Eva SamuelssonUniversitetslektor, docent
Jag är fil. doktor i socialt arbete och forskar om problem med substanser och spel om pengar – i huvudsak kring organisering av stöd och behandling för sådana problem. Tidigare har jag arbetat som socionom inom socialtjänsten och beroendevården. Just nu bedriver jag ett postdoc-projekt om hjälpsökande vid spelproblem.
Jag undervisar på Institutionen för socialt arbete på Stockholms universitet och i andra sammanhang om bland annat brukarinflytande, alkohol-, narkotika- och spelproblem, organisering av missbruks- och beroendevård och motiverande samtal (MI). På socionomutbildningens femte termin är jag kursansvarig för den verksamhetsförlagda utbildningen (VFU) och håller i samtalsövningar.
Postdoc-projektet Hjälpsökandets dilemman – om behov och erfarenheter av samt hinder för kontakt med vården vid spel- och alkoholproblem är finansierat av Forte och pågår under 2018 och 2019. Projektet är en del av Institutionen för folkhälsovetenskaps forskningsprogram REGAPS (Responding to and Reducing Gambling Problems Studies) – Möta utmaningar och minska spelproblem: Hjälpsökande, bedömningsinstrument, samsjuklighet och effekter av policy.
Tillsammans med kollegor på Institutionen för folkhälsovetenskap genomför jag intervjuer i ett projekt för att förstå ungdomars minskande alkoholvanor.
Jag disputerade i februari 2015 med avhandlingen Use or misuse? Addiction care practitioners’ perceptions of substance use and treatment som handlar om hur personal i den svenska missbruks- och beroendevården uppfattar alkohol- och narkotikakonsumtion, dess allvarlighet, möjligheten till självläkning och behov av olika former av behandling (läs mer om projektet här).
Tidigare har jag arbetat inom ett forskningsprojekt om förändring av spelvanor och spelproblem tillsammans med Kristina Sundqvist och Jenny Cisneros Örnberg på uppdrag av Folkhälsomyndigheten.
Tidigare har jag även forskat tillsammans med Jessica Storbjörk och Irja Christophs i projektet Individens ställning i missbruks- och beroendevården – en studie av brukarinflytande i praktiken om hur personer med alkohol- och narkotikaproblem får möjlighet att påverka den vård de erbjuds.
I urval från Stockholms universitets publikationsdatabas
Sense or sensibility—Ideological dilemmas in gamblers' notions of responsibilities for gambling problems
2022. Eva Samuelsson, Jenny Cisneros Örnberg. Frontiers in Psychiatry 13Artikel
The gambling market is a complex field of conflicting stakeholders and interests involving dimensions, such as economy, health, social inequality and morals. The division of responsibility between gamblers, the gambling industry and the regulating state for limiting the harmful effects of this activity, however, are unclear. The aim of this study was to explore how gamblers in the Swedish market attribute responsibility to various actors within the gambling field. Qualitative interviews were conducted with 37 gamblers experiencing extensive gambling problems. Based on a discourse analytical approach, five ideological dilemmas were identified, highlighting the tension between the, often contradictory, values that the participants need to relate to. On the individual level, the gamblers emphasize their own responsibility for their problem, thereby showing accountability in relation to themselves, their significant others and their peers as agents in recovery. On the corporate- and state levels however, the participants argue for a stronger public health approach, where the gambling companies should take further responsibility by living up to the legal regulations and where the state should ensure compliance and safeguard funding for treatment and research. The essential paradox between the individual responsibility discourse of self-regulation and the prevailing medical discourse of the gambler's incapacity for self-control signifies an impossible equation that imposes feelings of guilt and shame upon an individual who is concurrently considered as both responsible and incapable. In order to reduce harm, the gambling industry must be more proactive with coercive external control measures to fulfill the duty of care they claim to adhere to, and the regulating state must ensure its compliance.
Following the changes in young people’s drinking practices before and during the pandemic with a qualitative longitudinal interview material
2023. Jukka Törrönen (et al.). Journal of Youth Studies, 1-19Artikel
The paper analyses how the Covid-19 pandemic affected young people’s alcohol-related assemblages, trajectories of becoming and identity claims in Sweden. The data is based on longitudinal qualitative interviews among heavy and moderate drinking young people (n=23; age range 15–24 years). The participants were interviewed two to three times before the Covid-19 pandemic and once at the end of it, between 2017 and 2021. The analysis draws on actor-network theory and narrative positioning approach. The analysis demonstrates how the lockdown produced trajectories of becoming boring, normal, stress-free, self-caring, self-confident and shielded. In these trajectories, drinking was positioned into relations that either increased young people’s capacities for well-being or decreased them. Due to the lockdown, some participants learnt to be moved by relations that contributed to replace drinking with competing activities, while others experienced that the lockdown made drinking a more attractive activity, turning it into a collective force that helped them to overcome isolation. The results show how drinking is a heterogeneous activity which may increase or decrease young people’s capacities for well-being, depending on what kinds of assemblages and trajectories of becoming it is embedded in.
