Jag är docent i socialt arbete vid Institutionen för socialt arbete, Stockholms universitet. Under de senaste åren har min forskning huvudsakligen handlat om återhämtningsprocesser (recovery) från missbruksproblem, främst ur ett brukarperspektiv, där jämförelser gjorts mellan olika grupper (t ex kvinnor och män, personer med en marginaliserad eller integrerad social situation eller med problem både med psykisk ohälsa och med missbruk). Andra områden som jag arbetat med är användning av bedömningsinstrument inom socialt arbete och långtidsuppföljning av det s.k. BAK-projektet, dvs hur det gått för klienter som under tidigt 1980-tal fick institutionell vård för missbruksproblem i Sverige och som då ingick i BAK/SWEDATE-projektet.
Missbruks- och behandlingsforskning.
I urval från Stockholms universitets publikationsdatabas
Positiva förändringsprocesser bland unga vuxna i öppenvård
Lisa Skogens, Ninive von Greiff, Jasmine Esch-Ekström. Socialvetenskaplig tidskriftArtikel
Positive processes of change among young adults in out-patient care
In contemporary society, the transition phase from adolescence to adulthood is often described as a period of moving back and forth between youthful dependency and independent adulthood in what is called ‘yo-yo-transitions’. However, studies of young people in need of out-of-home care, or other child welfare, for psychosocial problems, points out that this vulnerable group have limited possibilities to do these transition movements. The present study investigates positive change processes during this particular part of life in out-patient care clients. The research questions are: 1) How do young adult clients describe important factors for a positive process of change and 2) How are important factors related to the treatment described by clients and by treatment staff. Data consists of seven personnel interviews and twenty interviews with young adults that have completed out-patient care. The results suggest that the relation between an individual treatment staff and the young adult is central for the positive change process. In the discussion it is suggested that the preconditions for this relation are: 1) A genuine engagement and dedication from the professional. 2) With this first point as a foundation, the mastering of a spectrum of professional methods and the ability to choose when to use them are necessary means for positive change processes to come about. 3) A supportive organisation and leadership are crucial for setting the frames that makes the first two points possible to establish.
Positive processes of change among male and female clients treated for alcohol and/or drug problems
2017. Ninive von Greiff, Lisa Skogens. Journal of Social Work 17 (2), 186-206Artikel
In social work practice, the role of substance use is often encountered in the context of other social problems such as child abuse and domestic violence. This article compares descriptions of important factors for initiating and maintaining positive changes among male and female clients treated for alcohol and/or drug problems. The results have a bearing both on substance use treatment and on other areas in social work practice where these problems are encountered. Studies highlighting gender perspective indicate differences regarding experience of alcohol and drug problems and treatment. An advantage of the study is the qualitative analysis of a rather comprehensive material (n = 90) enabling more general conclusions than in previous research with a limited number of clients.
Women more often than men stress poor mental health and their children as important for initiating change. When referring to partners, women report abusive rather than supportive partners while the opposite applies to men. For maintaining change, male clients more often stress changes in ways of thinking and feeling as important. Men also report becoming more sensitive while women get more active. This can be understood as transcending of gender with possibilities of a broader repertoire of how to act.
A challenge for practical treatment work is to create possibilities for clients to broaden their repertoire of ways of living and thinking about themselves, expressed by women as the importance of taking space and speaking up and by the men of showing emotion and listening more.
Understandingthe concept of the therapeutic alliance in group treatment for alcohol and drugproblems
2017. Ninive von Greiff, Lisa Skogens. European Journal of Social WorkArtikel
This article investigates how treatment factors are described by different client groups and by treatment staff. The material consists of interviews with clients (n = 81) and treatment staff (n = 18). The analysis focuses on two central themes – the importance of the treatment group and of the treatment staff, along with how these descriptions relate to the concept of the therapeutic alliance. The descriptions differ in parts between the client groups and between clients and staff. Clients as well as staff highlight structural and qualitative aspects of cohesion, but general patterns of how these are expressed in the groups are hard to grasp. However, some exceptions appear; while the clients often relate recognition to own experience of substance abuse, the staff often refer to external aspects of recognition, such as gender and/or experience of parenting. The results indicate that the social preconditions of the group members can influence group cohesion. In the treatment, focus is initially on cohesion and later on making change possible. This might create a dilemma; the homogeneity that initially creates cohesion can also act as a restraint on change. This is described in the results in relation to gender homogeneous client groups in treatment.
