Mats Ekendahl

Mats Ekendahl


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Works at Department of Social Work
Telephone 08-674 73 82
Visiting address Sveavägen 160, Sveaplan
Room 737
Postal address Institutionen för socialt arbete 106 91 Stockholm

About me

I was awarded my PhD qualification in 2002 on a dissertation about substance users’ views on lifestyle change and compulsory treatment. Since then my research has drawn on mainly qualitative approaches to study policy and practice in the field of alcohol and other drug use. It has covered a wide range of topics related to social work, such as motivation, mandatory treatment programs, aftercare interventions, opioid substitution treatment, risk perceptions, service provision and user perspectives.  


A selection from Stockholm University publication database
  • 2016. Josefin Månsson, Mats Ekendahl. Socialt arbete och internet, 74-89
  • 2016. Mats Ekendahl, Patrik Karlsson. Evidence in European social drug research and drug policy, 51-67

    The idea of placing the views of service users at the centre of evidence-based practice has been praised in theory but rather neglected in empirical drug treatment research. Knowledge is scarce about how users’ perspectives are handled in policy and practice. In this chapter, we explore how Swedish opioid substitution treatment (OST) was perceived by users themselves and how their views were taken up by the Swedish National Board of Health and Welfare in developing new treatment regulations for OST. We argue that, despite the current valorisation of ‘the user’s voice’ across the health professions, the concept basically has no meaning in Swedish drug policy. The user preferences we identified (such as a desire for less suspicious staff, and acceptance of some drug use on top of their prescription) appeared to be more or less impossible to realise given the core prohibitionist values underpinning Swedish OST policy. While user involvement is commonly described as a keystone in the ‘evidence movement’, our analysis, of a contemporary policymaking process in the field of drug treatment, indicates that it served more as a rhetorical device than as a sine qua non of OST.

  • 2015. Ekendahl Mats, Patrik Karlsson.
  • 2015. Josefin Månsson, Mats Ekendahl. Contemporary Drug Problems 42 (3), 209-225

    During recent years, political discussions about how to deal with cannabis use have become increasingly centered on harm reduction and liberalization in large parts of the Western world. In Sweden, however, no such re-framing of the issue has occurred. There has been political status quo with emphasis on prohibition and zero tolerance. This study aims to elucidate how the cannabis policy discourse in Sweden is characterized today to legitimize restrictive drug policy and counter global changes. Two symposia dedicated to dissemination of cannabis information in Sweden were analyzed to understand how policy players, service providers, and other professionals invited to speak at these events argue to maintain cannabis use a high-profile societal problem that necessitates prohibition. With the help of Carol Bacchi’s theoretical approach “What’s the Problem Represented to be,” we critically analyzed how cannabis is constructed in the material. This meant focusing on what policy and service provision that is described as meaningful and effective as a way to understand what the problem of cannabis is represented to be. Our analysis showed, among other things, that cannabis-positive attitudes are seen as utterly problematic, that youth users are portrayed as extremely vulnerable, and that current government responses are perceived as righteous and compassionate. It also showed how speakers at symposia construct a morally upright “us” who promote “reliable” scientific evidence about the dangers of cannabis. In this way, the choice between keeping prohibition and trying liberalization stands out as one between letting reliable or unreliable research guide drug policy. We conclude that youth becomes a perfect category to rationalize current problematizations; a vessel that may carry and protect drug prohibition in a globalized world where cannabis is increasingly handled like an ordinary commodity.