Becoming Safe, Legal, Mature, Moderate, and Self-Reflexive: Trajectories of Drinking and Abstinence among Young People
2022. Eva Samuelsson (et al.). International Journal of Environmental Research and Public Health 19 (6), 3591-3591Artikel
In recent years, a vast body of research has investigated trends of declining alcohol consumption among youths. However, the extent to which restrictive-youth approaches towards drinking are maintained into adulthood is unclear. The aim of this study is to explore how young people’s relation to alcohol changes over time. Our data are based on longitudinal qualitative in-depth interviews with 28 participants aged 15 to 23 conducted over the course of three years (2017–2019). The study draws on assemblage thinking by analysing to what kinds of heterogeneous elements young people’s drinking and abstinence are related and what kinds of transformations they undergo when they get older. Five trajectories were identified as influential. Alcohol was transformed from unsafe to safe assemblages, from illegal to legal drinking assemblages, from performance-orientated to enjoyment-orientated assemblages, and from immature to mature assemblages. These trajectories moved alcohol consumption towards moderate drinking. Moreover, abstinence was transformed from authoritarian assemblages into self-reflexive assemblages. Self-control, responsibility, and performance orientation were important mediators in all five trajectories. As the sober generation grows older, they will likely start to drink at more moderate levels than previous generations.
Treatment for problem gambling and counselors’ perception of their clinical competence: a national web survey in Sweden
2022. Viktor Månsson (et al.). Addiction science & clinical practice 17 (1)Artikel
Background: Despite their crucial role in bridging science and practice, not much is known about counselors offer-ing treatment for Problem Gambling (PG). This study maps current treatment, the type of change techniques that areprioritized in treatment and how counselors perceive their clinical competence in their work with PG clients. Methods: A sample of PG counselors from the healthcare and social services (N = 188, mean age: 49 years, 67%women) completed an online survey. A principal component analysis was conducted to map prioritized typesof change techniques, and a multiple regression analysis was carried out to analyze predictors of counselors’ roleadequacy in their clinical work. Results: There was a large variation in the type of treatments offered for PG (mean 3.6). Cognitive Behavioral Therapy(CBT) and Motivational Interviewing were the most common treatments offered and motivation was rated as themost important type of change technique prioritized in the treatment of PG. A principal component analysis identi-fied four components reflecting different types of change techniques prioritized by the counselors: (1) standard CBT,e.g., gambling cognitions, craving management, and finding alternative activities, (2) assessment of PG, (3) fam-ily orientation, i.e., involvement of concerned significant others in treatment, and (4) focus on exposure strategies. Counseling more clients monthly was associated with higher levels of willingness, adequacy and legitimacy in theirclinical work with clients with PG. Additionally, offering CBT was a predictor for higher role adequacy and providingcounseling on the origins of and consequences of PG. Conclusion: There was a large heterogeneity among the treatments offered and what change techniques that wereprioritized among the PG counselors. Clinical experience is of importance for developing competence in treatingclients with PG. This finding suggests there could be benefits to establishing specialized, more visible treatment unitswhere PG counselors could gain adequate clinical experience, thus increasing clinical competence for treating PG.
How Covid-19 restrictions affected young people's well-being and drinking practices: Analyzing interviews with a socio-material approach
2022. Jukka Törrönen (et al.). International journal of drug policy 110Artikel
Background: The Covid-19 restrictions – as they made young people's practices in their everyday life visible for reflection and reformation – provide a productive opportunity to study how changing conditions affected young people's well-being and drinking practices.
Methods: The data is based on qualitative interviews with 18- to 24-year-old Swedes (n=33) collected in the Autumn 2021. By drawing on the socio-material approach, the paper traces actants, assemblages and trajectories that moved the participants towards increased or decreased well-being during the lockdown.
Results: The Covid-19 restrictions made the participants reorganize their everyday life practices emphatically around the home and communication technologies. The restrictions gave rise to both worsened and improved well-being trajectories. In the worsened well-being trajectories, the pandemic restrictions moved the participants towards loneliness, loss of routines, passivity, physical barriers, self-centered thoughts, negative effects of digital technology, sleep deficit, identity crisis, anxiety, depression, and stress. In the improved well-being trajectories, the Covid-19 restrictions brought about freedom to study from a distance, more time for significant others, oneself and for one's own hobbies, new productive practices at home and a better understanding of what kind of person one is. Both worsened and improved well-being trajectories were related to the aim to perform well, and in them drinking practices either diminished or increased the participants’ capacities and competencies for well-being.
Conclusions: The results suggest that material domestic spaces, communication technologies and performance are important actants both for alcohol consumption and well-being among young people. These actants may increase or decrease young people's drinking and well-being depending on what kinds of relations become assembled.
“There’s a lot of stereotypes going on”: A cross-national qualitative analysis of the place of gender in declining youth drinking
2022. Amy Pennay (et al.). International journal of drug policy 108, 103827-103827Artikel
Introduction: Significant declines in drinking among young people have been recorded in many high-income countries over the past 20 years. This analysis explored the role of gender – which we interpret as socially constructed and relational – to provide insight into whether and how gender might be implicated in declining youth drinking.
Methods: Interview data from four independent qualitative studies from Australia, Denmark, Sweden and the UK (n=194; participants aged 15-19 years) were analysed by researchers in each country following agreement about analytical focus. Findings were collated by the lead author in a process of ‘qualitative synthesis’ which involved successive rounds of data synthesis and feedback from the broader research team.
Findings: Our analysis raised two notable points in relation to the role of gender in declining youth drinking. The first concerned the consistency and vehemence across three of the countries at which drinkers and states of intoxication were pejoratively described in gendered terms (e.g., bitchy, sleazy). The second related to the opportunities non- and light-drinking offered for expressing alternate and desirable configurations of femininities and masculinities.
Conclusions: We identified an intolerance towards regressive constructions of gender that emphasise weakness for women and strength for men and a valorisation of gendered expressions of maturity through controlled drinking. Though subtle differences in gendered drinking practices between and within countries were observed, our findings offer insight into how young people’s enactions of gender are embedded in, and evolve alongside, these large declines in youth drinking.