Conditions for recovery from alcohol and drug abuse
2016. Lisa Skogens, Ninive von Greiff. Nordic Social Work Research 6 (3), 211-221Artikel
This study adduces an interactive perspective on treatment and relates to research describing change as a process. It focuses on differences in how the importance of internal and social factors for the change process is described among male and female clients of different social position. The concept of recovery capital is used as analytic tool. Female and male clients were interviewed and asked to talk about factors they perceived as important for initiating and maintaining change. The use of a relatively large amount of interviews strengthen the possibilities of drawing generalized conclusions on differences between the groups, making comparisons possible while still keeping the qualitative meaning of the investigated factors. The most important finding in the study is that the implications of different factors during the change process seem to relate to gender stereotypes and that the client’s social position (defined as marginalized or integrated) seems to be important for how gender stereotypes emerge. It is argued that gender stereotypes can serve both as a support and a hinder during recovery. This is discussed using the concept of recovery capital to illuminate qualitative differences regarding the importance of internal and social factors for the process of change for men and women of different social position.
Behandlingens mekanismer – klienters och behandlingspersonals beskrivningar av förändringsprocesser i samband med behandling för missbruksproblem
2015. Ninive von Greiff, Lisa Skogens. Socionomens forskningssupplement 3 (37), 44-56Artikel
Recovery capital in the process of change-differences and similarities between groups of clients treated for alcohol or drug problems
2014. Lisa Skogens, Ninive von Greiff. European Journal of Social Work 17 (1), 58-73Artikel
The study investigated clients' retrospective descriptions of the impact of treatment interventions as well as other contextual factors in the clients' process of recovery. The data set was divided into two groups based on the clients' social integration, one marginalized and one integrated group, and analyzed for qualitative group-related differences in common factors described by the clients. The results showed some group-related differences in the process of change. When a process of change was initiated, family-related problems were more often severe for clients in the marginalized group than for those in the integrated group. Important factors for maintaining positive change were to a greater extent present in the integrated group while the marginalized group recreated them during treatment, for example by creating new social networks and getting employment. With these differences in mind, both groups stressed the same type of factors as important for a process of change. This might suggest that although the clients in the marginalized group had restored their external social conditions during treatment, their actual recovery capital was in general more fragile than that of clients in the integrated group and hence these clients might be in need of extended support after treatment.
The pursuit of evidence-based practice - a comparison of three guidelines on psychosocial interventions for alcohol problems
2014. Anders Bergmark, Lisa Skogens, Ninive von Greiff. Nordisk Alkohol- og narkotikatidsskrift (NAT) 31 (3), 271-288Artikel
The mechanisms of treatment – client and treatment staff perspectives on change during treatment for alcohol problems
2013. Ninive von Greiff, Lisa Skogens. Nordic Social Work ResearchArtikel
The overall aim of this study is to increase the understanding of operative factors in the treatment process by studying how clients and treatment unit staff perceive the relevance and value of the alcohol treatment intervention for a positive process of change. The specific research questions are: (1) How do clients describe the relevance and importance of treatment interventions in their own process of change? (2) How do treatment staffs describe experience and perceptions of how their work can contribute to a successful change process among treated clients? (3) How do client and the treatment staff descriptions relate to each other? Interviewees (40 clients and eight professionals) were recruited from four treatment units in the Stockholm area. In the results, the three treatment components most emphasised by clients are structure and regularity, friendship and support of the group and the personal conduct and professionalism of the staff. Both of the components referring to the client group and to the staff were also brought forward by the professionals interviewed. In treatment, the client group is used as an important tool for creating a sense of trust, confidence, acceptance and collaboration – all central components of the treatment alliance concept. With reference to the notion of rebuilding/extending recovery capital, it is suggested that in addition to the addiction problem intervention, a more extended system of support is vital for more marginalised clients.
