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CO-PRODUCTION OF CHILDCARE AND ADDICTION TREATMENT IN SWEDEN: THE SAME CO-PRODUCTION IN VERY DIFFERENT SERVICE AREAS?

100%

Vamstad J.

Polityka Społeczna

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2015

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vol. 42

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issue 1(11) CO-PRODUCTION – A DESIRABLE CHOICE OR AN INEVITABLE NECESSITY

15-20

EN

Co-production is a term that has been used to describe arrangements where receivers of services are also involved in producing them. This type of arrangements can be found in a wide range of services and situations, which has stretched the concept of co-production to a point where its meaning is becoming less clear. This paper presents research on co-production from two very different service areas that will show both commonalities and differences in the interpretation of the concept. What is at the core of the concept and how can co-production be transferred from one service area to another? These are questions addressed in this paper, using existing research on childcare and addiction treatment in Sweden.

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Kryminogenność alkoholizmu

65%

Mazur A.

Archiwum Kryminologii

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1991

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issue XVII

287-338

EN

The sample consisted of 718 men diagnosed as alcoholics and subjected to disaccustoming treatment at a mental hospital in Łódź in the years 1971-1975. They constituted over 98 per cent of hospital patients in that period, and over 87 per cent of them were sent to hospital treatment by the court. During the treatment on the disaccustoming ward, which lasted about three months on the average, extensive biographical material about each of the patients was gathered. In 1985, a follow-up examination was carried out with the aim to estimate the effects of treatment. All of the men were found to have relapsed into alcoholism at different times, mostly during several weeks after discharge. The examined sample included 429 men (59.7 per cent) with criminal records; in the case of 396 of them (92.3 per cent), their first conviction was preceded by the average of eight years of excessive drinking (from one to twenty-six years). Thus the men in the sample infringed the law at a much older age as compared with the total male population in Poland in the discussed period. The material presented in this paper concerns the role of alcoholism as an individual person’s illness rather than the role of alcohol as a crimegenerating factor. As shown by an analysis of a number of comparative data, biographies of the sample from before the emergence of the alcohol problem reflected the phenomena and processes taking place in the country. This concerns in particular migration to towns, advancement of the succeeding generations, the level of professional qualifications at the peak of economic activity, and the level of education. Also as regards behaviour, the men in the sample probably had not differed, before being subjected to disaccustoming treatment, from typical male representatives of excessively drinking circles, and particularly from alcoholics. The study included a comparison of the sample’s criminal records with the records of men in Poland in the years 1954-1985: the proportion of persons with criminal records among alcoholics proved nearly twice higher. Still more drastic differences were revealed by means of comparison of the incidence of the separate penalties and the numbers of convictions: penalties not involving deprivation of liberty were imposed over twice less frequently upon alcoholics, who instead were conicvted to over two years of imprisonment 4.5 time more often. Finally, the proportion of alcoholics convicted only once was twice lower, and of those convicted at least six times – 3.3 times higher than in the total population of convicted persons. This accumulation of multiplicities made it possible to estimate the threat of alcoholics’criminal acts at five to six times the index for the total male population. Further comparisons, this time concerning the types of offences committed, led to distinguishment of two such types which are typical of alcoholics: namely, offences against family, guardianship, and young persons, and those against private property. The number of convictions of alcoholics for offences against family was three times larger, and for those against private property – 1.3 larger; instead, convictions for offences against life and health, honour and bodily inviolobility, and public property were as frequent among alcoholics as in the total male population, and the number of alcoholics convicted for all of the remaining types of offences was 2.5 times smaller. An attempt was also made to identify the dominant crimegenerating factors in life histories of the men in the sample which provided a rich documentary evidence. Seven such factors were distinguished. Next, a matrix was constructed of their coincidence in pairs, and five factors were determined which are most strongly related to crime. The were: 1) excessive drinking under 19; 2) lack of permanent employment for at least 40 per cent of the time since leaving school; 3) an interval of at least one year from ending or leaving school till the first job; 4) lack of professional qualifications both of the examined man and of his father. Obviously, the latter factor results from chance and escapes any preventive activities. The remaining three, instead, concern the sphere of behaviour which may be subjected to appropriate preventive treatment, chiefly in the case of young persons threatened with alkoholism who still have no criminal record and maintained by their famikies despite having finished or left school, Since a long time, category of young persons living in a specific subculture has been pointed to as a crimegenerating group. Those, instead, who regularly evade permanent work and confine themselves to odd jobs, unlicensed trade, or simply sponge on their families, require an entirely different preventive treatment.