  • 2015. Mats Ekendahl, Patrik Karlsson. Nordic Studies on Alcohol and Drugs 32 (4), 395-410

    AIMS – Providing risk information on licit substances is a central health promotion strategy. Thereis, however, very little knowledge about public attitudes on this information. In this exploratorystudy we analyse the extent to which Swedish adults: 1) trust risk information regarding alcohol,cigarettes and wet snuff (“snus”) provided by public authorities, 2) perceive risk informationregarding alcohol, cigarettes and snus as consistent, and 3) have received an adequate amountof risk information from public authorities regarding these substances. The aim is also toinvestigate if certain characteristics among participants are related to their perceptions of suchrisk information. METHODS – A questionnaire was mailed to a random sample of individuals aged18 to 70 (n=1623, 54% response rate). Descriptive statistics and logistic regression techniqueswere used to process data. RESULTS – Participants trusted risk information concerning cigarettes,snus and alcohol provided by public authorities, and reported that they had received an adequateamount of it. Information about cigarettes was seen as more trustworthy and consistent thaninformation about alcohol and snus. The study suggests that attitudes on risk information aresubstance-specific and associated in complex ways with gender, age, education and experience ofown substance use. CONCLUSION – While only a first attempt to map an under-investigated area,our study highlights complexities in how people perceive risk information about licit substances. Italso indicates that the general population in Sweden receives what is seen as an adequate amountof knowledge from public authorities, and finds it consistent and trustworthy.

  • 2014. Mats Ekendahl. Sociology Study 4 (8), 714-727

    Heroin is considered potent and addictive and users are often stigmatised as the other. On the internet, however, hegemonicideas about drugs can be resisted. This study elucidates how efforts to normalise and demonise heroin meet at a Swedish online message board (Flashback Forum). The study aims at analysing how heroin use is given meaning by discussants in athread called “I will start with heroin”. The data were perceived and structured as a collaborative, overarching narrative about when, why, and for whom heroin use can make sense. Discussants used stories about pleasure‐seekers, miserable junkies, and self‐medicating addicts to depict the activity as unproblematic and rational, problematic and irrational, or as problematic and rational. No stories about heroin use departed from the plot‐lines of pleasure maximisation and pain minimisation. Results elucidate a discursive battle in which: (1) heroin use as minimisation of pain “wins” over heroin use as maximisation of pleasure; and (2) there is a general agreement that heroin use cannot be irrational and unproblematic at the same time. It is suggested that these features are central to contemporary drug discourse, and that they probably hinder public understanding of why people use heroin and therefore contribute to keep users stigmatised.

  • 2014. Mats Ekendahl, Patrik Karlsson. Paper presented at 40th Annual Alcohol Epidemiology Symposium of the Kettil Bruun Society, Torino, Italy, 9 - 13 June 2014.

    Aims: Providing risk information regarding licit substances is a central strategy in public health promotion. The aim of this paper is to explore the extent to which a random sample of Swedes: 1) trust risk information regarding alcohol, cigarettes and wet snuff (“snus”) provided by public authorities, 2) perceive risk information regarding alcohol, cigarettes and snus as contradictory, and 3) have received an adequate amount of risk information from public authorities regarding these licit substances. Methods: A questionnaire was mailed to Swedish adults aged 18 to 70 (n=1623, 54% response rate). Descriptive statistics and logistic regression techniques were used to process data. Results: Participants trusted risk information concerning cigarettes, snus and alcohol provided by public authorities, and reported that they had received an adequate amount of information. Information about cigarettes was seen as more trustworthy and consistent than information about alcohol and snus. Conclusion: The study suggests that attitudes toward risk information are substance-specific and associated with gender, age, education and experience of own substance use. While highlighting complexities in how people perceive risk information, our data also illustrate that the general population in Sweden seems to be quite well equipped when it comes to risk information about licit substances.