ASI i retorik och praktik
2012. Lisa Skogens. Socionomens forskningssupplement (32), 34-42Artikel
Här diskuteras användningen av ASI i socialtjänstens arbete med missbruksvård och om instrumentet i sig kan ge kvalitetsförbättringar i arbetet, både i form av att möjliggöra gruppsammanställningar och som instrument i det direkta klientarbetet. Utgångspunkt för diskussionen är dels en studie där socialarbetare återger hur de värderar instrumentet och dels exempel på hur gruppsammanställnignar görs på kommunnivå. Slutsatsen dras att det är av stor vikt att ASI användare är utbildade i att använda verktyget och att de är professionella socialarbetare, att ökad transparens och rättsäkerhet med hjälp a ASIinstrumentet troligtvis är avhängigt en bred användning samt att sammanställnignar på gruppnivå riskerar att bli missvisande om ingen kontroll finns över vilka klienter som inte finns med i sammanställningen.
Approaching drinking problems in single male clients receiving social assistance
2012. Lisa Skogens. European Journal of Social Work 15 (2), 257-274Artikel
How are drinking problems in single male clients receiving social assistance approached?This subject has been investigated in two studies. In Study I, 103 social workersresponded to a questionnaire on how they would act towards a hypothetical client. Theresults suggest that there is no consensus among social workers as to how to act towardstheir clients’ drinking problems and that personal values more than anything else arewhat seem to influence the choice of action taken. Study II is based on focus groupinterviews with social workers. The social workers’ approach to the clients’ problems isdescribed as a mobile point within a two-dimensional system. One dimension concernsthe client’s right to equal treatment versus the right to have their application judgedindividually with special circumstances considered. The other dimension is related to theclient’s integrity versus the need for support and control. The results are contextualisedmainly from three aspects: the demands on ‘knowledge’ in social work, the specificframework of social work, and changes in the public discourse regarding sociallyacceptable drinking habits.
Förändringsprocesser i samband med missbruksbehandling - vilka faktorer beskriver klienter som viktiga för att initiera och bibehålla positiva förändringar?
2012. Ninive von Greiff, Lisa Skogens. Nordisk Alkohol- og narkotikatidsskrift (NAT) 29 (2), 195-209Artikel
ABSTRACTProcesses of change during and after drug treatment, What factors are described by clients asimportant to initiate and maintain positive changes?AIMS – The aim is to describe and analyze how clients recovered from alcohol or drug abuse perceivechange in connection with treatment interventions. The specific questions are: What factors aredescribed as important to 1) initiate a process of change? 2) avoid returning to abuse? DESIGN – 40clients were interviewed according to a brief interview guide. The analysis resulted in models withfactors that the clients considered important for initiating and maintaining positive changes. RESULTS– The result suggests that a pattern is emerging in the process of change. Although the clients oftendescribe common factors as important, the variation of timing and severity for different factors makesthe individual story unique. CONCLUSIONS – The variation of timing and severity for different factorsimplies that it is very difficult to predict when a factor is important or not. This underlines the importanceof treatment systems with a structure and a flexibility that enables supporting factors to be used whenthey are of importance for the individual client.
Labour market status, requirements and social support—single male clientswith problematic alcohol consumption
2011. Lisa Skogens. European Journal of Social Work 14 (4), 513-523Artikel
The study presented in this article investigates relations between two phenomena that arewidely considered to be social problems*unemployment and alcohol abuse. Theinvestigated group is that of single male clients receiving social assistance in Sweden.Difficulty in supporting themselves is thus the main reason why these clients have contactwith the social welfare office, but to some extent the clients in focus do also have adrinking problem (defined as notes on drinking problems in their case files). Case files onmale, single clients in which alcohol-related notes were present are investigated(n297). The results indicate that social workers are more active in making demandson clients to change their alcohol habits if the clients are able to support themselvesthrough work than if they are not. This implies that resources for the treatment of alcoholand drug abuse may be allocated on the basis of which clients it is possible to removefrom the social service system*i.e. who are able to support themselves through work*and not on the basis of which clients are the most needy.
Building trust and recovery capital
2018. Alain Topor, Lisa Skogens, Ninive von Greiff. Advances in Dual Diagnosis 11 (2), 76-87Artikel
Purpose - The possibility of recovery for persons with co-occurring addiction and mental health problems has been contested. Though, recent studies show that recovery might happen, but without connection to specific treatment interventions. The purpose of this paper is to analyse professionals' perceptions of their contribution to improvement.