Secrecy, self-blame and risks for social exclusion—Family members’ experiences of gambling problems in Japan
2022. Naoko Takiguchi, Yuko Kawanishi, Eva Samuelsson. Frontiers in Psychiatry 13Artikel
The predominant gambling policy to respond to the adverse consequences of excessive gambling has been the Reno Model, which places the responsibility for gambling-caused problems on gamblers themselves. The newly implemented Japanese gambling policy, which shares basic premises with the Reno Model, focuses on the individual pathology of gamblers. However, this model lacks other critical perspectives: environmental and structural factors. To fully understand the harms caused by gambling; it is important to also pay attention to the negative consequences for affected others. In this brief report, we explore family members’ experiences of gambling problems within the specific context of the Japanese gambling policy. Interviews with family members reveal self-stigma of being bad parents which elicits shame and efforts to maintain secrecy, as well as public stigma involving labeling, isolation, risks of status loss, social exclusion and discrimination. The focus on individual pathology in Japanese legislation as well as in public and professional perception, reinforces self-blame, anxiety, and remorse on the part of affected family members. When contrasted with the lived experiences of gamblers’ family members, the inconsistencies and unreasonableness of the individual pathology paradigm in Japanese gambling policy become evident. It is necessary to shift the focus of gambling policies from individual to socio-political-cultural factors, investigating how these factors influence gambling-caused harm, especially in the Japanese context.
Making sense of gambling. Swedish youth navigating between risk and responsibility
2022. Jessika Spångberg (et al.). International Gambling Studies, 1-18Artikel
Youth gambling is commonly described in policy and research as a high-risk behavior. To design relevant measures to prevent gambling problems among youth, it is important to understand how youth themselves relate to gambling. To explore how youth navigate their position on gambling in the context of their everyday lives, we conducted qualitative interviews with 35 participants aged 17–21 years in Sweden; 15 had gambled and 20 had experience of others’ gambling. The thematic analysis showed that both gamblers and non-gamblers overall had negative attitudes toward gambling and emphasized repeatedly discourses of personal responsibility in it. The participants used various neutralization techniques to navigate the economic and addictive risks of gambling. Youth who gambled distanced themselves from the risks of gambling by drawing a line between themselves and excessive gamblers, between safe and unsafe gambling, or highlighted how their skills and strategic thinking made gambling less problematic. Also, gambling in liminal circumstances abroad or in alcohol-serving venues offered a safe time and place for gambling by separating it from everyday life practices. The findings provide important cues to how young people locate gambling in their everyday life, which is useful knowledge for policy and prevention.
The Zone and the Shame: Narratives of Gambling Problems in Japan
2022. Eva Samuelsson (et al.). Critical Gambling Studies 3 (1), 83-95Artikel
Japan has one of the highest rates of severe gambling problems in the world. However, the gambling forms that cause the most harm—pachinko and pachislot—are not recognized as gambling in the key legislation. They are understood as entertainment. On the basis of two group interviews with those who have experienced problems with gambling, this study explores how they have dealt with the shame, guilt, and stigma of pachinko-related gambling problems. The narrative analysis shows that the participants carry self-stigma as a result of self-reproach and others’ condemnation of their behavior. Feelings of shame, guilt, and fear of being stigmatized have distinctly hindered the process of seeking help. The participants describe how their gambling, which they had attempted to limit, had led to isolation from normal life. The isolation and the failures to control the gambling increased their feelings of shame and destructive behavior. Considering the characteristics of the zone, the loss of self, and the shame, guilt and stigma of failing to control excessive pachinko gambling, it is unreasonable to place the main responsibility on the individual gambler. To reduce gambling harms in Japan and the stigma associated with pachinko and pachislot problems, these gambling forms need to be acknowledged as public health concerns and categorized as gambling in the legislation.
Negotiating Emerging Adulthood With Master and Counter Narratives
2021. Jukka Törrönen (et al.). Journal of Adolescent ResearchArtikel
This study analyzes how emerging adults negotiate their relation to alcohol in the context of declining youth drinking and how this relationship changes over time. The sample consists of longitudinal qualitative interview data (N = 28) with 9 boys and 19 girls aged 15 to 21. The participants were recruited through schools, social media and non-governmental organizations from mainly the Stockholm region and smaller towns in central Sweden to reach a heterogeneous sample in terms of sociodemographic factors and drinking practices. We interviewed the participants in-depth three times between 2017 and 2019. Thematic coding of the whole data with NVivo helped us select four cases for more detailed analysis, as they represented the typical trajectories and showed the variation in the material. We used the master narrative framework and Bamberg’s narrative positioning analysis to examine the data. The analysis demonstrates what kinds of narrative alignments in identity development encourage heavy drinking, moderate alcohol consumption, and fuel abstinence. The results suggest that the decline in youth drinking is produced by a co-effect of multiple master narratives that intersect and guide the identity development away from heavy drinking.
Doing adulthood—doing alcohol: what happens when the ‘sober generation’ grows up?
