Missbrukets paradox – hegemoni och paradigmskifte

Sammanfattning: Substance abuse constitutes a multi-layered social issue. The practical social work carried out with individuals suffering from substance abuse is, among other things, directed by the guidelines set out by Socialstyrelsen. This study aims to, from a critical discursive point of view, map out the discursive field within those guidelines for care and support in cases of substance abuse and its consequences. Additionally, the study aims to clarify the connection between policy and real- world social work practices by illuminating subject positions articulated within the discourses of substance abuse contained in those same guidelines. Six different, partly if not fully competing, discourses within the guidelines are identified through the study, within which the subsequent subject positions affects any practical social work carried out. Furthermore, the study shows the hegemonic status of the medical discourse – how its construction of the substance abuse subject as medically afflicted is the most dominant. Finally, the results indicate, in accordance with previous research, the discourse of harm reduction is increasing its extent as a discourse surrounding substance abuse. Possibly, this signifies a paradigm shift in the making as regards perspectives on substance abuse and its treatment.