Design/methodology/approach - In all, 15 experienced professionals were interviewed. The interviews were analysed using thematic analysis.
Findings - Recovery processes were dependent of the persons' access to different forms of recovery capital (RC). Lack of RC was often associated with lack of trust in one's self and others (identity and personal capital). Professionals had to be accepted as trustful agents through co-creating changes in the person's life. Trusting a professional might be a basis for trusting one's self as an agent in one's recovery process and develop a social network (identity and relationship capital). Other aspects stressed by the professionals were to manage their own fragmentized organisations and societal shortcomings (economic capital).
Practical implications - Recovery has been described as a profoundly individual journey. However, it is also deeply social, involving other persons and contextual factors. Focusing on just one level might counteract the complex work behind double recovery.
Originality/value - Improvement was described as dependent on the presence of personal, inter-personal, organisational and societal factors. The findings give a deep and concrete understanding of the process constituting the development of a working alliance and its dependence on factors outside the direct relation between the staff member and the person.
Initiating and maintaining a recovery process - experiences of persons with dual diagnosis
2018. Lisa Skogens, Ninive von Greiff, Alain Topor. Advances in Dual Diagnosis 11 (3), 101-113Artikel
Purpose - The purpose of this paper is to investigate the internal and social factors that persons with experience from severe mental illness and alcohol and other drugs problems, and who have received treatment for these problems, describe as important for initiating and maintaining a recovery process.
Design/methodology/approach - In total, 40 persons were interviewed and asked to describe factors they perceived as important for initiating and maintaining recovery. The software Nvivo was used to categorise data in internal and social factors with subcategories.
Findings - There is significant variation in how recovery emerged but involved in general having a proper social situation and finding meaning in life. Initially, the majority had a marginalised situation with need of assistance with housing, employment, financial and social support.
Research limitations/implications - The change process in the investigated group is interpreted as related to individual resources rather than belonging to a group defined as having double trouble.
Practical implications - The study implies that in addition to professional help to handle diagnosed problems, the group in focus also need support and interventions that address individual complex needs.
Social implications - Supporting activities/peer support seem to be important for those lacking support from family. At the same time, it is important to recognise the risk of being forced into a recovery identity which might lead to worsening the situation for those who do not fit into this.
Originality/value - By using the same design as in previous studies, comparisons with other groups are possible while still keeping the qualitative meaning of the investigated factors.
Mortality and Cause of DeathA 30-Year Follow-Up of Substance Misusers in Sweden
2018. Ninive von Greiff (et al.). Substance Use & Misuse 53 (12), 2043-2051Artikel
Background: This article presents a 30-year follow-up study of a cohort of 1163 substance misusers who were in inpatient treatment in the early 1980s. Data was originally collected in the Swedish Drug Addict Treatment Evaluation (SWEDATE). Objectives: The aim is to examine the overall mortality and identify causes of death in different groups based on self-reported most dominant substance misuse among those who have died during January 1984-December 2013. Methods: SWEDATE-data was linked to the National Cause of Death Register. Five mutually exclusive study groups were created based on self-reported most dominant substance misuse for the last 12 months before intake to treatment: Alcohol, Cannabis, Stimulants, Opiates, and Other. The Standardized Mortality Ratio (SMR) was calculated. Results: During the follow-up, 40% died. SMR is 10.3 for women and 11.7 for men. The study groups differed regarding SMR; 13.1 in the Alcohol group, 9.2 in the Cannabis group, 9.6 in the Stimulants group, 16.7 in the Opiates group and 10.8 in the Other group. Drug related death was the most common cause of death (28% only underlying, 19% both underlying and contributing) followed by alcohol related reasons (17% vs. 9%). Conclusions: Alcohol misuse among substance abusers might have a negative impact on mortality rates. Methodological changes in how drug related deaths is registered affects the interpretation of the statistics of cause of death. Further analysis on the relation between drug related cause of death and drug misuse related death is needed.
