It is quite noteworthy that relapse in substance use has been discussed more on an international level, than on a national level. In Sweden, research has focused on the recovery process, relapse avoiding strategies, and on relapse prevention treatment. Therefore, this study aims to describe and analyze individual and social risk factors for relapse in substance use from the perspective of both therapists and substance users. This is to analyze whether there are common denominators and/or major differences between these perspectives. Through qualitative interviews, where four therapists and four previously treated substance users were interviewed, we got access to different people’s substance use stories and opinions on relapse. To summarize our results, both users and therapists named triggers as negative emotions, and multi-problems such as mental health issues, but even damaged brain as an individual risk factor. They mentioned, furthermore, social relations, poor working alliance between users and professionals, and alcohol availability as Swedish tradition as social risk factors. Users alsomentioned exclusion and stigma in Sweden as social risk factors, meanwhile, therapists named loneliness as a social risk factor. These perspectives overlapped to a considerable extent, but therapists in some cases had a more scientific understanding of relapse.

Bakgrund: Psykisk ohälsa och substansbruk utgör båda separat globala hälsoproblem. Samsjuklighet i form av psykisk ohälsa och substansbruk är vanligt förekommande och komplexiteten av denna sjukdomsbild utgör utmaningar för hälso- och sjukvården.  Syfte: Studiens syfte var att beskriva upplevelser av möten med omvårdnadspersonal bland personer med samsjuklighet i form av psykisk ohälsa och substansbruk.  Metod: En allmän litteraturstudie genomfördes, i enlighet med Nio-Stegsmodellen av Polit och Beck. Denna översikt inkluderade och metodiskt analyserade nio originalartiklar, med användning av innehållsanalysmetodiken som beskrivits av Graneheim och Lundman.  Resultat: Tre huvudkategorier framträdde: Personen bakom substansbruket, Vårdrelations betydelse och Utmaningar kopplade till samsjuklighet, tillsammans med sex underliggande subkategorier.  Slutsats: Personer med samsjuklighet i form av psykisk ohälsa och substansbruk utgör en komplex patientgrupp. Studiens resultat tyder på att vårdsystemets utformning och upplevd bristande kunskap hos omvårdnadspersonalen utgör hinder för dessa patienter att erhålla adekvat vård. Det krävs en ökad kunskap och förståelse hos omvårdnadspersonal för de unika utmaningar som dessa personer står inför för att bättre kunna möta deras behov. Ytterligare forskning på detta område behövs därmed för att förbättra vården av denna patientgrupp. / Background: Mental health and substance use both separately constitute global health challenges. Comorbidity of mental health issues and substance use is common, and the complexity of this clinical picture poses challenges for healthcare.  Aim: The study's aim was to describe experiences of encounters with nursing staff among individuals with comorbidity of mental illness and substance use.  Method: A general literature review was conducted, adhering to the Nine-Step model by Polit and Beck. This review included and methodically analyzed nine original articles, employing the content analysis methodology outlined by Graneheim and Lundman.  Results: Three main categories were identified: The person behind the substance use, The significance of the care relationship, and Challenges related to comorbidity, along with six associated subcategories.  Conclusions: People with comorbidity in the form of mental disorder and substance use constitute a complex patient group. This study’s results imply that the design of the healthcare system and the perceived lack of knowledge among nursing staff pose barriers for these patients to receive adequate care. There is a need for increased knowledge and understanding among nursing staff regarding the unique challenges faced by these people to better meet their needs. Further research in this area is therefore needed to improve the care of this patient group.

Bakgrund: Substansbruk är ett växande problem i världen och personer med substansbruk påträffas i alla delar av vården på grund av deras omfattande samsjuklighet. Patientgruppen upplever att de fördomarna som finns mot substansbruk i allmänhet även är närvarande i vårdmötet. Syfte: Syftet med studien var att undersöka vårdpersonals erfarenhet av att möta patienter med substansbruk i somatisk vård. Metod: En litteraturstudie baserad på nio kvalitativa artiklar. Databassökningen genomfördes i Cinahl, PubMed, PsychInfo samt via en manuell sökning. Resultatanalysen gjordes enligt Fribergs femstegsmodell. Resultat: Utifrån resultatet formades två huvudkategorier och nio underkategorier. De två huvudkategorierna var; Vårdpersonalens inre kamp mellan fördomar och professionalism och Konkreta hinder och förutsättningar för en förändring. Konklusion: Vårdpersonal upplevde flertalet hinder kring att ge en god vård till patientgruppen. Många av de hinder som upplevdes skulle kunna förklaras med den allmänna okunskapen, avsaknaden av stöd och begränsade erfarenheten av patientgruppen. Mer utbildning och stöd skulle i förlängningen kunna leda till ett bättre bemötande och vård för denna patientgrupp. / Background: Substance use is a growing problem in the world and people with substance use are found in all parts of the healthcare system due to their extensive comorbidity. The prejudices that exist against substance use in general is also experienced by the patient group in the care setting.  Aim: The purpose of the study was to investigate healthcare professionals' experience of meeting patients with substance use in somatic care. Methods: A literature study based on nine qualitative articles. The database search was conducted in Cinahl, PubMed, PsychInfo and by a manual search. The result analysis was conducted according to Friberg's five-step model. Results: Based on the results, two main categories and nine subcategories were formed. The two main categories were; The inner struggles of healthcare professionals between prejudice and professionalism and Specific obstacles and opportunities for change. Conclusion: Healthcare professionals experienced several different obstacles in providing good care to the patient group. These could be explained by the general lack of knowledge, support and limited experience. Further education and support could in the long run lead to better treatment and care for this patient group.

