| 1. |
- Blom, Björn, 1965-, et al.
(författare)
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Symposium: Below the surface – Critical realism and social work research
- 2023
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The theme of the symposium is how critical realism has been applied in social work research since the early 2000s. This symposium is strongly linked to the subtheme of Theory and practice in social work and more specific to theory development in social work. The aim of the symposium is to describe and discuss research where critical realism (CR) has been applied as a theoretical framework, and to inspire others to utilize CR in social work research. The first presentation is based on a systematic literature review of critical realism in social work research conducted between 2001 and 2022. The following two presentations concentrates on the CAIMeR-theory (Blom & Morén 2010; 2019), which is a general theory developed at Umeå University, based on CR, used for explaining client outcomes. The second presentation focuses on a revised version of the CAIMeR-theory. The third presentation demonstrates how the CAIMeR-theory underpinned and guided a small evaluation project. The presentations in the symposium will address central concepts of CR in different ways, and will altogether, serve as an introduction to critical realism and its use in social work research in different contexts.
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| 2. |
- Blom-Nilsson, Marcus, Fil. dr, et al.
(författare)
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Socionomers förutsättningar för ett systematiskt arbetssätt? : Organisatoriska hinder i arbetet med ASI Uppföljning
- 2023
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Ingår i: Socialmedicinsk Tidskrift. - 0037-833X. ; 100:5, s. 666-678
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Tidskriftsartikel (refereegranskat)abstract
- I det systematiserade arbetet med att följa upp hjälpbehov för personer med alkohol- eller narkotikaproblem har Addiction Severity Index uppföljnings-intervju (ASI U) en central funktion. I den här deskriptiva tvärsnittsstudien undersöker vi närmare hur demografiska, yrkesrelaterade och organisato-riska faktorer är relaterade till yrkesverksamma socionomers benägenhet att arbeta med ASI uppföljning. Studien omfattar 135 yrkesverksamma socionomer som arbetar med att utreda och följa upp hjälpbehov för personer med skadligt bruk eller beroende av alkohol eller narkotika. Bristande kompetens framträder som förenat med en lägre sannolikhet att arbeta med ASU upp-följning. För att öka medarbetares benägenhet att arbeta med ASU U bör chefer och andra personer i arbetsledande position ge medarbetare reella förutsättningar till fortbildning och vidareutbildning.
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| 3. |
- Grahn, Robert, 1972-, et al.
(författare)
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Associations between a risky psychosocial childhood and recurrent addiction compulsory care as adult
- 2020
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Ingår i: Nordic Studies on Alcohol and Drugs. - : Sage Publications. - 1455-0725 .- 1458-6126. ; 37:1, s. 54-68
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Tidskriftsartikel (refereegranskat)abstract
- Background: Treatment for substance use disorder (SUD), results, in general, in improvements in terms of both drug use and social functioning. However, there are clients who are in need of repeated treatment. The aim of this retrospective study was to identify, for adults in compulsory care for severe SUD, the association between reporting having experienced a risky psychosocial childhood and repeated entries into the Swedish compulsory care system for SUD.Method: Hierarchical logistic regression and mediation analysis methods were used to analyse data from the Swedish National Board of Institutional Care (SiS) database. The sample included 2719 adults assessed at their compulsory care intake. The study examined the association between history of institutional care, family with SUD or psychiatric problem and repeated compulsory care entries as an adult controlling for main drug, age and gender.Results: In the regression model the factor with the strongest association with repeated compulsory care intakes for SUD, was as a child having been in mandated institutional care (OR = 2.0 (1.60–2.51)). The proportion of the total effect that is mediated through LVU (law (1990:52) the care of young persons (special provisions) act) was 33% for SUD problems in family during childhood, 44% for psychiatric problems in family during childhood, and 38% for having been in foster care.Conclusion: Having been in mandated institutional care as a youth was strongly associated with repeated compulsory care for SUD as an adult. This is concerning since receipt of services as a child is supposed to mediate against the consequences of risky childhood conditions. These adults, as a group, are in need of a well-coordinated and integrated system of extensive aftercare services to reduce the likelihood of re-entry into compulsory care for an SUD.