  • 2013. Mats Ekendahl, Patrik Karlsson.
  • 2013. Josefin Månsson, Mats Ekendahl. Addiction Research and Theory 21 (6), 469-478

    In Sweden, prohibitionist drug policy has contributed to making cannabis an illegal drug, viewed as dangerous, while alcohol is considered a legitimate recreational commodity. But the official Swedish cannabis discourse is now being contested on internet. In virtual environments an often employed way to try to legitimize cannabis use is by comparing it to alcohol. This indicates the importance of analyzing how substances are attributed with meaning in various contexts. This study aims to describe and analyze the discursive role of alcohol in Swedish online discussions of cannabis use and policy. Approximately 700 alcohol-related comments, posted during one year period, were retrieved from the cannabis-section of Swedish Flashback Forum (a website open for public viewing). The sample was analyzed qualitatively with analytical tools such as nodal points, analogies, distinctions and typological examples. Two concepts, danger and discrimination, were identified as nodal points in a cannabis legalization discourse, and provided a backdrop from which comparisons between alcohol and cannabis were made meaningful. We have found that cannabis and alcohol ‘‘changed places’’ in these online discussions. The participants drew on a prohibitionist cannabis discourse but applied its arguments to alcohol; alcohol was thereby given the role of the ‘‘ideal enemy’’ while cannabis was presented as a harmless plant rejected by society on moral rather than scientific grounds. The relevance of acknowledging and reflecting upon the influence that online ‘‘talk’’ has on young people’s attitudes towards drugs is discussed.

  • 2012. Mats Ekendahl. Addiction Research and Theory 20 (5), 423-434

    Sweden's response to drug problems has long been governed by zero tolerance, as manifested by the motto 'a drug-free society' and the criminalisation of drug use. In this context, the legitimacy of methadone maintenance treatment and other interventions often depicted as harm reduction has been questioned. This highlights that solutions to drug problems are circumscribed by culture-specific ideologies and definitions of reality that are articulated in different discourses. The study aims to elucidate how Denmark's decision in 2008 to launch heroin prescription (a controversial form of maintenance treatment) was addressed in Swedish print media, and identify how key concepts such as 'heroin users' and 'treatment' were attributed with meaning. In order for the analysis to go beyond apparent differences between the discourses of harm reduction and zero tolerance, specific interest was placed in constructions that were shared by protagonists on the issue of heroin prescription. The data encompasses 29 articles (news agency announcements plus daily press) that were analysed with focus on binary oppositions and then coded thematically. Four themes were identified: 'Users as passive victims'; 'Methadone as benchmark'; 'Treatment as necessity' and 'Swedish drug policy as unique'. These themes appear as presuppositions, or silent agreements, that precede different understandings of heroin prescription in Swedish press. It is concluded that the media representations reproduced traditional constructions of heroin users as victims in need of society's help. The relevance of characterising heroin prescription as a 'new way' of handling heroin dependence problems is discussed.

  • 2011. Mats Ekendahl. Nordisk Alkohol- og narkotikatidsskrift (NAT) 28 (4), 297-319

    Social service and addiction treatment: rehabilitation or harm reduction?

    AIM –This paper aims to depict and analyze how professionals in Swedish social services legitimize two ideologically controversial help interventions, methadone maintenance and coercive treatment. Should addiction treatment primarily rehabilitate clients, or should it be a short-term measure for harm reduction? This question has been less and less discussed inSwedenduring the past few years, as it has been accepted that all help should be based on science, not ideology – irrespective of it being aimed at harm reduction or rehabilitation. However, there is a lack of research regarding how crucial players in addiction treatment relate to this development, especially when applied on socially vulnerable clients. MATERIAL & METHOD – The empirical material consists of 33 qualitative interviews with social workers from Stockholm and its surrounding area. The interviews are analyzed through discourse analysis. RESULT – When describing their work, the respondents' discourse assumed and advocated progress in client case management. CONCLUSION – By emphasizing concepts such as lifestyle change, client motivation, psychosocial support and aftercare the social workers could construct the two forms of treatment as less ideologically extreme, but also as undoubtedly aligned with the political goal of rehabilitation. 

