Medicinen är kryckan, inte lösningen: personals upplevelser av de psykosociala inslagen i läkemedelsassisterad underhållsbehandling

Sammanfattning: The meaning of the concept of psychosocial treatment is ambiguous. The purpose of this study was to examine how professionals within some care institutions, which provide methadone, buprenorphine or naloxone treatment, regard and carry out the psychosocial features of such treatment. Central issues discussed were; how personnel approach the psychosocial features of the treatment, what personnel regard as a focus in the psychosocial treatment, what conditions personnel consider affect treatment positively in order for it to be successful and how personnel see the relation between the medical and psychosocial features of the treatment. The method used was interviews with nine professionals in six qualitative interviews. The theoretical perspectives and concepts used in our analysis were; the theory of biological dependence, an organizational perspective, Prochaska and DiClemente's Stages of Change Model, the concept of individual reality and the concept of marginal conflict. Results show that the conditions most important for successful treatment are; that the patient has a place to live, an occupation, motivation, that the patient take responsibility for his/hers progress and have realistic expectations about the effects of the medicine. Working practises vary among personnel but focus is often on working with, and changing, the patient's conduct. Creating a good patient relationship and the patient's confidence in the personnel are also fundamental in a successful treatment. Likewise, adaptation to every patient's specific needs and conditions is important. Views differ upon what aspects should be focused upon and what needs the patients have. Typically, focus can be on how the patient handles creating a new identity and a new everyday life, on resuming important relationships, on working through difficult experiences and handling everyday situations. Medication is believed to be an essential part, though not the most important part of the treatment, because of the way it makes the patient more susceptible to psychosocial change, which is where focus in treatment should lie.