consultation, and policy making that focuses on increasing employment length and reducing absenteeism due to substance use. Employment is one route to engagement that can help to improve the lives for those involved.

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Socialstyrelsen, i sin roll av tillsynsmyndighet för den läkemedelsassisterade opiatvården, utfärdar riktlinjer för detta arbete. Av dessa framkommer vissa skyddsfaktorer av särskild vikt, vilka har operationaliserats i en factorial survey med en randomiserad och en standardiserad vinjettkomponent. Dessa bedömdes av yrkesverksamma inom underhållsbehandling, totalt 38 personer. Materialet bearbetades genom multipel regressionsanalys. Resultatet visade att tre av variablerna - psykosocial intervention, boendesituationen samt familjen/nätverkets stöd, har ungefär lika stor påverkan på bedömningar. Variabeln för sysselsättning hade ytterst marginell påverkan. Vidare visade materialet att den arbetsplats som respondenten var yrkesverksam på var viktigare för att förstå påverkan av bedömningar än någon av ovan nämnda variabler. Detta diskuteras med hjälp av de teoretiska modellerna för återhämtningskapital, handlingsutrymme och judgement theory. / The swedish national board of health and welfare is the regulatory body for the medically assisted opiate care. As such, the board issues guidelines for this field. Theese guidelines contain several recommendations concerning salutogen factors, namely housing, the role of the family and network, work and psychosocial care. These are incorporated in vignettes using the factorial survey approach, and distributed to 38 swedish opiate care professionals. The results show that while the variables family/network, housing and psychosocial care have a relatively coherent influence on professional judement, work does not. However, the single most relevant factor is the clinicians workplace to understand influence om professional judgement. The results are discussed using a framework of recovery capital and judgement theory.

Most gamblers never experience addiction and the majority of those who do eventually recover. This thesis investigates how most maintain control over their gambling and how the majority of those who do experience gambling addiction regain control. Findings are based on 25 qualitative semi-structured interviews with participants who fit one of three ideal-type groups: (i) gamblers who have never experienced addiction; (ii) gamblers who have regained control after experience of gambling addiction; and (iii) gamblers experiencing addiction at time of interview. Participants were recruited who had never engaged in formal treatment because existing research suggests most who experience gambling addiction and/or recovery never to do so. This study is underpinned by a synthesis of Bourdieusian theory and Foucauldian-inspired governmentality literature which was used to guide the thesis and help explain gambling behaviour. Taking a Foucauldian genealogical approach, the dominant theory of addiction as a biomedical disorder is critiqued and revealed to be myth. Instead, (gambling) addiction is demonstrated to be a social construction which becomes embodied within individuals and thereby influences gambling behaviour. Consequentially, it is shown that research concerning substance use is applicable to the investigation of gambling behaviours. Given paucity of gambling research, substance-related literature is drawn upon throughout the thesis. Attention is given to research demonstrating regulation over drug use to be influenced by the social settings in which consumption takes place as well as the wider social and cultural milieus in which the lives of actors are embedded. Moreover, particular appreciation is given to literature indicating recovery from addiction to be supported by shifts in socio-cultural milieu. In contrast to most existing addictions/gambling research, the agential capacities of gamblers to shape their own behaviours, albeit in ways heavily constrained by context (or ‘structure’) are emphasised throughout the thesis. Data revealed various gambling-related strategies to help constrain gambling and minimise harm. These are examined and it is recommended that this knowledge could be used to aid development of more effective ‘harm-reduction’ style interventions and policies in ways which support less harmful patterns of gambling behaviour. However, although valuable, those with greater control tended to rely little on such strategies to manage their gambling. Instead, greater control over gambling and recovery from gambling addiction was found to have less to do with how participants gamble (e.g. whether or not they followed harm-reduction strategies) and far more to do with the wider, non-gambling-related, aspects of their lives and the nature of their subjectivities/dispositions. Principally influential were found to be the qualities of interviewees’ socio-cultural milieus. Alongside gambling, those with greater control tended to participate in non-gambling-related communities with attendant ways of thinking and cultural expectations (values/norms) that marginalise (heavier) gambling. Drawing on Bourdieusian and Foucauldian governmentality theory, it is argued that, because of their day-to-day participation in such communities/milieus, those with greater control embody mentalities and expectations which discourage riskier gambling behaviour. This, in turn, results in more ‘prudential’ subjectivities which discourage problematic gambling behaviour. Participants who had experienced recovery and many of those who had never experienced addiction revealed long-term reductions in gambling behaviour. Findings suggested these reductions (as well as recovery) to be supported by social and cultural processes, occurring over the life-course, which encourage increased participation in more ‘conventional’ life/milieus and thereby promote alterations in subjectivities in ways more conducive to control. A dual approach to discouraging problematic gambling behaviour is recommended. Although it is important to promote ‘safer’ ways of gambling (e.g. through promotion of harm-reduction style interventions and by designing gambling environments in ways to support greater constraint), it is also imperative to support the development of lives/milieus and subjectivities more conducive to control (e.g. participation in ‘conventional’ life and access to resources required to do so).

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