2020. Josefin Månsson, Eva Samuelsson, Jukka Törrönen. Journal of Youth Studies, 1-16Artikel
Since the 2000s, there has been a worldwide trend of decreased alcohol consumption among young people. Although recent studies have given multiple explanations for this, we know little about the meaning of alcohol for this generation as they enter adulthood. The aim of this article is therefore to describe and analyze the age-related views toward alcohol among this group as they transition from adolescents to adults. The study was based on 39 qualitative interviews with people aged 17–21. Theoretical concepts such as doing age and symbolic boundaries were used to analyze the material and investigate how age can structure alcohol use, and how alcohol consumption can be narrated to produce maturity and adulthood. The analysis showed that participants presented their relation to alcohol in nuanced and responsible ways, signaling maturity. The participants’ navigation of acceptable alcohol consumption differs in terms of agency and control in different life phases. ‘Doing adulthood’ in relation to alcohol for abstainers and drinkers seems to center on the same understandings of legitimate behavior: being moderate, nuanced, and in control. This focus linked alcohol to the position these emerging adults hold in wider society, given that participants incorporated societal demands for a neoliberal lifestyle.
Lockelsen och skammen –berättelser om spelproblem i Japan
2020. Eva Samuelsson. Orientaliska Studier 164, 38-77Artikel
Syftet med den här studien är attbelysa spelproblem i en japansk kontext och att undersöka hur lockelsenoch skammen med ett överdrivet pachinkospelande kan te sig för personersom sökt hjälp inom självhjälpsgrupper eller i vårdsystemet. Mer specifiktundersöks hur personer med spelproblem beskriver utvecklingenav sitt problem, hjälpsökandeprocessen och hur de förhåller sig till skam,skuld och stigma. Avslutningsvis diskuteras olika åtgärder för att minskaskadeverkningarna av spel om pengar i Japan.
Health, risk-taking and well-being: doing gender in relation to discourses and practices of heavy drinking and health among young people
2020. Jukka Törrönen, Eva Samuelsson, Filip Roumeliotis. Health, Risk and SocietyArtikel
In the last 20 years, adolescents’ heavy drinking in many western countries has declined. Simultaneously, researchers have identified an increased interest in health among young people. The paper compares adolescents’ gendered discourses and practices on intoxication and health in order to clarify the role gender plays in their current low alcohol consumption. The data consists of semi-structured interviews about alcohol, health and leisure activities among adolescents aged between 15 and 19 (N = 56). In the coding of the material, we have singled out two approaches to health and well-being among the participants, which we name the ‘social’ and ‘physical health’ approaches. By drawing on Butler’s work on ‘gender as performativity’, Connell’s understanding of gendered identities as ‘multidimensional’ and Bourdieu’s concept of ‘habitus’, we analyse how the participants align with, negotiate or oppose the hegemonic masculinities and femininities in these approaches, and examine the everyday practices that the two approaches are embedded in. Our analysis shows that the participants’ gendered performances in the ‘physical health’ approach are more variable, reflective and critical than those in the ‘social health’ approach. Moreover, the physical health approach modifies young people’s risk-taking practices of heavy drinking and helps to reinforce practices that favour young people’s low alcohol consumption. We propose that the move from doing gender in relation to risk-taking by heavy drinking towards doing it more through health- and physical appearance-related activities may generate processes that narrow the gender gap between masculinities and femininities and encourage new kinds of interaction and gender blending between them.
Online gambling venues as relational actors in addiction: Applying the actor-network approach to life stories of online gamblers
2020. Jukka Törrönen, Eva Samuelsson, Malin Gunnarsson. International journal of drug policyArtikel
With the emerging technologies of the Internet and smartphones during the last decades, the gambling environment has undergone a massive transformation. In Sweden, and Europe in general, online gambling has more than doubled since 2007.
The paper studies online gambling venues (OGVs) as relational actors of addiction. By drawing on the actor-network theory (ANT) and assemblage thinking, we examine how OGVs, as actors in specific networks of attachment, enable the development of gambling addiction and facilitate its continuation. The data consists of life story interviews with 34 online gamblers.
Online gambling venues extend the scope of gambling opportunities through space, providing an easy portable 24-hours-a-day access to gambling online and on smartphones. This increases the spatial mobility of gambling to diverse contexts. By linking gambling to more unpredictably evolving patterns of relations, online gambling venues also increase gambling's temporal mobility to intrude in the habitual trajectories of everyday life. By enhancing the gambling mobility through space and time, OGVs simultaneously extend the scope of situations in which gambling may transform from a controlled activity into an addiction. It is then that the actor-networks of gambling infiltrate in the actor-networks of work, domestic life and leisure, and start to feed processes where they are translated to serve the interests of gambling.
By giving us tools to challenge simplistic and taken-for-granted explanations of gambling addiction and by allowing us to grasp the flux and changing nature of addiction as a relational pattern of heterogeneous contextual attachments, the actor-network theory can help us to understand the complexity and multiplicity of gambling problems. The knowledge on what kinds of contextual attachments in diverse actor-networks enable harmful gambling and sustain unhealthy relations helps practitioners to focus treatment interventions especially on these contextual linkages and their configurations.
‘Social health’, ‘physical health’, and well-being: Analysing with bourdieusian concepts the interplay between the practices of heavy drinking and exercise among young people
2020. Jukka Törrönen (et al.). International journal of drug policyArtikel
The article examines the interplay between the practices of heavy drinking and exercise among young people. The comparison helps to clarify why young people are currently drinking less than earlier and how the health-related discourses and activities are modifying young people's heavy drinking practices.
The data is based on interviews (n = 56) in Sweden among 15–17-year-olds and 18–19-year-olds. By drawing on Pierre Bourdieu's concepts of habitus, field, and capital, we examine what kinds of resources young people accumulate in the fields of heavy drinking and exercise, how these resources carry symbolic value for distinction, and what kind of health-related habitus they imply.