Supporting recovery in social work with personshaving co-occurring problems – clients’ andprofessionals’ perceptions
2018. Ninive von Greiff, Lisa Skogens, Alain Topor. Nordic Social Work ResearchArtikel
Micro-affirmations and Recovery for Persons with Mental Health and Alcohol and Drug Problems
2021. Alain Topor, Ninive von Greiff, Lisa Skogens. International Journal of Mental Health and Addiction 9 (2), 374-385Artikel
Recurrent factors contributing to a recovery process from co-occurring mental health and addiction problems mentioned by users and professionals have been analyzed as part of working alliances and helpful relationships. Still, we lack knowledge about how helpful relationships are developed in daily practice. In this article, we focus on the concrete construction of professional helpful relationships. Forty persons in recovery and fifteen professionals were interviewed. The interviews were analyzed according to thematic analysis, resulting in three themes presented as paradoxes (1) My own decision, but with the help of others; (2) The need for structures and going beyond them; and (3) Small trivial things of great importance. Micro-affirmations have a central role in creating helpful relationships by confirming the individuals involved as more than solely users or professionals. More attention and appreciation should be paid to practices involving micro-affirmations.
Recovery and identity
2021. Lisa Skogens, Ninive von Greiff. DrugsArtikel
Recovery is an established term used to describe positive processes of change concerning problemsrelated to alcohol and other drugs (AOD). The present article investigates first-person experiences ofrecovery self-identification over time in clients who have completed 12-step programs with a positiveoutcome (sobriety). The data comprises qualitative interviews with 47 individuals five years after thefirst post-treatment interview, analyzed in a process inspired by reflexive thematic analysis. Althoughall the individuals had continued their recovery, their recovery paths and how they identified themselvesin relation to their AOD problems had taken different directions. Thus, many of the individualsdescribed their recovery in a broader sense which ranges from abstinence to moderation. Some individualsperceived themselves as no longer in recovery. The multitude of recovery processes describedin the study underlines the need for acceptance and respect for individual identity processes.Furthermore, the importance is stressed of supporting an individual’s perceptions of how their recoveryprocess should best be outlined. The results should not be interpreted as a critique of the 12-stepapproach. Instead, there is a need for variety over time in the support and treatment options availablefor people in need of treatment for AOD problems.
Abstinence or controlled drinking - a five-year follow-up on Swedish clients reporting positive change after treatment for substance use disorders
2020. Ninive von Greiff, Lisa Skogens. Drugs and alcohol today 20 (2), 147-156Artikel
Purpose - The purpose of this paper is to investigate how clients - five years after completing treatment interventions endorsing abstinence - view abstinence and the role of Alcoholics Anonymous (AA) in their recovery process.
Design/methodology/approach - Interviews with 40 clients were conducted shortly after them finishing treatment and five years later. All the interviewees had attended treatment programmes based on the 12-step philosophy, and they all described abstinence as crucial to their recovery process in an initial interview.
Findings - At follow-up, the majority remained abstinent. For many, attending AA meetings was still important - some described attending as a routine, whereas others stressed that the meetings were crucial for remaining abstinent. For those who reported controlled drinking (CD), this was described either as a natural step in their recovery process or as associated with worries and self-doubts.
Research limitations/implications - The results suggest the importance of offering interventions with various treatment goals and that clients choosing CD as part of their sustained recovery would benefit fromsupport in this process, both from peers and professionals.
Originality/value - There are heterogeneous views on the possibilities of CD after recovery from substance use disorder both in research and in treatment systems. This study on client views on abstinence versus CD after treatment advocating total abstinence can contribute with perspectives on this ongoing discussion.
The relation between out-of-home care, early school failure, and premature mortality
2020. Marie Berlin, Ninive von Grieff, Lisa Skogens. Nordic Social Work ResearchArtikel
Evidence from Swedish and international studies show that a high proportion of children from out-of-home care (OHC) have poor school performance and that this is strongly associated with their substantial risk of adverse development in future life. However, risk factors for poor school performance and adverse development are difficult to disentangle since they are often interrelated and enforce each other over the life course. This study examines premature mortality in relation to early school failure (drop-out from compulsory school) and OHC experience in childhood (0–17 years of age) among clients who were in treatment for substance misuse in the early 1980s (N = 1,036). The analyses were based on record linkages between interview data collected during treatment and national register data covering approximately 30 years of follow-up, from exit from treatment until 2013. Our results showed that 54 per cent had been placed in OHC as children, half before their teens and half as teenagers. The OHC population had a higher prevalence of school failure compared with clients who had not been exposed to childhood OHC. OHC was associated with an excess mortality, although this was only significant for females who had entered OHC before their teens. Adjusting results for school failure reduced their excess mortality by half, and additional life course factors associated with mortality among people with substance misuse adjusted for most of the remaining excess mortality. School failure was strongly associated with the excess mortality of females, but not with the excess mortality of males.