  • 2011. Mats Ekendahl. Addiction Research and Theory 19 (5), 427-437

    Background: It is widely acknowledged that the social meaning of maintenance treatment (MT) with methadone is context-dependent and that different discourses influence how this approach to opiate addiction problems is practised. In Sweden, MT has long been ideologically controversial, even if the past decade’s emphasis on evidence-based interventions has made it more accepted and prevalent in the treatment system. MT may thus be seen as a discursive field where science and values are intertwined and impact practice jointly, which emphasises the importance of analysing how MT is attributed with meaning. Objectives: The study aims to identify and analyse the discourses that service providers in Swedish opiate addiction treatment refer to in their efforts to legitimise MT. Methods: Twenty-eight interviews focused on MTrelated issues were conducted with Swedish social workers and health care workers. The material was analysed qualitatively according to discourse theory. Findings: Three key features of MT were identified: as therapeutic intervention; as beyond harm reduction and as pragmatic solution. The respondents constructed MT as a necessary medical and psychosocial treatment aimed at rehabilitation and patients’ complete break with drug abuse, which reflects a policy-context where solutions to drug problems are supposed to be resolute, thorough and abstinence-oriented. Conclusions: The service providers handled the controversy between science and values by drawing on a decent-life discourse, where opiate addiction problems are solved with a pragmatic stance towards evidence and where only interventions that make patients’ lives allegedly decent are considered legitimate (excluding, e.g. heroin prescription and liberal methadone distribution).

  • 2009. Mats Ekendahl. International Journal of Social Welfare 18 (3), 260-269

    In Sweden, the social welfare boards have a statutory duty to provide aftercare for compulsorily treated substance abusers. However, there are no data on how the aftercare is organised and how clients perceive this phase of the compulsory treatment process. The aim of the study is to analyse how a sample of compulsorily treated alcohol abusers (n = 12) characterise the current coercive treatment episode and evaluate previously experienced and forthcoming aftercare interventions. Qualitative interview-data were coded into themes and sub-themes encompassing relevant client perspectives. Results show that the alcohol abusers claimed to want (but be denied) adequate help for their problems, both during primary treatment and after discharge. Their perspectives on coercive care and aftercare interventions appeared related to their views on their own problems and on being incarcerated. For instance, those who recognised their own alcohol problems emphasised the importance of quitting consumption and were dissatisfied with interventions offered during and subsequent to compulsory treatment referrals.

  • 2009. Mats Ekendahl. Nordic Studies on Alcohol and Drugs 26 (4), 399-414

    In Sweden, maintenance treatment (MT) with methadone has been a controversial exception to drug-free treatment. However, efficacy, prescription control and the provision of simultaneous psychosocial treatment (PST) have provided MT with political legitimacy. This view, notably stressing that PST is an important complement to medication, was presented in central Swedish policy documents that paved the way for less strict MT regulations in 2005.

    Aim: The present study aims to analyse how the various stakeholders involved in this policy process described and evaluated the efficacy and legitimacy of PST within the framework of the MT discussion.

    Data & method: The data consists of a document authored by a state agency (a preliminary review of MT research) and various stakeholders' written commentaries on it. Different representations of PST (so-called constructions) were coded thematically and analysed using discourse analytical concepts.

    Results: The results show that stakeholders' constructions of PST draw on different discourses related to the governance of Swedish opiate addiction treatment. Four constructions were identified, PST as: "mere complement" (narrow empirical discourse); "underrated intervention" (practitioner discourse); "preferred intervention" (ideological discourse) and "complex intervention" (anti-reductionist discourse).

    The study illustrates how the narrow empirical discourse's construction of PST as a mere complement was challenged by the three other discourses, but shows that the former remained the dominant influence on subsequent MT regulations. It also highlights that references to beliefs and alleged facts are intertwined in stakeholders' rhetorical efforts to assign meaning to PST.