The analysis shows that young people's practices in the social spaces of intoxication and exercise are patterned around the ‘social health’ and ‘physical health’ approaches and shaped by gendered binaries of masculine dominance. The ‘physical health’ approach values capable, high-performative, and attractive bodies, whereas the ‘social health’ approach is oriented towards accumulating social capital. The analysis demonstrates that these approaches affect the interviewees’ everyday life practices so that the ‘physical health’ approach has more power over the ‘social health’ approach in transforming them.
As the ‘physical health’ approach appears to modify young people's practices of drinking to be less oriented to intoxication or away from drinking, this may partly explain why young people are drinking less today than earlier. Compared to drinking, the physical health-related social spaces also seem to provide more powerful arenas within which to bolster one's masculine and feminine habitus. This further suggests that intoxication may have lost its symbolic power among young people as a cool activity signalling autonomy, maturity, and transgression of norms.
Utbud av stöd och behandling för spelproblem. Uppföljning av förtydligat ansvar i lagstiftningen
2020. David Forsström, Eva Samuelsson.Rapport
Den 1 januari 2018 förändrades den svenska lagstiftningen för att utvidga socialtjänstens och hälso- och sjukvårdens ansvar för stöd och behandling av spelproblem. Vad har hänt sedan dess med utbudet av stöd och behandling? Vad har förbättrats och vilka utmaningar kvarstår? I den här rapporten kartläggs situationen med fokus på hjälpsökande, behandlingsutbud och samverkan. För att få klarhet i detta har 16 nyckelpersoner från myndigheter, organisationer, självhjälpsgrupper och behandlingsverksamheter intervjuats. Rapporten beskriver även relevant statistik från Folkhälsomyndigheten, Stödlinjen och Spelberoendes riksförbund. Föreliggande rapport ger därmed en lägesbild som tydliggör framsteg och luckor i utvecklingen för att kunna erbjuda personer med spelproblem och deras anhöriga det stöd och den behandling de behöver.
How do social media-related attachments and assemblages encourage or reduce drinking among young people?
2020. Jukka Törrönen (et al.). Journal of Youth StudiesArtikel
Research shows that young people’s online practices have become a continuous, seamless and routine part of their physical and social worlds. Studies report contradictory findings on whether social media promotes intoxication-driven drinking cultures among young people or diminishes their alcohol consumption. By applying actor-network theory, our starting point is that the effects of social media depend on what kinds of concerns mediate its use. Social media alone cannot make young people drink more or less but influences their drinking in relation to specific attachments that we call here ‘assemblages’. The data consist of individual interviews among girls (n = 32) and boys (n = 24) between 15 and 19 years old from Sweden, covering topics such as alcohol use, social media habits and leisure time activities. The paper maps the variety of assemblages that mediate young people’s online practices and analyzes how young people’s drinking-related social media assemblages increase, decrease or exclude their alcohol consumption. The analysis shows that social media-related attachments seem to reduce our interviewees’ use of alcohol by providing competing activities, by transforming their drinking under the public eye, by reorganizing their party rituals to be less oriented towards drinking and by facilitating parents’ monitoring of their drinking situations.
Gamblers’ (mis-)interpretations of Problem Gambling Severity Index items
2019. Eva Samuelsson, Peter Wennberg, Kristina Sundqvist. Nordic Studies on Alcohol and Drugs 36 (2), 140-160Artikel
The Problem Gambling Severity Index (PGSI) is a screening instrument frequently used to identify risk and problem gambling. Even though the PGSI has good psychometric properties, it still produces a large proportion of misclassifications. Aims: To explore possible reasons for misclassifications in problem gambling level by analysing previously classified moderate-risk gamblers’ answers to the PGSI items, in relation to their own current and past gambling behaviours. Methods: Semi-structured telephone interviews were conducted with 19 participants reporting no negative consequences from gambling. They were asked the PGSI questions within an eight-year time frame (2008 to 2016). Ambiguous answers to PGSI items were subject to content analysis. Results: Several answers to the PGSI items contained ambiguities and misinterpretations, making it difficult to assess to what extent their answers actually indicated any problematic gambling over time. The item about feelings of guilt generated accounts rather reflecting self-recrimination over wasting money or regretting gambling as a meaningless or immoral activity. The item concerning critique involved mild interpretations such as being ridiculed for buying lottery tickets or getting comments for being boring. Similar accounts were given by the participants irrespective of initial endorsement of the items. Other possible reasons for misclassifications were related to recall bias, language difficulties, selective memory, and a tendency to answer one part of the question without taking the whole question into account. Conclusions: Answers to the PGSI can contain a variety of meanings based on the respondents’ subjective interpretations. Reports of lower levels of harm in the population should thus be interpreted with caution. In clinical settings it is important to combine use of screening instruments with interviews, to be able to better understand gamblers’ perceptions of the gambling behaviour and its negative consequences.
