Caring for elderly substance users: Challenges, dilemmas and recommendations.

Aim: To investigate the challenges and barriers in Danish care professionals' work in relation to elderly citizens who use substances. Method: The study draws on data from a "going along" study of care professionals' encounters with citizens as well as interviews with professionals. This was conducted in two smaller, rural municipalities in Denmark. Findings: Providing adequate care for elderly citizens who use substances can be highly challenging. This is due to a multitude of factors, especially (1) the complexity of their health conditions, (2) contradictory logics of care (autonomy vs. healthy living), (3) citizens often unpredictable behaviours, (4) lack of cooperation between welfare systems and, not least, (5) lack of knowledge and education among healthcare professionals. Conclusions: There is a need for more specialised procedures locally, the appointment of local "experts", better cooperation between sectors and easier accessible training and information on the group on a national level.

As Long As it Lasts-Older Substance Users, Brittle Ties and Danish Health Care.

In this article, we examine a group of older marginalized substance-using citizens and their relations to Danish health care. We offer empirical examples collected through ethnographic fieldwork, about how they handle their health situation and encounters with the Danish healthcare system. Analytically, we particularly draw on the concept of disposable ties, and suggest the term "brittle ties" to nuance the term and examine how perceived individual autonomy is weighted against health care trajectories and how these citizens often prefer to fend for themselves or lean on provisional networks rather than enter into health care trajectories and follow-up treatment.

What are dually diagnosed patients' problems represented to be in mental health? A WPR analysis of the multistability purpose of digital health records.

No previous studies have investigated how political measures, opinions and views of people with dual diagnoses, organisational requirements and professional values are purposefully communicated, mediated and/or integrated in digital records in mental health care. It remains unclear how health records function as both clinical vehicles for documentation, audit and quality assurance in patient care as well as political vehicles of power to articulate and reproduce idealised relations among actors and their roles in mental health. Informed by Bacchi's 'What's the problem represented to be' (WPR) approach, we consider how problems of dually diagnosed persons with co-occurring mental health conditions and drug use (DDPs) are represented and how the tools required to fix the patients' problems are communicated and legitimised in 10 digital health records consisting of 3830 pages of data. In the discussion, we distinguish their multiple purposes by discussing how their structure is shaped by broader discourses in health care. Then, we consider how the structure of records delineates professionals' autonomy, discretionary action and service provision in ways that limit possibilities for including mental health patients' experiences and exclude service users' voices from care planning.

Complex cases - Complex representations of problems.

Many Danish drug users do not only require services related to drug use, but face other obstacles such as mental illnesses and unemployment. The services are constituted by different types of policies, which represent both overlapping and sometimes conflicting ideas of how to frame, intervene and 'fix' problems. Policy research has mainly focused on these fields separately, however, in this article, we scrutinize policies in the fields drug use and treatment, unemployment and mental health separately and we bring together our findings to conduct a cross-sectorial analysis of how and why citizens with a mix of problems related to the three fields are produced into particular 'kinds' of subjects amenable to particular kind of tools, interventions and outcomes. Methodologically, we apply an explorative, descriptive policy analysis strategy of key policy documents. We conduct an analysis of the content of policy documents in which data sources are coded focusing on key concepts and arguments as well as examining how problem representations are embedded. Analytically, we draw on constructivist approaches exploring how problems and citizens in need of help are represented in different types of policy documents as well as how interventions are legitimized and how methods, tools and outcomes of interventions are represented. The article shows how policies altogether problematize drug users with complex problems as both morally obliged to find inner motivation and willpower and as victims of poor circumstances depriving them the benefits of leading a 'normal' life. This should be 'fixed' by treatment and interventions, resulting in that socially marginalized citizens 'get better' and, hence, are being transformed into 'someone else'. Finally, we discuss the potential benefits and limitations of the ways in which the proposed problems, solutions and expected outcomes are represented.

Stakeholders in opioid substitution treatment policy: similarities and differences in six European countries.

Based on the research papers within this special issue, this overview discusses similarities and differences in stakeholding in drug user opioid substitution treatment policy in Britain, Denmark, Italy, Austria, Poland, and Finland. It explores factors that have influenced stakeholder activity, including the importance of crisis, the impact of evidence, the availability of resources, the wider political context, the influence of moral frameworks and ideologies, and the pressure of external influences. The paper highlights the important differences in the emergence and evolution of stakeholder groups and in the political, cultural, and economic circumstances, which both constrain and enable their activities.

Shifts in opioid substitution treatment policy in Denmark from 2000-2011.

This article discusses how opioid substitution treatment policy has developed from 2000 to 2011 in Denmark. Empirically, it takes its point of departure in a stakeholder analysis including 17 qualitative interviews with stakeholders who have played important roles in this field. Analytically, it is inspired by Kingdon's concepts of agenda and policy window. Three major shifts are identified: a shift from psychosocial to medical thinking and practice, from an abstinence driven ideology to health care, and from perceptions of passive clients to user involvement. These shifts are discussed in relation to the legal context of substitute prescribing medicine.

Empowerment in drug treatment: dilemmas in implementing policy in welfare institutions.

This article analyzes how and why welfare policies focusing on empowerment as users' self-management create dilemmas in medically assisted drug treatment in Denmark. Drawing on ethnographic fieldwork, the article points to two sets of dilemmas by focusing on the relationship between legal and institutional setups and staff and user possibilities for agency. The first dilemma concerns how to provide user self-management and individualized services and the actual possibilities of effectuating this in welfare institutions imbued by limited resources, manpower, and local rules. The second, how to create a balance between notions of user self-management and legal demands of control regarding substitution medicine. The article analyzes empowerment as a policy arguing that implementation of policy--also called policy in practice--is integral to policy studies, rather than a domain that is separate from policy making.