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| 4. |
- Grahn, Robert, 1972-
(författare)
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Missbruk och kriminalitet
- 2023. - 1
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Ingår i: Effektiv insatsplanering vid svår substansanvändning. - Lund : Studentlitteratur AB. - 9789144155180 ; , s. 133-147
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 5. |
- Grahn, Robert, 1972-, et al.
(författare)
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Repeated addiction treatment use and compulsory care 2001-2009
- 2014
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Ingår i: Institutionsvård i fokus.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Repeated addiction treatment use and compulsory care 2001-2009.Uppföljningar och registerstudier av klienter i LVM-vård.Att vårda en klient mot sin vilja är ett långtgående ingrepp i en persons liv. Det innebär samtidigt att det är extra viktigt att ta reda på hur det går på längre sikt och följa upp den vård som getts. Hur det hade gått om samhället inte ingripit vet vi förstås inte men kunskap om utfallet är ett första, viktigt steg. Att följa upp klienter är emellertid mycket krävande, åtminstone om man vill försöka nå många för att exempelvis intervjua dem personligen. Därför används ofta registeruppgifter, med alla sina brister och förtjänster.Studiens syfte är att identifiera och beskriva särskilda grupper av klienter som återkommande är föremål för LVM-behandling i Sverige, t.ex. med avseende på kriminell bakgrund, samsjuklighet, psykiska problem och föräldrar med barn som är omhändertagna.Undersökningen bygger på befintliga databaser som Statens institutionsstyrelse förfogar över. Data avser personer som med stöd av Lagen om vård av missbrukare (LVM) placerats på behandlingshem – vid ett eller flera tillfällen – under perioden 2001-2009.
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| 6. |
- Grahn, Robert, 1972-, et al.
(författare)
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Repeated addiction treatment use in Sweden : a national register database study
- 2014
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Ingår i: Substance Use & Misuse. - London : Informa Healthcare. - 1082-6084 .- 1532-2491. ; 49:13, s. 1764-1773
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Tidskriftsartikel (refereegranskat)abstract
- Sweden has a free, universal addiction treatment system yet few studies examining utilization of treatment in this country. This study identified predisposing, enabling and need factors associated with history of number of voluntary addiction treatment episodes for a national sample of 12,009 individuals assessed for an alcohol and/or drug use disorder in Sweden. On average, people reported 4.3 prior treatment episodes. Linear regression methods identified that of predisposing factors older age and being male were associated with more voluntary addiction treatment episodes compared to younger and female clients; a higher Addiction Severity Index (ASI) employment score (an enabling factor) was associated with more voluntary addiction treatment episodes; and need factors including a history of inpatient mental health treatment, a higher ASI psychiatric score, a higher ASI alcohol score, higher levels of illict drug use, more compulsory addiction treatment episodes, a lower ASI legal score and history of criminal justice involvement were all associated with more voluntary addiction treatment episodes compared to their counterparts. There were no differences in number of treatment episodes by education or immigrant status. Implications: (1) Need is a key factor associated with more treatment use. (2) Further studies are needed to identify gender differences in access/use of treatment. (3) Given multiple treatment histories Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.
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| 7. |
- Grahn, Robert, 1972-, et al.