Denna uppsats uppmärksammar hur föräldrar till tonårsbarn med substansbruk upplever sin situation och det anhörigstöd de fått. Syftet är att skapa en förståelse för föräldrars egen situation kopplat till sitt tonårsbarns substansbruk, med särskilt fokus på att undersöka upplevelsen av behandlingsprocessen och egna behandlingsinsatser för föräldrarna på Mariamottagningarna i Skåne samt att få en ökad förståelse för vilka önskemål om förändring och förväntningar som föräldrarna har gällande anhörigstöd. Uppsatsen baseras på nio semi-strukturerade intervjuer med föräldrar till tonårsbarn under 18 år med substansbruk. Föräldrarnas berättelser och erfarenheter analyseras genom Scheffs teoribildning kring sociala band. Resultatet visar en tung belastning och bröda inom föräldragruppen, vars tonårsbarn hade komplexa problembilder. Föräldrarna hamnade lätt i problem- och emotionsfokuserade beteenden. Likaså beskrevs ett inre föräldraproblemfokus som skapade skam och försämrad kommunikation mellan förälder och tonåring och i värsta fall kris i familjen. I vissa fall resulterade detta i att föräldern satte sitt eget liv på paus med ökad risk för stressrelaterad ohälsa. Olika sårbarhets- och skyddsfaktorer hos föräldrarna genererar olika behov vilket talar för ett kartläggande av dessa för att sedan anpassa stöd och insatser till föräldrarna. Föräldrarnas hade blandade känslor kring det professionella anhörigstödet. Ett positivt upplevt anhörigstöd relaterades till en behandlarens eller socialsekreterarens bemötande, kompetens, helhetsperspektiv och samverkan med andra professionella i kontakt med tonåringen. Önskemål från föräldrarna handlade om ökad delaktighet i tonåringens behandling. / This thesis explores how parents of adolescents with substance abuse experience their situation and the support they have received from professionals. The purpose is to create an understanding of the parents' own situation linked to their adolescent’s substance abuse, with a particular focus on examining the experience of the treatment process and interventions for the parents at the Maria treatment centers in Skåne, In addition, the thesis aims to gain an increased understanding of parents´ own expectations, and wishes for change, regarding the provided support. The essay is based on nine semi-structured interviews with parents with adolescents under the age of 18 with substance abuse. The parents' narratives and experiences are analyzed through Scheff’s theory regarding social bonds. The result shows a heavy burden and load within the parental group, whose adolescents have a high level of comorbidity. The parents easily ended up in problem- and emotion-focused behaviors. Likewise, an internal parental problem-focus was described, which created shame and impaired communication between parent and adolescent, and in the worst case a crisis in the family. For some parents this resulted in the parent putting their own life on hold with an increased risk of stress-related illness. Different vulnerability and protective factors within the parental group generate different needs, which speaks for these being mapped in order to adapt support and interventions to the parents. The parents had mixed feelings about the professional support. Positively perceived support was related to a therapist’s or social worker’s reception, competence, overall perspective, and cooperation with other professionals in contact with the adolescent. Wishes from the parents included increased participation in the adolescent’s treatment.

This study aims to examine how pre-existing discourses (in example medicalization) in society may impact the opinions of substance users by analyzing the interactions between users of the forum subcategory “Drug rehabilitation”, in the “Drugs” section on the Swedish internet site Flashback.org. This is achieved using Fairclough’s critical discourse analysis combined with Bourdieu’s theory of social capital. The findings indicate; an emphasis on self-examination and the way users formulate their own views of their problems, help-seeking and needs. The meaning-making processes that occur between the users, where they draw on personal experience of substance use and/or treatment, commonly oppose general explanations of substance use from a clinical perspective. This illuminates the importance of communicating genuine care, listening and respecting client agency among professionals who come in contact with substance use problems, i.e. through health care, counseling and social work.