Recovery processes among young adults treated for alcohol and other drug problems
2020. Lisa Skogens, Ninive von Greiff. Nordic Studies on Alcohol and Drugs 37 (4), 338-351Artikel
Aim: Studies on recovery from alcohol and other drugs (AOD) among young adults are scarce. In the present study, young adults, previously interviewed with a focus on their recovery process shortly after they completed treatment, were re-interviewed five years later focusing on their recovery process during the last five years in relation to their former AOD problems, other problems and processes of change. Methods: Twenty-one young adults were interviewed: 16 women and five men aged between 25 and 33 years. After transcribing the interviews, the material was analysed thematically. Results: Three overall themes emerged: previous problems, mental illness and the search for identity. The results were discussed in relation to recovery capital, primarily focusing on human and social capital. The results indicate that the group in focus often needs professional support for mental health issues in order to reach a stable recovery. Conclusions: Since the problems described were heterogeneous, this client group might benefit from individual treatment and extended support after treatment. Further, the results indicate that the established period of five years for a stable recovery might need to be extended for young adults.
A 30-year follow-up of substnace misusers in Sweden – differences and predictors of mortality between women and men
2019. Lisa Skogens (et al.). Addiction Research and Theory 27 (4), 328-336Artikel
Background: Differing results on gender specific factors related to mortality risks among substance misusers highlights the need for further research. The present article is based on a 30-year follow-up study on substance misusers treated in residential care for drug problems in Sweden in 1982-1983 aiming to identify and compare gender differences in predictors of mortality.
Method: Original data consists of personal interviews with 1163 substance misusers treated in inpatient units in Sweden during 1982-1983. The outcome variable is death retrieved from the National Cause of Death Register held by the National Board of Health and Welfare. Gender differences and similarities regarding predictors of mortality was estimated in univariate and multivariate models, using Cox proportional hazards models.
Results: School failure, imprisonment and being a parent without custody of the child seem to constitute risk factors for mortality among women, but not among men. A social network of friends seemed to be more important for men. Treatment-dropout was a significant risk factor for premature death among men, but not among women. Both gender reporting alcohol as their self-reported most dominant substance misuse showed higher mortality risks compared with those with stimulants as dominant substance misuse.
Conclusions: Imprisonment was highly predictive of mortality for the women, suggesting that this group is important to pay particular attention to. Suggested differences in the importance of social factors need to be investigated more thoroughly. The substantial hazard revealed for women with polydrug misuse including alcohol calls for attention to this in treatment for substance misuse.
Social inclusion of clients treated for substance abuse in Sweden in the 1980s
2019. Ninive von Greiff, Lisa Skogens, Marie Berlin. Nordic Studies on Alcohol and Drugs 36 (4), 314-329Artikel
Aim: To investigate social inclusion/exclusion in terms of criminality, substance abuse and participation in the labour market in clients treated for substance abuse in Sweden in the 1980s during a follow-up period of 27 years.
Method: SWEDATE data are used for background information on the clients. The data were collected through interviews with clients registered for treatment in 31 in-patient treatment units in 1982 and 1983. Data on labour market status, education and medication related to drugs were collected from public registers. The study population consisted of 1132 individuals, who were followed from the year after exiting from treatment (Year 1) until the end of the follow-up (December 2013).
Results: Among those who survived, the women seem to have succeeded better in terms of social inclusion both at an aggregated level and when the individual pathways were followed during the follow-up period. When comparing pathways between adverse and non-adverse groups during the follow-up period the results show movements from being adverse to non-adverse but also the opposite. In the last follow-up in 2013, the majority of the clients defined as non-adverse for the last nine years were in some way established in the labour market (including studies). In total, about two fifths of the group were in some way established in the labour market.
Conclusions: The fairly high proportion of clients moving between being adverse and non-adverse during the follow-up might support the perspective suggesting that dependence should not be considered as chronic.