Storbjörk is involved in the development of new courses and bachelor's and master's programs at the Department of Public Health Sciences. She is currently teaching two basic-level courses (on addictive substances and behaviors and the collection and analysis of public health data) and two advanced-level courses on welfare states and policies, and qualitative research methods.

She is the supervisor of PhD candidate Tuulia Lerkkanen studying drug policy in Sweden, and co-supervisor of Elin Holmén who is researching patients at the Stockholm Needle Exchange Program.

Storbjörk conducts research into alcohol and other drugs with special emphasis on substance use treatment (SUT) and treatment systems in Sweden as well as internationally. She is currently leading a project on Risks of injection drug use in a Swedish context: Prevention of harms in practice according to users, treatment staff, and societal actors. She is also involved in a long-term follow-up of women and men that entered SUT 20 years ago. Previous research has focussed on the organization and government of SUT and how New Public Management (NPM) impacts daily practices in the social services, health care system and other for-profit and not-for-profit organizations. Other topics of interest are drug policy, harm reduction, social exclusion, and user perspectives.

A selection from Stockholm University publication database

• Take-Home Naloxone and risk management from the perspective of people who survived an opioid overdose in Stockholm — An analysis informed by drug, set and setting

  2023. Elin Holmén (et al.). International journal of drug policy 115, 104021-104021

  Article

  Background: Take-Home Naloxone (THN) programs were introduced in Sweden in 2018 —a country with one of the highest rates of overdose mortality in the EU and a severe stigmatisation of people who inject drugs. This qualitative study builds on the international research that has expanded a previously narrow and medical focus on overdose deaths. It uses Zinberg’s framework to look beyond the role of the “drug ”to include the attitudes and personality of the person ( “set ”) and contextual factors ( “setting ”). This study explores the impacts of THN from the perspective of overdose survivors. Methods: Between November 2021 and May 2022 semi-structured interviews were conducted with 22 opioid overdose survivors, recruited among clients of the Stockholm needle and syringe program. All the participants had been treated with naloxone in an overdose situation. The interviews were processed through thematic analysis using deductive and inductive coding in accordance with the theoretical framework. Results: Interviewees included men and women who used different types of drugs. THN has impacted on “drug ”in terms of naloxone-induced withdrawal symptoms and peers having to deal with survivors’ emotions. Exploring “set ”revealed feelings of shame following naloxone revival for the person who overdosed. Despite such reactions, participants retained an overwhelmingly positive attitude towards THN. Participants integrated THN into their risk management practices ( “setting ”) and some acknowledged that THN provided a new way to treat overdoses without necessarily needing to interact with authorities, especially the police. Conclusion: The THN program has influenced “drug, set and setting ”for participants, providing increased safety at drug-intake and transferring overdose management and the burden of care to the community. The lived experi- ence of participants also exposes the limitations of THN indicating that there are additional unmet needs beyond THN programs, particularly in terms of “setting ”.

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• Debating the Drug Policy in Sweden: Stakeholders’ Moral Justifications in Media 2015–2021

  2023. Tuulia Lerkkanen, Jessica Storbjörk. Contemporary Drug Problems 0 (0), 0-0

  Article

  Drug-related harms continue to increase globally and governments struggle in search of effective and legitimate countermeasures. The choice between policy options is intertwined with the arguments that dominate drug policy discussions, which in turn are closely related to who has access to the policy debate. In this study, we examine stakeholders’ visibility and moral justifications of argumentation in the Swedish drug policy debate in the media (2015–2021). Justification analysis (JA) is used as a methodological and theoretical tool to illustrate the moral principles behind the claims by the stakeholders. The results show that the most visible stakeholders were politicians, government agencies and molders of public opinion. Furthermore, the stakeholders with successful active attempts to participate in the debate were molders of public opinion, NGOs, and politicians. The silent stakeholders in the media were people who use drugs and significant others. Stakeholders generally revolve around a dividing line regarding the restrictive features of Swedish drug policy, and were divided into proponents, opponents and neutral ones. All stakeholder groups included all three sides, hence reflecting the ingroup dissonance that may explain the continuing deadlock in Swedish drug policy. Justifications that value evidence-based policymaking (industrial worth) was used in the argumentation by the majority of the stakeholder groups, often combined with other moral justifications. This notion challenges the dichotomy of evidence and values in drug policy debates. Proponents relied more on the justifications that value paternalism (domestic worth), while opponents leaned toward the justifications valuing civil rights and social justice (civic worth). The development of Swedish drug policy may depend on the relative strength of these two value positions (domestic versus civic worth) in society and among stakeholders in power. This study continues the discussion of making contesting values explicit in the drug policy, serving a riveting case for international comparison.