    This suggests that science and ideology are interrelated in policy discussions on opiate addiction treatment, and that firm conclusions about the value of help interventions rely as much on scientific evidence as on strategic argumentation

  • 2009. Mats Ekendahl. Alkohol och droger, 209-226

    För några år sedan satsade regeringen stort på att ge kommunerna ökad ekonomisk möjlighet att tillhandahålla adekvat hjälp till vuxna missbrukare som skrivs ut från tvångsvård. Det saknades dock då, precis som nu, dokumenterad kunskap om vad denna så kallade eftervård kan eller bör vara i socialtjänstens handläggning av tvångsvårdsärenden. Faller till exempel boendestöd och nykterhetskontroll inom ramen för vad som kan kallas för eftervård? Likaså är det ovisst hur tvångsomhändertagna missbrukare själva förhåller sig till eftervård. I kapitlet görs ett försök att analysera närmare och diskutera några olika perspektiv på eftervård i LVM-ärenden. Dels åskådliggörs vad forskningen har att säga om lyckosamma rehabiliteringsprocesser, samt dels presenteras socialsekreterares respektive tidigare LVM-klienters bild av eftervårdens praktik och potential. I kapitlet anläggs ett samhällsvetenskapligt och i viss mån kritiskt perspektiv på det förhållningssätt gentemot tvångs- och eftervård som tycks dominera i det svenska vårdsystemet. På så sätt problematiseras snarare än godtas tanken om att eftervård kan utgöra en lösning på tvångsvårdens avgörande dilemma; det vill säga att den i många fall söker hjälpa dem som inte vill bli hjälpta.

  • 2009. Mats Ekendahl. Evidence & Policy 5 (3), 247-265

    Opiate addict maintenance treatment (MT) has been controversial in Sweden. In 2004, however, a public authority conducted a review of MT research that paved the way for a relatively less restrictive policy. The present study examines how scientific evidence was constructed in the preparation of this policy shift. Written commentaries (by authorities, organisations etc) on a preliminary version of the review were analysed by use of discourse theory. The results suggest that the final review contains elements of three competing discourses and elucidate how a particular MT regime was made to appear objectively as the only viable solution for dealing with opiate addicts.

  • 2007. Mats Ekendahl. Contemporary Drug Problems: An Interdisciplinary Quarterly 34, 137-161
  • Article Time to Change
    2007. Mats Ekendahl. Addiction Research and Theory 15 (3), 247-261

    This exploratory study examines whether the attitudes towards change and treatment of untreated non-abstinent substance abusers differ from those of patients undergoing treatment in residential care. The sample (n=97) consists of untreated, voluntarily and compulsorily treated substance abusers who completed a questionnaire in 2003. Attitudes were measured with scales on e.g. problem recognition, desire for help, treatment readiness and aspects of time perspectives, e.g. past, present and future orientation. The attitudes of the three groups -- untreated, voluntarily and compulsorily treated subjects -- differed with respect to lifestyle change. Factor analysis of the measures revealed one component of primary interest, general willingness to change. Results show that willingness to change was correlated with other attitudinal characteristics in the three groups. The stability of substance abusers’ motivation is discussed with the focus on different social contexts’ influence on change-compliant attitudes and behaviour.

  • Article Will and Skill
    2007. Mats Ekendahl. European Addiction Research 13 (3), 148-155

    Background/Aims: This exploratory study focus attitudes towards lifestyle change among untreated, voluntarily and compulsorily treated Swedish substance abusers (n=97). Methods: Attitudes were measured with scales on e.g. problem recognition, treatment readiness and the time perspective of future orientation. Subjects were categorised into four ‘addict-types’ according to their viewpoint on changing substance use habits, i.e. ‘less change willing’: non-addicts (n=16) and consonant addicts (n=32); ‘more change willing’: dissonant (n=13) and transient addicts (n=36). Results: It was shown that ‘less change willing’ subjects had experienced less dependence disorders and expressed less treatment demand and motivation than ‘more change willing’ subjects. A general measure of willingness to lifestyle change correlated with future orientation among ‘more change willing’ subjects. Conclusions: The study suggests that individuals’ time perspectives ought to be considered when trying to illuminate the process of change and understand what attitudes exercise positive influence on and are associated with successful lifestyle change-efforts. The consistency of substance abusers’ motivational structures over time and in different social contexts is discussed.