(författare)
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Repeated addiction treatment use in Sweden : a national register data base study
- 2013
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: This study examines alcohol and drug treatment utilization among a nationally representative sample of 13, 464 individuals interviewed and assessed for an alcohol and/or drug use disorder in the Swedish welfare system. The aim of this study is to identify and describe specific groups who are treatment repeaters of the Swedish addiction treatment system.Methodology: Univariate descriptive statistics, chi-square, one-way ANOVA, and correlation methods were used to examine the characteristics associated with history of number of addiction treatment episodes. A linear regression model was developed with variables that were significant at the bivariate level.Results: On average, the respondents reported 4.3 prior addiction treatment episodes. Results of the study show that those who were older, men, those who reported more years of polydrug and alcohol use to intoxication, who reported more compulsory treatment episodes for narcotics and alcohol, who had ever been charged with crime, who had ever been inpatient mental health treatment, and who reported a more mental health symptoms were significantly more likely to report having a history of engaging in more addiction treatment episodes. The strongest significant association with the number of treatment episodes was the number of compulsory treatment episodes for alcohol and/or for drugs.Conclusion: Implications include the need to change perspectives about addiction treatment from it being an acute care model to a viewing addiction treatment as a chronic care model. Many individuals have multiple- treatment episodes and need multiple treatment. Further, with respect to effectiveness, overall, the Swedish treatment system responds to need in the meaning that the individuals who need treatment for their addiction also have access to treatment. Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.
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| 8. |
- Grahn, Robert, 1972-
(författare)
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The association between history of civil commitment for severe substance use and future imprisonment : A Swedish registry study
- 2022
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Ingår i: Journal of Substance Abuse Treatment. - : Elsevier. - 0740-5472 .- 1873-6483. ; 134
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Tidskriftsartikel (refereegranskat)abstract
- Background: Civil commitment for individuals with severe substance use is fairly common and a part of many treatment systems worldwide. In Sweden, individuals with severe substance use and experience with civil commitment are more likely to use higher levels of alcohol and drugs, to be younger, and be more socially marginalized compared to their counterparts. The study examined whether civil commitments for severe substance use increased the likelihood of imprisonment following the civil commitment.Method: Baseline ASI-data merged with national registry data on prison sentences (2007 through 2016). Cox regression was used to estimate, for a Swedish sample of 12,044 adults assessed for risky substance use, the importance of having a history of civil commitment for severe substance use, controlling for age, gender and baseline assessment of ASI composite scores in seven areas (alcohol, drugs other than alcohol, legal, mental- and physical health, family & social relationships and employment) on the likelihood of future imprisonment.Results: The regression showed that being a male, those with experience of civil commitment and elevated ASI composite scores for both legal and employment were significantly associated with imprisonment post-civil commitment. Civil commitment for severe substance use showed 1.29 (HR = 1.29, 95% CI: 1.03–1.49, p < 0.001) increased likelihood of imprisonment post-civil commitment.Conclusion: Having been in treatment through civil commitment due to severe substance use was strongly associated with imprisonment post-civil commitment episode. This is concerning since civil commitment is supposed to mediate against the consequences of severe substance use and promote voluntary treatment participation. Those with severe substance use and a history of civil commitment are in need of a well-coordinated and integrated system of extensive aftercare services to reduce the likelihood of imprisonment.
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| 9. |
- Grahn, Robert, 1972-, et al.
(författare)
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The Associations between Risky Psychosocial Environment, Substance Addiction Severity and Imprisonment: A Swedish Registry Study
- 2020
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Ingår i: Substance Use & Misuse. - : Taylor & Francis. - 1082-6084 .- 1532-2491. ; 55:5, s. 697-706
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Both childhood and adult psychosocial stressors have been identified as links to both increased risk for substance use disorder (SUD) and increased risk of imprisonment. The aim of this retrospective study is to identify, for a sample of 14,914 adults who all were assessed for risky substance use or a SUD, the importance of having a history of psychosocial stressors compared to current addiction severity. The analyses control for age, gender and education on the likelihood of future imprisonment. Method: Baseline Addiction Severity Index data (ASI) were merged with national registry data on prison sentences from 2003 to 2016. In the analysis, a Cox regression was used to study the association between independent variables and the likelihood of future imprisonment. Results: In the regression, five variables showed significant association to increased risk of imprisonment: ASI drugs other than alcohol Composite Score (positive relationship), ASI alcohol Composite Score (negative relationship), age (younger), education (lower) and parental problems with drugs other than alcohol. The factor with strongest association with imprisonment was the ASI drugs other than alcohol Composite Score, which showed the highest HR = 10.63 (3.50–32.31) for women and HR = 5.52 (3.77–8.08) for men to predict the likelihood of imprisonment. Discussion: Research is needed on why individuals with history of psychosocial stressors have a higher likelihood of imprisonment compared to their counterparts. Findings indicate that a high ASI Composite Score for drugs other than alcohol are strong predictors of future criminality and criminal justice system involvement.