Based on the premise that addiction care requires collaboration between municipalities and regions, the Maria clinics have been highlighted as good examples of how addiction care in Sweden can work. Despite this, there is a lack of updated knowledge about how staff understand and give meaning to substance-using youth and the treatment system. By adopting Carol Bacchi's critical approach "problematizations", this study examines how youth with substance use problems, as well as interprofessional treatment collaboration around them are constructed. Twenty semi-structured interviews with staff in Maria clinics and municipal social services, have been analyzed using post-structural interview analysis. Three main subject positions were identified: self-medicating, disturbing and law-breaking youth whose characteristics made them fit better or worse with the current supply of interventions in the treatment system. In discussing the key aspects of professional collaboration, the participants concentrated on leadership, healthcare and shortcomings in psychiatry. The staff tended to create a reality through a medical discourse where the complexity of youth substance use is reduced to an isolated individual problem, that should primarily be identified and treated through medical interventions. This can be limiting regarding the staff's understanding of substance-using youths’ situations and how interprofessional collaboration can support them.

Syftet med uppsatsen var att undersöka personers erfarenheter och upplevelser av att växa upp med en förälder som har ett missbruk. I vår kvalitativa studie har sex självbiografier analyserats genom en tematisk analysmetod. Resultatet för uppsatsen påvisar att en uppväxt med en förälder med ett substansbruk kan medföra emotionella och praktiska konsekvenser. Vidare visar resultatet att personerna har som barn behövt tillgodose sina behov som till exempel omsorg eller mat. Det som även var gemensamt för barnen var de otrygga förhållandena i hemmet och att de fick agera förälder i hemmet. Det huvudsakliga resultatet presenterar att de anknytningsmönster som framträder hos barn till föräldrar med substansbruk visar på en otrygg anknytningsstil. / The aim of this study was to examine people´s experiences and perceptions of growing up with a parent who has a substance abuse problem. In this qualitative study, six autobiographies were analyzed by a thematic analysis method. The results show that growing up with a parent with substance abuse can have emotional and practical consequences. Further, the results show that as children, the subjects had to provide for thei needs such as care or food. What was also common for the children was the insecure conditions at home and having to act as a parent at home. The main result shows that the attachment patterns that emerge in children of parents with substance use show an insecure attachment style.

The study aims to uncover social workers understandings of substance use (SU) among people with intellectual disabilities (ID) and ways in which social work with this group should be carried out.  Previous research has asserted that people with ID use drugs to a lesser extent, and therefore experience less drug related issues in general compared to the general popuation. However, people with ID experience more severe consequences from SU than others. Evidence for specific methods for working with this group is scarce.  The theoretical framework for this thesis is first based in the social model of disability. This enables the use of Goffmans symbolic interactionism with an emphesis on his theories of social roles. The last piece to the theoretical framework is cooperation theory which assists in analysing the themes of issues in cooperation that professionals express.  The thesis is carried out through semi-structured interviews with 6 interviewees, chosen through a combination of strategic- and snowball selection methods. The results are analysed thematically. Three main themes emerge from the empirical data: social factors, matters of cooperation between professionals and their organizations and communication styles between professionals and people with ID.  The main findings of the thesis is first: that Swedish research on the topic is practically non-exictent. Second: that effective methods are developed by professionals such as writing and drawing to enhance communication and that this knowledge is not transferred and expanded upon. Third: that professionals view SU among people with ID as caused by a need for social inclusion which they get from SU. / Undersökningen syftar till att ådagalägga socialarbetares förståelse av drogbruk bland personer med intellektuellt funktionshinder (IF) och hur socialt arbete med denna målgrupp bör utföras.  Tidigare forskning har visat att personer med IF använder droger i lägre grad, och därför erfar mindre drogrelaterade problem än befolkningen i övrigt. Personer med IF erfar dock allvarligare konsekvenser av sitt drogbruk än andra. Forskningsunderlaget för behandlingsmetoder är tunnsått.  Uppsatsens teoretiska utgångspunkter börjar i det sociala funktionshinderbegreppet som möjliggör användandet av Goffmans symboliska interaktionism med fokus på hans teori om sociala roller och masker. Slutligen används samverkansteori för att analysera samverkansrelaterade problem som framkommer i socialarbetares utsagor.  Undersökningen utförs som semistrukturerade intervjuer med 6 intervjupersoner som valts i kombinerad strategisk urvalsprocess och snöbollsurval. Empirin analyseras sedan tematiskt.  Tre huvudsakliga teman framkommer i empirin: sociala faktorer, samverkan mellan organisationer och professionella och kommunikation mellan professionella och personer med IF. Uppsatsen kommer fram till tre slutsatser. 1: Att svesnk forskning på ämnet saknas. 2: Att effektiva metoder för att arbeta med målgruppen så som att ritprata utvecklas i verksamheter men att denna kunskap inte förs vidare i organisationer över tid eller mellan organisationer och att denna kunskap behöver tas till vara och vidareutvecklas till arbetsmetoder. 3: Att socialarbetare ser drogbruk bland personer med IF som en konsekevens av ett behov av social tillhörighet.