Why are young people drinking less than earlier? Identifying and specifying social mechanisms with a pragmatist approach
2019. Jukka Törrönen (et al.).Artikel
Recent surveys have found a strong decrease in alcohol consumption among young people and this trend has been identiﬁed in European countries, Australia and North America. Previous research suggests that the decline in alcohol consumption may be explained by changes in parenting style, increased use of social media, changes in gender identities or a health and ﬁtness trend. We use qualitative interviews with drinking and non-drinking young people from Sweden (N=49) to explore in what way and in what kinds of contexts these explanations may hold true and how they alone or together may explain declining alcohol consumption among young people. By using the pragmatist approach, we pay attention to what kinds of concerns, habits, practices, situations and meanings our interviewees relate to adolescents' low alcohol consumption or decline in drinking. By analyzing these matters, we aim to specify the social mechanisms that have reduced adolescents' drinking. Our paper discovers social mechanisms similar to previous studies but also a few that have previously been overlooked. We proposethattheculturalpositionofdrinkingmayhavechangedamongyoungpeoplesothatdrinkinghaslostits unquestioned symbolic power as a rite of passage into adulthood. There is less peer pressure to drink and more room for competing activities. This opening of a homogeneous drinking culture to the acceptance of diﬀerences may function as a social mechanism that increases the success of other social mechanisms to reduce adolescents' drinking. Furthermore, the results of the paper suggest a hypothesis of the early maturation of young people as more individualized, responsible, reﬂective, and adult-like actors than in earlier generations. Overall, the paper provides hypotheses for future quantitative studies to examine the prevalence and distribution of the identiﬁed social mechanisms, as well as recommends directions for developing eﬀective interventions to support young people's healthy lifestyle choices
Det svårfångade problemspelandet – spelares subjektiva tolkningar av Swelogs bedömningsinstrument
2019. Eva Samuelsson, Sundqvist Kristina.Övrigt
Överdrivet spelande om pengar kan få ekonomiska, känslomässiga och sociala konsekvenser i olika grad. Hur spelare själva upplever bekymren är centralt för huruvida de kommer att försöka förändra sina spelvanor. Men vad är det egentligen vi fångar när vi mäter problemspelande i befolkningen? Vi har undersökt hur spelare som tidigare bedömts ha ett problemspelande tolkar frågorna som användes vid just denna bedömning.
Help-seeking behaviour ofproblem gamblers: a narrative review
2018. Johanna K. Loy (et al.). SUCHT 64 (5-6), 259-272Artikel
Background: There is evidence for low rates of help-seeking among problem gamblers. Identifying reasons for and barriers to seeking help is essential for improving help supply and gamblers’ treatment utilisation. The present study examines treatment utilisation of problem or pathological gamblers and reviews the evidence related to motives for and barriers to seeking help. Methods: The databases Medline, PsycInfo, and PubMed were searched for English-, Swedish- and German-language studies published between 2000 and 2017. Furthermore relevant references of included studies were analysed. Results: After exclusion of non-relevant publications 34 journal articles and seven reports covering the prevalence of help-seeking among gamblers or self-reported reasons for/barriers to help-seeking were maintained. The proportion of problem gamblers seeking help was less than 10 % in most studies. Problem severity was found positively associated with treatment attendance. Financial issues, negative emotions and crises were identified as main motives for seeking treatment. Main barriers to seeking treatment were shame, problem denial and lack of treatment availability. The results were similar across the examined studies. Conclusion: Low rates of treatment utilisation by problem gamblers strongly indicate that treatment providers and the society should strive to eliminate structural barriers that hinder gamblers to seek help. To better match problem gamblers´ needs, low-threshold early intervention, increasing knowledge of treatment options and efforts to reduce stigmatisation are important strategies to enhance access to help offers.
Configurations of gambling change and harm: qualitative findings from the Swedish longitudinal gambling study (Swelogs)
2018. Eva Samuelsson, Kristina Sundqvist, Binde Per. Addiction Research and TheoryArtikel
Background: Gambling participation and problems change over time and are influenced by a variety of individual and contextual factors. However, gambling research has only to a small extent studied gamblers’ own perceptions of transitions in and out of problem gambling.
Method: Qualitative telephone interviews were made with 40 gamblers who had repeatedly participated in the Swelogs Swedish Longitudinal Gambling Study. The framework approach was used for analyses, resulting in a multiple-linkage typology.
Results: Our analyses revealed four configurations of gambling: (a) stable low frequency with no or minor harm, (b) decreasing high frequency with occasional harm, (c) fluctuating with moderate harm, and (d) increasing high frequency with substantial harm. Natural recovery and return to previous levels of gambling intensity were common. Change occurred either gradually, as a result of adjustment to altered personal circumstances, or drastically as a consequence of determined decisions to change. Personal and contextual factors such as psychological well-being, supportive relationships, and meaningful leisure activities played a part in overcoming harmful gambling and keeping gambling on a non-problematic level. Gambling advertising was commonly perceived as aggressive and triggering.
Conclusions: The experience of harm is highly subjective, which should be taken into account when developing preventive measures. Considering the fluid character of gambling problems, help and support should be easily accessible and diversified. To repeatedly be interviewed about gambling and its consequences can contribute to increased reflection on, and awareness of, one’s own behaviours and the societal impacts of gambling.
