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Freedom of choice in substance abuse treatment . First data from a Swedish study

Freedom of choice in substance abuse treatment . First data from a Swedish study. Kerstin Stenius and Samira Radwan SoRAD , Stockholm university and Ersta-Sköndal. Freedom of choice and social rights.

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Freedom of choice in substance abuse treatment . First data from a Swedish study

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  1. Freedom of choice in substanceabusetreatment. First data from a Swedishstudy Kerstin Stenius and SamiraRadwan SoRAD, Stockholm university and Ersta-Sköndal

  2. Freedom of choice and social rights • Nordicmodel: collectivelygranted and extensive social rights. Universalism • Freedom of choice: citizens’ participationin production and delivery, route to autonomy, empowerment. Right and duty to choose as an individual • Linked to marketsolutions: choicebetweenpublic and private . With (hopes for) shrinkingwelfarebudgets • Howdoesthisideologyeffectdifferentgroups of citizens, inlcudingthtepotentiallyundeservingpoor?

  3. Whatdoesfreedom of choicerequire? • Possibility to choosebetweenclearlydistinguishablealternatives • Possibility to choosebetweenalternativesthathavedifferentmeaning for the user • Autonomy: the individualshallhave the possibility to reachwhathe/shedefines as herdesiredresults (for instanceinfluencekind, amount and content of tx) (Bavetta 2004)

  4. Data • Threetownswithestablishedpolicy of freedom of choice • Threegroups of citizens: elderlywith home care, youngpersonswhohavechoosenhighschool and persons in substanceabusetx • Structuredinterviews, personalinterviews, focusgroups, expertinterviews and policymaterial • Citizengroupsexperiences of choice • Hypotheses: withinallthreegroups, the possibility and wish to choosevaries; the expereincedbenefits of choicevariesbetween and withingroups; freedom of choiceeffectscitizens’ participation and influence and thustheircitizenship

  5. Table 1

  6. Questions • Whatare the consumersexperiences of and attitudes to choice? • Is thererealchoice for persons in substanceabusetreatment? • Aretheredifferent and distinguishableservicealternatives? • To whatextentcan the usersinfluence the contentortreatment, orexitfromtreatment?

  7. Attitudes to choice • 45 % veryorrathersatisfiedwithpossibilities to choosetx , 25 % didnotknow. Moresatisfactionamongoutpatient and personswithhigherincomes • Almost 80 % veryorratherimportant to choosebetweendifferentproviders of treatment

  8. Possibilities to choose in general

  9. Are there alternatives? If you thinkabouttreatment options in substance abuse treatment in your municipality, would you say that they are:

  10. Waitingtime • 16 % had to waitmorethan 3 months for the treatmenttheyneeded (23 % in inpatient) • 78 % in out-patientdidnothave to wait at all (35 % in inpatient)

  11. Did you have alternatives? Howmanysimilarcareplacescould you choose from when you startedthistreatment?

  12. Wherethere real alternatives for you? Did you thinktherewas a differencebetweenwhattx the providersoffered? Out-patIn-pat Total

  13. Information • 60%: enoughinformation to choose • 36 % said the informationabout the txplacewas in accvordancewithhowitwas (49 % out-pat, 29 % inpat) • Mostimportantsource of inf. wasstafffrommunicpality, txproviders, and internet for outpatient • Nacka: morechoice and moresatisfiedwithinformation)

  14. ”Autonomy” • 40 % hadchosentxthemselves (50 % out-pat, 30% inpat) • 20 % hadchosentogetherwith social servicestaff (10 out-pat, 28 % inpat) • Half of respondentswouldturn to txstaffiftheywereunsatisfied • 60 % didnotknowwhom to turn to iftheywanted to formallycomplainovertheirtx • Iftheyhadarticulatedcritique (more common amonginpat) itwasmore common thannotthatithad led to change • ¼ hadchangedtx, a majority of themthoughtitwaseasyorfairlyeasy

  15. Conclusions • 1/3 had a realchoice – the majoritydidnotknowiftherewas a diff. Bewteenalternativeordidnotchoose • 40 % didnotthinktheyhadenoughinformation (real and distingusihablechoice) • Autonomy. Diffbeteenin- and outpatient. Outpatcouldmoreinfleuncelength and content. Txstaffor social workerswere the naturalpatries to turn to for complaints – fewknewaboutformalcomplaints

  16. Cont. • Unevendistribution of choice, benefits of choice and influence • In longerinterviewsmoreexamples of bothpossibilities to influence, mainlythroughgoodcontactswith social serviceortxstaff, and presssuresordramaticlack of choice • Substanceabusers as a groupnotpoliticallyactive • Valfrihet as a conceptdoesnotclarify the realdilemmas for many in thisgroup

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