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Postawy rodziców i opiekunów wobec zażywania środków uzależniających przez młodych pacjentów poradni odwykowych

55%

Zakrzewski P.

Archiwum Kryminologii

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1991

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issue XVII

339-373

EN

The paper presents the finding of a longitudinal study of two problems: the addicts’ prospects of quitting drugs, and the psycho-social factors conducive to success in this respect. The first study (conducted in the years 1974–1976) concerned all patients aged 15–28 treated in that period for repeated taking of drugs, at the disaccustoming clinic for young persons and at district clinics for adults in the city of Łódź. The total of 107 patients were examined (23 per cent of girls and 77 per cent of young men). According to medical diagnosis, 21 per cent of them suffered from a social, 50 per cent – from a psychological, and 29 per cent – from a physical dependence. After about 10 years, a catamnesis was carried out which concerned 80 patients. The methods applied in both parts of the study were: detailed interviews with the patients and their families; medical examination; and analysis of a variety of documents. For the estimation of the fates of the sample, the following issues were of the key importance: persistence in or abandonment of addiction; permanence of abstinence; and the extent of self-dependence achieved. This complexity of the examined persons’ situation taken into account, the following criteria of improvement have been adopted: a) medical (persistence in abstinence); b) psychological (psychological acceptance of abstinence and the resulting change of lifestyle); and c) social (active engagement in the appropriate social roles). Basing on the above criteria, the following categories were distinguished within the sample:1) persons who persisted in addiction; 2) deceased in consequence of addiction; 3) those who quit taking drugs but still had various problems resulting from their former addiction; and 4) those who quit and had no special problems. Against previous expectations, persons who kept taking drugs (26 per cent) did not constitute the mos tnumerous group. Their mean period of taking drugs was 13.6 years. Their interests and social contacts were narrowed to problems related to the taking and production or obtaining drugs. They were generally emaciated and had increasing withdrawal symptoms. Persons of this group went through several months’periods of abstinence due to treatment, imprisonment, or a favourable occurrence in their lives. All of them, however, relapsed into addiction quite promptly, particularly when faced with unavoidable difficulties. Family life or married persons in this group was unhappy, and most marriages broke up: only those between two addicts still lasted. Biographies similar to those discussed above were also found in the case of persons (9 per cent) who died during catamnesis in circumstances that pointed to their death’s relationship with the taking of drugs and with addiction, interpreted also as a certain lifestyle. All persons of this group had been taking drugs for a long time (over five years), and their death was due either to serious diseases combined with emaciation, or occurred in unexplained circumstances as a border-line case between accident, suicide, and homicide. 3.The largest group (46 per cent) consisted of persons who admittedly quit taking drugs but still had various health and social problems related to their previous addiction. Their main problems were as follows: in the sphere of physical health, chronic gastritis, entero-gastric disorders. diseases of liver, heart probiems, reduced physical endurance, disturbances of sleep, and in the sphere of mental health: anxiety, hypersensibility, difficulties in establishing relations with others, depression, low selfesteem, lack of self-confidence, high emotional instability, latent inward anxiety, etc. The most important and frequent social problems included leaving secondary school and the related subsequent lack of professional qualifications, a more difficult start into adult life, the need to relinquish certain professional aspirations and a more interesting job, and a lack of prospects of promotion. In most respondents, this caused a sense of instability and inevitably gave rise to frustrations, increasing their passiveness and apathy. This situation was particularly painful for persons whose intellligence had been rather high before they started taking drugs and who used to have various interests and aspirations. The coincidence of the ahove circumstances also negatively affected their family and marital situation. The fates of persons who quit after several years of taking drugs seem to indicate that those persons’ tolerance to stress and ability to overcome difficulties had been greatly impaired during the period of addiction: as a consequence, they were subsequently unable to cope even with everyday matters which they perceived as great problems. The last group consisted of persons (19 per cent) who had been taking drugs for a shorter period as a rule (not longer than five years in general), and who were not only able to persist in abstinence during catamnesis but also met the psychological and social criteria of improvement. A high proportion of girls in this group (over 