  • 2006. Mats Ekendahl. Contemporary Drug Problems: An Interdisciplinary Quarterly 33 (4), 645-668

    In this study a sample of non-abstinent untreated amphetamine users’ accounts of lifestyles, living conditions and efforts to change were described and analysed. The objective was to inductively identify the qualitative characteristics of their potential distance to the treatment system. The analysis focused how self presentations and descriptions of reality were related to views on treatment and lifestyle change. Results showed that respondents distanced themselves from the individuals and practices of several social contexts, which was interpreted as indicating a limbo between substance abuse and conventional life. Yet, to solve acute predicaments the substance abusers were confronted with the demands of the supposedly condemning treatment system. It is suggested in the article that the Swedish treatment system develop further ‘low threshold’ interventions that address life problems as identified by the clients themselves. This should enable less motivated substance abusers to acquire stable living conditions that may facilitate lifestyle change efforts.

  • 2004. Mats Ekendahl.
  • 2018. Patrik Karlsson (et al.). Nordic Studies on Alcohol and Drugs 35 (2), 131-146

    Background and aims: The school-class context is a crucial social environment for young people but substance use researchers have largely overlooked potential influences operating at this level. This study explores associations between school-class and individual-level factors and cannabis use in Swedish youth.

    Data and methods: Data comprised four waves (2012–2015) of the Swedish Council for Information on Alcohol and Other Drugs’ (CAN) nationally representative school surveys among individuals in 9th and 11th grade. For the present analyses, we had data on totally 28,729 individuals from 2377 unique school classes. Multilevel logistic regressions predicted lifetime and 10+ times use of cannabis from both individual-level predictors and school-class-level measures derived from the individual-level variables.

    Results: There were individual-level associations between most predictor variables and cannabis use. An early debut of tobacco use and binge drinking as well as low cannabis related risk perceptions had strong associations with cannabis use. Conversely, several school-class-level variables had aggregate relationships with cannabis use, most notably the overall level of risk perceptions in the school class. Some of the school-class factors predicted cannabis use over and above the individual-level covariates, suggesting the presence of contextual effects. Surprisingly, while female gender was negatively related with cannabis use at the individual level, a higher proportion of females in the classroom increased the odds for lifetime cannabis use even after controlling for individual and other contextual-level covariates.

    Conclusions: Youth cannabis use is related to various factors at both the individual and school-class level in Sweden. Truancy and perceived risk related to cannabis use had contextual associations with cannabis use. The positive contextual association between a higher proportion of females in the classroom and lifetime use should be explored further.

  • Mats Ekendahl, Patrik Karlsson, Josefin Månsson.

    Liberal views on cannabis use are widespread in many Western countries, but prohibitionism remains strong in Sweden. According to Swedish drug policy, comprehensive prevention and treatment interventions are necessary because young people are considered particularly vulnerable to cannabis-related harm. In this article, we examine how staff at Swedish outpatient treatment centers for young substance users (called “MiniMaria”) use different logics when legitimizing their work in youth treatment. We also analyze how this legitimizing process contributes to both justifying solutions and constituting the cannabis “problem” that MiniMaria centers are established to handle. This will shed light on what “drug reality” the staff make up through their articulations. Eighteen interviews with social workers from six MiniMaria centers in the Stockholm region were analyzed. To illustrate how staff made sense of their work, we used the concepts of “problem representation”, “legitimation”, and “logics”. We identified four logics: A scientific and a structural logic linked to knowledge claims, policy goals, and organizational setting, and a professional and a procedural logic linked to work experience, client interaction, and therapeutic methods. Participants used logics to emphasize that the character of the cannabis problem demands wide-ranging interventions and to explain how they made youth cannabis users realize they need treatment. The structural logic of drug prohibitionism was only mentioned as a last resort when other logics were not applicable, for example, when a young person refused to engage in treatment and quit using cannabis. The strategic use of logics provided MiniMaria with a moral legitimacy that represented youth cannabis use as a high-profile problem and young people as in need of protection and control. This legitimizes prevention of youth cannabis use in a national setting where cannabis prevalence and harm remains relatively low.