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• The social perspective and the BDMA's entry into the non-medical stronghold in Sweden and other Nordic countries

  2022. Jessica Storbjörk, Lena Eriksson, Katarina Winter. Evaluating the Brain Disease Model of Addiction, xxx-xxx

  Chapter

  Sweden and the other Nordic countries have held an alternative way to many other countries of understanding and responding to substance use and addiction. The non-medical approach grew particularly strong in the 1960s, but this social perspective has, since the 1990s, become increasingly challenged. This chapter outlines the social understanding and the developments within substance use treatment (SUT), policy, and everyday society in Sweden. A renewed medicalization began at the turn of the millennium, and has accelerated in more recent years, increasingly so due to an underlying brain disease model of addiction (BDMA) and sometimes also by outspoken BDMA arguments. Some explanations for the BDMA’s entry into the Nordic non-medical stronghold are: the medical perspective embedded in both evidence-based practices (EBP) and New Public Management (NPM), and the related fragmentation of the treatment system and demands for cost-effectiveness, communication and public outreach. Explanations are also found in worldwide trends, e.g., a mainstreaming of diagnoses; the public health movement; drug-related deaths and a push towards medical harm reduction measures; and, most recently, by a BDMA rhetoric emerging in public and policy debate and SUT. Understood from processes of ‘copresence’ and ‘vaguification’, the BDMA is in line with these forces driving towards a biomedical understanding of substance use problems.

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• Restructured welfare service provision

  2021. Jessica Storbjörk (et al.). Nordisk välfärdsforskning | Nordic Welfare Research 6 (3), 142-159

  Article

  The welfare state has been found to be highly resilient and protected from retrenchment by institutional and popular support. However, marketization with restructuration of publicly funded health and welfare services is changing the composition of service providers in the Nordic welfare model, heavily relying upon public provision. Sweden has been the Nordic country most favourable for the establishment of for-profit private welfare providers. The present article uses the case of residential substance use treatment (SUT) to outline and elaborate upon the mix of public, for-profit and non-profit private providers in Denmark, Finland, Norway and Sweden in 2019–2020. The comparison takes its point of departure in Sweden, which, as expected, presented the biggest and most profit-oriented SUT market. The other countries presented smaller markets, measured by the number of units. Denmark and Norway had the highest presence of NGOs, while Norway stood out with a high share of public provision and few for-profit units. The article identified the market-friendly Sweden, ambivalent Finland, stable, market-regulating Denmark and stable, welfare-corporatist Norway, and investigated the country-specific factors potentially influencing the different developments. Implications for the future development of SUT within the Nordic welfare state were discussed.

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• When the organization is a problem

  2021. Kerstin Stenius, Jessica Storbjörk. Nordic Social Work Research

  Article

  New Public Management (NPM) has added new aspects to the conflict between political-bureaucratic steering and professional autonomy in the search for a substance use treatment system (SUT) that is economic and characterized by high quality, accessibility, and professional discretion. This article analyses if and how organizational aspects of NPM imply additional challenges for professionals and SUT. The experiences of 29 social workers, in different positions in the services and administration of SUT, in six municipalities with different degrees of NPM and post-NPM, form the empirical data. Many quality problems were common across municipalities: frequent unevaluated reforms, lack of resources for SUT, and cooperation issues. Several problems were especially pronounced in statutory social work. NPM added challenges. Competition with private providers was viewed as initially (in the 1990s) having improved treatment, but the present market was regarded as creating quality problems without savings. Cooperation between providers was a special quality challenge in NPM municipalities, and NPM added to treatment continuity challenges. While accessibility for resourceful clients was linked to NPM models, treatment for less resourced users was obstructed by NPM. Workplace climate and trust issues were more problematic in the most NPM-permeated municipalities. Professional discretion was difficult to link to local NPM degree. Increased standardization and documentation were often accepted as improving quality. While a system based on competition ideology appeared destructive for treatment quality, post-NPM reforms with cooperation between needs-assessment, treatment, and economic support, conformed better with professionals’ perceptions of good treatment.