50 per cent) seems characteristic. Moreover, nearly all those persons were married: their marriages, happy as a rule, were a great assistance to them. Therefore, the total of 65 per cent of the sample succeeded to quit addiction. What was crucial here was not exactly the form of dependence (social, psychological, physical) but rather the length of the period of taking drugs. If a person has been taking drugs for over five years, his prospects of improvement diminish greatly, and favourable results can only be obtained in the course of a prolonged rehabilitation. The reasons that made most persons in the sample abandon their addiction were seeked both in their personality traits and family environments. What is characteristic is that a considerable portion of respondents come from the intelligentsia, with an average or even high social status and good material situation (in which respect they differ greatly from e.g. juvenile delinquents or young alcoholics). There is in such families a rather small extent of pathology such as alcoholism, crime, or prostitution. In most cases, the parents’ attitude to their children’s taking of drugs should be estimated as proper. The parents played an effective role, fighting for their children to quit as a general rule. Aware of the dangers related to drugs, they took energetic steps which consisted among others in changing the child’s environment (e. g. moving with him to another town), inducing him to undergo treatment and organizing that treatment, supervising his leisure activities, etc. Parents’ improper attitudes such as scenes, turning the child out, etc., were most seldom. The analysis of the reasons which made about two-thirds of respondents quit addiction included their character and intellectual traits defined in the course of psychiatric examination. There was in the sample a rather large number of individuals with the so-called immature personality, who at the age of about 25 were still characterized by traits such as a passive attitude to life; inconsideration for their own future; a poorly developed critical attitude towards themselves and their situation; emotional immaturity; dependence on others (e.g. the mother or friends); inabitity to act effectively, to overcome obstacles and to achieve distant aims; easy discouragement when faced with difficulties, etc. It was only during catamnesis, at the age of about 25, that the respondents’ former, largely childish attitudes were transformed with delay into normal traits of young persons. This development and the crystallization of personality, connected with the parents’ activities and their proper attitude towards the children’s addiction, were conducive to abandonment of addiction by, a considerable portion of the sample. Other factors which played this favourable role in the respondents’ biographies were: a rather high intellectual level; the “psychological shock” caused e.g. by detoxification at a mental hospital or the death of a close friend due to overdose; and imprisonment and going through the withdrawal syndrome in such conditions, etc. To interpret the findings, the conception of American alcohologist J. Ewing has been used: it speaks of inducing and protecting factors in the development of alcoholism. According to Ewing, an individual who starts taking drugs regularly is influenced by a number of biological, psychological, and social factors, some of them conducive to the development of addiction and others protecting the individual against it. Despite the opinions of some researchers, “protecting” factors prove strong enough to hold back even an already addicted person and to contribute to his abandonment of drugs. With the prolongation of the period of taking drugs, the influence of protecting factors wanes, and that of the ones which induce the individual to continue the taking of drugs and thus foster a further development of addiction spreads. The following practical conclusions have been drawn from the study: – Intensified therapeutic and rehabilitative treatment, during the first years of taking drugs in particular. – Co-operation with the addicts’ parents who should be instructed (e.g. about the ways of soothing difficulties in adjustment); whose activity should be assisted, e.g. through the organization of parents’ self-help associations; whose contacts with specialist clinics should be made easier, etc. – Creation of possibilities of medical and rehabilitative treatment for various cotegories of young persons addicted to drugs (not all of them feel comfortable in the existing centres, e.g. of the MONAR movement). – Short-term hospital treatments are reasonable at the initial stage of addiction (several years of taking drugs), as in that period the addicted person’s power of resistance can be strengthened inherent both in his personality and the environment. Help and care should be provided for addicts who have already drugs but have life problems caused or aggravaquited by their previous addiction.

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2 Archiwum Kryminologii

1 Polityka Społeczna

1 2015

2 1991

1 Mazur A.

1 Vamstad J.

1 Zakrzewski P.

CO-PRODUCTION OF CHILDCARE AND ADDICTION TREATMENT IN SWEDEN: THE SAME CO-PRODUCTION IN VERY DIFFERENT SERVICE AREAS?

Kryminogenność alkoholizmu

Postawy rodziców i opiekunów wobec zażywania środków uzależniających przez młodych pacjentów poradni odwykowych