  • 2019. Mats Ekendahl, Josefin Månsson, Patrik Karlsson. Drugs

    A key question in drugs research is why people use psychoactive substances. Diverse motives such as boredom, habit, and pain relief have served as explanations, but little is known about how adult cannabis users motivate their use in prohibitionist policy contexts, like Sweden. The aim is to explore what motives a sample of adult Swedish cannabis users refer to when they give meaning to their use. We ask: what aspects of cannabis use (e.g. drug effects, individual characteristics and social contexts) are emphasized in their accounts, and how are such aspects combined to describe motives and justify use? In this study, motives are perceived as culturally situated action, and our analysis is based on online text messages (n = 238) and interviews (n = 12). Participants emphasized either the characteristics of the use situation (motives such as party, relaxation and social function) or of him-/herself as an individual (motives such as mindfulness, identity marker and somatic function). They often mentioned medical and recreational motives in the same account, and carefully presented themselves as rational individuals. The motives reflect that the drugs discourse is increasingly medicalized, that responsibility is highly esteemed in contemporary societies, and that cannabis use is still stigmatized in Sweden.

  • 2019. Mats Ekendahl, Patrik Karlsson, Renate Minas. Nordic Social Work Research

    EU citizens from Central and Eastern Europe travelling to cities in other countries to make a better living have become an issue of major political concern across Europe. This study explores how professionals from Swedish municipal social service organizations in urban areas construct the phenomenon of poor visiting EU citizens. The impact of social constructions on the practice and design of policies makes it important to analyse how target groups, such as poor visiting EU citizens, are characterized and what normative assumptions are made about them. The study is theoretically based on Schneider and Ingram’s work on ‘Social Constructions of Target Populations’. Interviews with social workers in the three largest cities in Sweden were conducted. The results suggest a clear ambivalence among interviewees regarding how to conceptualize EU citizens. They were careful not to highlight any subgroups, instead defining the group as consisting of different individuals with varying needs. While the interviewees constructed members of the target group in a way similar to what Schneider and Ingram describe as dependents, they also attributed them with some agency. We conclude that this may be a reflection of the political and organizational setting in which social work with poor visiting EU citizens is conducted in Sweden.

  • 2019. Patrik Karlsson (et al.). Nordic Studies on Alcohol and Drugs 36 (1), 21-35


    It is often assumed that illicit drug use has become normalised in the Western world, as evidenced for example by increased prevalence rates and drug-liberal notions in both socially advantaged and disadvantaged youth populations. There is accumulating research on the characteristics of young illicit drug users from high-prevalence countries, but less is known about the users in countries where use is less common. There is reason to assume that drug users in low-prevalence countries may be more disadvantaged than their counterparts in high-prevalence countries, and that the normalisation thesis perhaps does not apply to the former context.


    This article aims to explore to what extent such assertions hold true by studying the characteristics of young illicit drug users in Sweden, where prevalence is low and drug policy centres on zero tolerance.

    Material and Method:

    We draw on a subsample (n = 3374) of lifetime users of illicit drugs from four waves of a nationally representative sample of students in 9th and 11th grade (2012–2015). Latent class analysis (LCA) on ten indicators pertaining to illicit drug use identified four classes which we termed “Marijuana testers”, “Marijuana users”, “Cannabinoid users” and “Polydrug users”.


    Indications of social advantage/disadvantage such as peer drug use, early substance-use debut and truancy varied across groups, particularly between “Marijuana testers” (low scores) and “Polydrug users” (high scores).