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• How substance use treatment professionals manage organisational tensions

  2020. Jessica Storbjörk. SUCHT 66 (2), 93-103

  Article

  Aims: The study examined how substance use treatment professionals managed problems and tensions in their work, and explored if the strategies varied by organisational features related to New Public Management (NPM). Methods: A total of 69 semi-structured interviews(2017–2018) with treatment staff in nine sampled local/regional areas formed the basis for constructing a web survey administered to staff across Sweden in 2019 (n=606). The means showed how often the different strategies were used. Regression analyses examined organisationaldifferences, and central strategies were illustrated by the interview study. Results: Treatment professionals in general reported satisfactory freedom in their work. Staff in more NPM-like organisations were less likely to report autonomy and more inclined to report conflicting demands.When conflicts emerged, the staff used both passive strategies indicating adaptation or resignation, and active strategies including boundary spanning, protest, and liberty-taking. Some challenging strategies such as looking for other jobs or reporting one thing but doing anotherwere more common in more NPM-like organisations. The opposite was found for customer orientation. Conclusions: While NPM features on customer orientation and steering methods appeared to create fewer problems, more NPM-like organisations appeared to be less favourableoverall and should be applied with caution.

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• Balancing welfare and market logics

  2019. Kerstin Stenius, Jessica Storbjörk. Nordic Studies on Alcohol and Drugs, 1-26

  Article

  Aim: In increasingly market-oriented welfare regimes, public procurement is one of the most important instruments of influencing who produces which services. This article analyses recent procurement regulations in four Nordic countries from the point of view of addiction treatment. The implementation of public procurement in this field can be viewed as a domain struggle between the market logic and the welfare logic. By comparing the revision of the regulations after the 2014 EU directives in Denmark, Finland, Norway, and Sweden, we identify factors affecting the protection of a welfare logic in procurement. We discuss the possible effects of different procurement regulations for population welfare and health. Data and theoretical perspective: The study is based on the recently revised procurement laws in the four countries, and adherent guidelines. The analysis is inspired by institutional logics, looking at patterns of practices, interests, actors, and procurement as rules for practices. Results: Procurement regulations are today markedly different in the four countries. The protection of welfare and public health aspects in procurement – strongest in Norway – is not solely dependent on party political support. Existing service providers and established steering practices play a crucial role.  Conclusion: In a situation where market steering has become an established practice and private providers are strongly present, it can be difficult to introduce strong requirements for protection of welfare and population health in procurement of social services.

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• The new privatized market

  2018. Jessica Storbjörk, Kerstin Stenius. Social Policy & Administration

  Article

  Given its traditions of universal welfarism and social democracy, Sweden had already scored unexpectedly high on New Public Management by the 1980s. Health and welfare services remain primarily tax‐funded, but the production of care is increasingly transferred to a competitive quasi-market. To what extent can this development be understood in terms of right‐wing governments, and to what extent in terms of other, socioeconomic and pragmatic factors? We examined this question through official statistics on providers of institutional addiction care since 1976, and through the total expenditure and purchases by local‐level municipal social services of interventions for substance users in Sweden in 1999, 2004, 2009, and 2014. We have analyzed the distribution across publicand private providers within the addiction treatment system, and whether national developments and local differences across the 290 municipalities—which bear the major treatment responsibility—can be understood in terms of local‐level political majority, population size, and local wealth. The share of purchased services has remained stable, but the treatment system shows increasing financial turnover and an increasing share of for‐profit providers among producers of purchased care, especially in outpatient treatment. While venture capital enterprises emerged as a new actor, non‐governmental organizations lost out in importance. Bourgeois government correlated with larger shares of purchasing and purchases from for‐profit providers. However, purchasing on a market dominated by for‐profit providers has also become the “newnormal”, regardless of ideology, and recent years have shown a reversed effect of left‐wing municipalities purchasing more services than right‐wing governments. Pragmatic reasons also influence local‐level purchasing.