Utbud av stöd och behandling för spelproblem
2018. David Forsström, Eva Samuelsson.Rapport
Den 1 januari 2018 genomfördes lagändringar som innebar ett förtydligat ansvar för socialtjänsten samt hälso-och sjukvården att förebygga, motverka och bistå individer med insatser vid spelmissbruk. Syftet med föreliggande studie var att undersöka utbudet av stöd och behandling vid spelproblem innan lagändringen trädde i kraft. En sammanställning av befintliga uppgifter från Folkhälsomyndigheten och Stödlinjen gjordes. Intervjuer genomfördes med sexton nyckelpersoner inom spelbehandlingsfältet från kommuner, landsting, myndigheter och frivilligorganisationer. Intervjumaterialet analyserades med hjälp av tematisk analys. Preliminära resultat presenterades för en grupp behandlare för att validera och få kommentarer. Undersökningen visade att stödet för personer med spelproblem varierar i landet och är fragmentariskt. På vissa orter finns behandling att tillgå, men dagens behandlingsutbud bygger på enskilda behandlare som har ett specialintresse för målgruppen. Det är ofta bara en till två behandlare i en organisation som arbetar med målgruppen vilket skapar en sårbarhet. Få personer utbildas på övergripande nivå och om en behandlare slutar ersätts sällan personen. Den behandling som erbjuds är huvudsakligen kognitiv beteendeterapi. Det finns behov av att utveckla mer specifika och integrerade behandlingsalternativ till olika målgrupper. Frivilligorganisationer fyller en viktig funktion genom att erbjuda stöd som komplement till behandling eller som alternativ och när behandling inte finns tillgänglig. Det huvudsakliga resultatet är att kommuner och landsting är dåligt rustade för att möta att målgruppen. Resurser och kompetens saknas på många håll för att tillhandahålla stöd och behandling som kan hjälpa hjälpsökande att komma ur ett problemspelande. Mer satsning på utbildning och screening föreslås som sätt att åtgärda bristerna. Även om utvecklingsarbete påbörjats innebär lagändringarna en stor utmaning för kommuner och landsting för att få till fungerande samverkan för att tillmötesgå spelares och deras anhörigas behov. En uppföljning av föreliggande studie planeras under 2019/2020 för att kartlägga hur behandlingsutbudet har utvecklats efter att lagändringen trädde i kraft.
Brukarinflytande på vårdmarknaden
2018. Jessica Storbjörk, Eva Samuelsson. Socialtjänstmarknaden, 85-115Kapitel
Kapitlet behandlar brukarinflytande inom missbruks- och beroendevården och diskuterar den potentiella konflikten mellan denna företeelse och New Public Management (NPM). Kapitlet diskuterar hur företeelser som ofta förknippas med NPM (t.ex. upphandling och ramavtal, valfrihet, prestationsbaserade ersättningssystem) inverkar på handlingsutrymme och vårdbeslut utifrån personalens och brukarnas utsagor, liksom hur klienter och patienter ser på sina möjlighetertill inflytande i en NPM-inspirerad vård.
Spelares upplevelser av förändringar i vanor och problem. En kvalitativ studie om spel om pengar
2017. Eva Samuelsson, Kristina Sundqvist, Jenny Cisneros Örnberg.Rapport
Spelvanor och spelproblem är föränderliga i människors liv beroende på en mängd olika faktorer. För att fördjupa kunskapen om hur spel om pengar förändras över tid och vad som påverkar dessa förändringar, har kvalitativa telefonintervjuer genomförts med 40 personer som tidigare deltagit i Swelogs kvantitativa longitudinella undersökningar. Resultaten visade att både individ-, relations- och samhällsrelaterade faktorer påverkade spelandets upp- och nedgångar. Faktorer som personliga egenskaper, mående, föreställningar om spel, tillgång till pengar, arbetssituation, familjeliv, livshändelser, mognadsprocesser, reklam och tillgänglighet samverkar för förändrade spelvanor och måste förstås i ett sammanhang. Fyra olika typfall identifierades som representerade varierande problemgrad och förändringsmönster. Situationer som var förknippade med ökat spelande var relaterade till att bli myndig, spela med vänner i samband med berusningsdrickande, storvinster, att ha ett kringresande arbete, negativa livshändelser, depression, ensamhet och brist på meningsfull sysselsättning. Psykiskt välbefinnande, stödjande relationer och meningsfull sysselsättning var centralt för att ta sig ur destruktiva spelvanor eller att hålla vanorna på en ickeproblematisk nivå. Spelreklamens aggressiva utformning upplevs som ett problem av många, och restriktioner förespråkades. Slutligen vittnade intervjupersonerna om att deltagandet i en longitudinell undersökning om spelvanor kan bidra till ökad reflektion och högre medvetenhet om egna beteenden och spelproblem i samhället.
A study of service user involvement in practice in the Swedish substance abuse treatment system
2016. Jessica Storbjörk (et al.).Rapport
Demands for service user involvement has a long history in the general health and welfare sectors in Sweden, but user involvement has been lagging behind as concerns substance abuse treatment. “The position of the service user in substance treatment: A study of user involvement in practice” therefore sought to analyze perceptions of user involvement and the extent to which alcohol and drug users in this treatment sector can influence the choice of intervention in their own case. The study included both the perspectives of the service users and their professional service providers. The relationship between user involvement, satisfaction, and outcomes were explored, as well as potential differences in perceptions and experiences between various service user groups and service providers. The study applied a qualitative research approach by interviewing 36 service users and 23 service providers (pairs of service users and providers), and following them up three months later.
The primary goal of the present technical report was to provide a quantitative exploration of research participant characteristics, user involvement and treatment satisfaction by different groups, including outcomes. The report uses tabular formats as well as several summaries of interview accounts. The report also outlines our theoretical point of departure and detailed information concerning the research methods and methodological considerations.
[A Swedish summary is available in the report]
Perceptions of treatment needs
2015. Eva Samuelsson, Lisa Wallander. Addiction Research and Theory 23 (6), 469-480Artikel
The aim of the study was to analyze addiction care staff (N=447) perceptions of needs for psychosocial and medical treatment, and possibilities for self-change in relation to fictitious cases. By means of a factorial survey and multilevel analysis, the importance of user, respondent and work characteristics were estimated, with a particular focus on the comparison between healthcare staff and social services staff. Healthcare staff were more skeptical than social services staff towards self-change and assessed the need for medical treatment to be greater. Despite the ongoing medicalisation of Swedish addiction care, psychosocial interventions were still seen as a central part of treatment by both groups. The importance of user characteristics for the assessments was surprisingly similar across the two groups of staff, suggesting that staff perceptions are analogous to the governing images of substance use and treatment needs that prevail in society.