    Our findings corroborate the idea that the majority of those who have used illicit drugs in the Swedish youth population have tried marijuana a few times only. We discuss whether or not the comparably large share of socially advantaged “Marijuana testers” in a comparably small sample of lifetime users can be interpreted as a sort of normalisation in a prohibitionist drug policy context.

  • 2019. Mats Ekendahl, Josefin Månsson, Patrik Karlsson. Drugs

    There is a lack of research on how youth make sense of substance abuse treatment. The aim of this article was to explore how young people in Stockholm, Sweden, perceive outpatient treatment for cannabis use, position themselves as subjects in relation to it, and how they respond to staff’s appeals to rationality and responsible action. The data, consisting of 18 interviews with clients recruited from six treatment centers, were explored using narrative and thematic analysis. Results show that the young clients understood their histories in a responsibilized way where the risk information about cannabis they received was considered crucial. Those who resisted treatment rejected cannabis problematizations by staff, did not value interventions and felt that they had control over their use. Those who complied with treatment said that cannabis problematizations helped them acknowledge their own difficulties, handle substance dependence and mature. We conclude that treatment resistance among young cannabis users would perhaps be prevented if the adult world acknowledged that some believe it is rational and responsible to use cannabis. While the criminal offense of substance use is often expiated through ‘treatment’ in Sweden, young clients establishing a substance use identity could possibly be avoided if cannabis was not equated with risk.

  • 2018. Suzanne Fraser, Kylie Valentine, Mats Ekendahl. Body & Society 24 (4), 58-86

    Over the last few decades feminists, science and technology studies scholars and others have grappled with how to take materiality into account in understanding social practices, subjectivity and events. One key area for these debates has been drug use and addiction. At the same time, neuroscientific accounts of drug use and addiction have also arisen. This development has attracted criticism as simplistically reinstating material determinism. In this article we draw on 80 interviews with health professionals directly involved in drug-related public policy and service provision in three countries to identify the main ways the neuroscience of addiction (and thus the agency of the brain) is understood. We analyse these understandings using contemporary posthumanist theory to develop new options for conceptualizing matter in public responses to addiction. We close by calling for a new approach to addiction and the brain based on a process model of materiality and public debate.

  • 2018. Suzanne Fraser, Mats Ekendahl. Contemporary Drug Problems 45 (2), 87-106

    The alcohol and other drug field is characterized by great diversity in kinds of treatment and treatmentphilosophies. Even the kinds of problems treatment is expected to address vary significantly, althoughagreement seems to exist that the general purpose is to help people “get better.” This article considersthis diversity, drawing on a qualitative project conducted in three countries: Australia, Canada, andSweden. Inspired by the project’s multisite approach and the questions it raises about comparativeresearch, the article critically engages with the notion of “comparison” to think through what is atstake in making comparisons. Analyzing 80 interviews conducted with policy makers, service provi-ders, and peer advocates, the article maps key ways treatment is conceptualized, identifying in them acentral role for comparison. Participants in all sites invoked the need to consider addiction a multi-faceted problem requiring a mix of responses tailored to individual differences. Related notions of“holism” were also commonly invoked, as was the need to concentrate on overall improvements inwell-being rather than narrow changes in consumption patterns. In conducting this analysis, this articleposes a series of critical questions. What kinds of comparisons about quality of life, the self, and well-being do treatments for addiction put into play? What categories and criteria of comparison arenaturalized in these processes? What kinds of insights might these categories and criteria authorize,and what might they rule out? In short, what does it mean to understand alcohol and other drug useand our responses to it as intimately intertwined with the need to “get better,” and what happenswhen we scrutinize the politics of comparison at work in getting better through addiction treatment?We conclude by arguing for the need to find new, fairer, ways of constituting the problems we pre-sently ascribe to drugs and addiction.

Show all publications by Mats Ekendahl at Stockholm University

Last updated: October 6, 2020

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