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• Why Research Should Pay Attention to Effects of Marketization of Addiction Treatment Systems

  2019. Jessica Storbjörk, Kerstin Stenius. Journal of Studies on Alcohol and Drugs (s18), 31-39

  Article

  Objective: Researchers generally assume that addiction treatment systems can be viewed as entities and planned with the citizens’ best interests in mind. We argue that another steering principle, the market logic, has permeated many Western World treatment systems but is neglected in research. We demonstrate how it may affect system-level planning, service provision, and the service users.

  Method: Wedraw on an ongoing Swedish study, with some Nordic references, using several data sources: (1) public statistics on treatment expenditures and purchases; (2) interviews with service users (n = 36) and their service providers (n = 23) on different market features; (3) an observation of a large public procurement process concluding framework agreements based on competitive tendering; (4) interviews with officials involved with steering of the system and procurement (n = 16); (5) a workshop on procurement in the Nordic countries (n = 11 participants); and (6)77 interviews with professionals, managers, and elected representatives.

  Results: We outline seven propositions that call for further research attention: public procurement, as regulated in the European Union, is not suitable for addiction treatment; marketization challenges democracy, equity, needs assessment, and treatment planning; marketization causes new accountability problems and idle monitoring; marketization causes fragmentation and obstructs coordination and continuity of care; marketization causes unification of services and favors big bureaucratically sophisticated providers; treatment professionals’ values are downplayed when a mistrust-based market logic replaces a trust- and needs-based logic; and marketization marginalizes treatment professionals and service users by limiting discretion.

  Conclusions: Findings point toward the importance of acknowledging and mitigating market principles in treatment systems to safeguard needs assessments and planning that serve the interests of the service users and the public. (J. Stud. Alcohol Drugs, Supplement 18, 31–39, 2019)

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• One model to rule them all? Governing images in the shadowof the disease model of addiction

  2018. Jessica Storbjörk. Drug and Alcohol Review

  Article

  Treatment providers demonstrate a quite strong support for a disease model of addiction, particularly so in the United States. However, conceptions vary and the problems may be perceived as primarily a disease, moral or social problems, or a combination of these (Barnett et al. in press). This commentary discusses the ongoing and dynamic process of defining addiction problems and notes that non-medical perspectives often appear in the shadow of and tend to oppose the disease model that stands quite inviolable – i.e., like the One Ring to rule them all by citing The Lord of the Rings. Recent changes in the Swedish Addiction treatment system, well known for its social perspective on the nature and handling of addiction problems, are highlighted to demonstrate that the world may be changing, or not. It is argued that there cannot be just one model. 

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• The Treatment Response

  2016. Harald Klingemann, Storbjörk Jessica. The SAGE Handbook of Drug & Alcohol Studies, 260-286

  Chapter

  Following some introductory notes on addiction treatment management as a specific case of societies’ response to deviant behaviours and social problems, an overview of the theoretical classifications and dimensions of addiction treatment systems is presented. The anti-thesis to these ideal-type system concepts is represented by the market New Public Management model oriented towards outcomes, regardless of the nature and organizational features of addiction interventions. As complementary to these general theoretical orientations, this serves as a review of specific issues concerning ‘a combined and integrated approach versus a specialized and segregated approach’, ‘the quest for the best treatment modalities’, ‘empirical and ethical aspects of coercion in treatment’ and ‘the relevance of user needs and orientation’. The empirical part begins by highlighting the ‘expert survey‘, ‘case study‘ and dynamic diffusion‘  approaches as treatment mapping strategies and informs on some key results, e.g. from the WHO Atlas –SU survey and the International Studies in the Development of Alcohol and Drug Treatment Systems. Results from an expert survey from fourteen countries conducted in 2014 illustrate the role of general political changes, efforts to control treatment systems, integration dynamics, the treatment gap and changing outcome criteria with concrete current examples. The conclusions point to the relative importance of professional addiction interventions drawing upon self-change research and the role of alternative lay help and outline factors in impeding system changes.

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