The purpose of this study has been to describe and analyze the significance of cooperation among qualified personnel in School, Social services, Police and Leisure services (SSPF) in addressing substance use problems among children and young people at risk, along with potential challenges. The study explores two primary questions: 1. How do professionals engaged in SSPF-collaboration perceive their work with children and young people at risk of substance use problems? 2. What opportunities and challenges do these professionals identify in collaboration? Furthermore, qualitative semi-structured interviews were conducted with eight SSPF professionals within two different municipalities. The study draws upon Ecological systems theory by Urie Bronfenbrenner, the Dynamic Cooperation Model for the welfare system, and critical perspectives on cooperation by Chris Huxham. Finding suggest that the SSPF-work often varies depending on municipality size, with individual professional presence and commitment significantly influencing collaboration’s effectiveness. Furthermore, the results show disparities in working methods, interpretive frameworks, and responsibilities among the different SSPF professions that can lead to dilemmas and tensions in the collaboration process.

Emotionsreglering har de senaste åren fått alltmer uppmärksamhet och stöd som en faktor associerat med substansbruk. Däremot finns till författarnas vetskap ingen tidigare forskning som undersökt sambandet mellan emotionsreglering och substansbruk i ett rättspsykiatriskt urval. Syftet med denna studie var att beskriva substansbruket och utforska associationer mellan emotionsreglering och substansbruk i ett rättspsykiatriskt urval. Deltagarna (N = 98; 13 % kvinnor) rekryterades från en kohort av rättspsykiatriska patienter i Sverige från 2016-11-01 till 2020-11-30.  Data samlades in genom journalgranskningar, självskattningar och kompletterades med semistrukturerade intervjuer. För att beskriva substansbruk i gruppen användes deskriptiv statistik. Vidare användes instrumentet Difficulties in Emotional Regulation Scale (DERS) för att undersöka deltagarnas svårigheter med emotionsreglering. Som mått på substansbruk använde författarna debutålder av substanskonsumtion och antalet testade substanser. För att utforska sambandet mellan emotionsreglering och substansbruk användes korrelationsmatriser.  Resultatet visade att 64,3 % av deltagarna någon gång hade diagnostiserats med substansbrukssyndrom. Vidare hade 79.5 % av urvalet någon gång använt cannabis och hade i större utsträckning använt andra substanser jämfört med en generell svensk population. Studien fann inga signifikanta samband mellan emotionsreglering och substansbruk, vilket går emot tidigare forskning. Det motsägelsefulla resultatet kan bero på metodologiska skillnader och/eller att deltagarna hade andra gemensamma och inflytelserika erfarenheter i relation till emotionsreglering som påverkade resultatet. / Emotional regulation has in recent years gained more attention and support as a factor associated with substance use. However, to the authors knowledge, no research has examined the association between emotional regulation and substance use in a forensic psychiatric sample. The aims of this study were to describe substance use and examine associations between emotional regulation and substance use in a sample of forensic psychiatric patients. Participants (N = 98; 13% female) were recruited from a cohort of forensic psychiatric patients in Sweden from 2016-11-01 to 2020-11-30.  Data were collected through file information, self-reports and complemented with semi-structured interviews. The study used descriptive data to report the use of substances within the sample. Furthermore, the study used the instrument Difficulties in Emotional Regulation Scale (DERS) to examine the participants' emotional dysregulation. To measure substance use, the authors used age of onset of substance consumption and the number of substances tested as variables. Correlational matrices were used to explore the association between emotional regulation and substance use.  The results showed that 64.3% of the participants had at some point been diagnosed with SUD. Furthermore, 79.5 % of the sample had at some point used cannabis and had to a large extent used other substances. No significant associations were found between emotional regulation and substance use. The result goes against previous research, methodological differences may cause this contradiction. Another possible explanation is that the participants had other common and influential experiences in relation to emotional regulation that influenced the result.