Substance use and treatment needs
2015. Eva Samuelsson. Contemporary Drug Problems 42 (3), 188-208Artikel
Men’s and women’s drinking tend to elicit different societal reactions, which may be attributed to different perceptions of masculinity and femininity. This study analyzes addiction care practitioners’ constructions of substance use and treatment needs in relation to gender. Data were collected by means of six focus group interviews with 30 addiction care practitioners. An interpretative repertoire of difference emerged, whereby women were constructed as being different from men in psychological, social, and biological respects. The practitioners related to gender in addiction care as an ideological dilemma resulting from the contradictory ideals of on the one hand treating everybody equally and on the other giving special attention to what is regarded as women’s needs. Reflections emerged regarding the need to be aware of one’s own stereotyped assumptions, and also to be attentive toward men’s specific problems, thus constituting a reflective repertoire. In order to avoid potentially stereotyped treatment, the application of a gender-sensitive approach should acknowledge the variety of ways in which femininity and masculinity may be performed.
Use or Misuse?
2015. Eva Samuelsson (et al.).Avhandling (Dok)
The aim of this thesis has been to study boundary-making in addiction care practitioner’s perceptions of substance use and treatment. The four papers are based on three data collections in Swedish outpatient addiction care: a) a survey conducted in 2006 (n=655), b) a factorial survey using randomly constructed vignettes conducted in 2011 (n=474), and c) a focus group interview study from 2013 (n=30) with a sample of the respondents from the factorial survey.
The analyses show that practitioners tend to draw boundaries between various forms of substance use, with alcohol use being perceived as a less severe problem than narcotics use and requiring less extensive treatment measures. There are also partially varying perceptions in different parts of addiction care. By comparison with social services staff, regional healthcare staff generally see a greater need for treatment, recommend medical treatment to a greater extent, and display less confidence in the possibility of handling problematic use without professional treatment. Despite an ongoing medicalization at the policy level, psychosocial treatment interventions appear to have legitimacy in both regional healthcare and social services settings.
Boundary-making processes are also found in relation to the specific user’s age, family situation, socio-economic status and in some cases gender, with young women’s drinking being seen as more severe than young men’s drinking for example. The boundary-making between different substance users may be interpreted as a sign of an approach based on a professional consideration of the person’s socially exposed situation, which might require more comprehensive support. At the same time, it may be an expression of a stereotyped approach, involving a normative evaluation of women’s behaviour as being more deviant than men’s, thereby having a limiting effect on the conduct norms that regulate women’s behaviour and making the problems of men invisible. To avoid disparities in addiction care delivery, it is of major importance that practitioners are given room to reflect upon the assumptions and values that underlie the assessments they make in practice. Combining a factorial survey with focus group interviews is proposed as one means of facilitating this type of reflection.
Disentangling practitioners’ perceptions of substance use severity
2014. Eva Samuelsson, Lisa Wallander. Addiction Research and Theory 22 (4), 348-360Artikel
The aim of this study was to examine the influence of user, staff and work unit characteristics on addiction care practitioners’ assessments of the severity of alcohol and drug use. A factorial survey was conducted among 489 social workers, therapists, nurses, doctors and executives from 77 addiction care units in the three largest Swedish counties. Staff assessed the severity of 10 fictive scenarios, vignettes (n = 4724), describing persons with varying social characteristics who were users of alcohol, cannabis or cocaine. The effects of user, respondent and work-unit variables on the practitioners’ severity assessments were estimated using multilevel regression analysis. The results show that perceived severity was influenced not only by the substance, the frequency and character of the negative consequences of the use, but also by the age, socio-economic status and family situation of the user. Women, older respondents and respondents with a medical education rather than a social work education were on average more inclined to assess the vignettes as being more severe. Analyses of various interactions revealed that practitioners viewed the drinking of young men as being less severe than that of young women. Doctors saw women's use as more problematic than men's, irrespective of the context. To conclude, alcohol and drug consumption is judged by different norms, depending on various characteristics of the users, of the practitioners and also of their workplaces. To avoid potential negative consequences of the application of such varying standards in addiction care, more individual reflection and workgroup discussion are needed.
Addiction and recovery
2013. Eva Samuelsson, Jan Blomqvist, Irja Christophs.Artikel
AIMS - The objective of the study was to explore perceptions of different addictions among Swedish addiction care personnel. DATA - A survey was conducted with 655 addiction care professionals in the social services, health care and criminal care in Stockholm County. Respondents were asked to rate the severity of nine addictions as societal problems, the individual risk to getting addicted, the possibilities for self-change and the perceived significance of professional treatment in finding a solution. RESULTS - The images of addiction proved to vary greatly according to its object. At one end of the spectrum were addictions to hard drugs, which were judged to be very dangerous to society, highly addictive and very hard to quit. At the other end of the spectrum were smoking and snuff use, which were seen more as bad habits than real addictions. Some consistent differences were detected between respondents from different parts of the treatment system. The most obvious was a somewhat greater belief in self-change among social services personnel, a greater overall change pessimism among professionals in the criminal care system and a somewhat higher risk perception and stronger emphasis on the necessity of treatment among medical staff. CONCLUSION - Professionals’ views in this area largely coincide with the official governing images displayed in the media, and with lay peoples’ convictions.