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| 10. |
- Grahn, Robert, 1972-, et al.
(författare)
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The importance of risky psychosocial childhood for repeated addiction compulsory care as adult
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Treatment for substance use disorder (SUD), results, in general, in improvements in terms of both drug use and social functioning. However, there are clients who are in need of repeated treatment. The aim of this retrospective study is to identify, for adults in compulsory care for severe SUD, the association between and reporting have experienced a risky psychosocial childhood and repeated entries into the Swedish compulsory care system for SUD.Method: Hierarchical logistic regression and mediation analysis methods were used to analyze data from the Swedish National Board of Institutional Care (SiS) database. The sample included 2719 adults assessed at their compulsory care intake. The study examined the association between history of institutional care, family with SUD or psychiatric problem and repeated compulsory care entries as adult controlling for main drug, age and gender.Results: In the regression model the factor with the strongest association with repeated compulsory care intakes for SUD, was that as a child having been in mandated institutional care (OR=2.0 (1.60-2.51)). The proportion of the total effect that is mediated through LVU was 33% for SUD problems in family during childhood, 44% for psychiatric problems in family during childhood, and 38% for having been in foster care.Conclusion: Having been in mandated institutional care as a youth was strongly associated with repeated compulsory care for SUD as an adult. This is concerning since receipt of services as a child is supposed to mediate against the consequences of risky childhood conditions. These adults, as a group are in need of a well-coordinated and integrated system of extensive after care services to reduce the likelihood of re-entryinto compulsory care for an SUD.
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| 11. |
- Grahn, Robert, 1972-, et al.
(författare)
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The predictability of the Addiction Severity Index criminal justice assessment instrument and future imprisonment : a Swedish registry study with a national sample of adults with risky substance use
- 2020
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Ingår i: Drug And Alcohol Dependence. - : Elsevier. - 0376-8716 .- 1879-0046. ; 217
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Tidskriftsartikel (refereegranskat)abstract
- Objective: In Sweden, social workers uses the Addiction Severity Index (ASI) as their main assessment tool when assessing individuals with risky substance use (RSU) or substance use disorder. The aim of this study is to identify among individuals with RSU, the associations of ASI Composite Scores (CSs) with future imprisonment controlling for age, education level and gender.Method: Baseline ASI-data was merged with national registry data on prison sentences (2003–2016). Cox regression was used to estimate the associations between CSs for alcohol, drugs other than alcohol, legal, family and social relationships, employment, mental- and physical health and future imprisonment for adults (n = 14,914) assessed for RSU.Results: The regression showed that all ASI CSs, age, education level and gender were significantly associated with imprisonment post ASI base-line assessment. The variables with the strongest association with imprisonment were ASI legal CS, followed by ASI drugs other than alcohol CS, ASI employment CS and being a male. ASI legal score showed the strongest association with imprisonment, with a 6 time increase in likelihood of imprisonment.Discussion: Given the findings in this study, the strong significant association between ASI legal CS and future imprisonment, it seems as that the ASI-assessment instrument is a reliable and trustworthy assessment tool to use in clinical work. This should motivate social workers and other clinical health professionals to use and rely on the ASI assessment in their intervention planning for clients with RSU, to hopefully reduce future imprisonment and improve their social situation.
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| 12. |
- Grahn, Robert, 1972-
(författare)
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Treatment repeaters : re-entry in care for clients with substance use disorder within the Swedish addiction treatment system
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- According to the regulations contained in the Social Services Act (SFS 2001:453), Swedish social services have a legal responsibility to provide support, care, and treatment for individuals with substance use problems. This law mandate those who are responsible to provide treatment to motivate drug users to actively seek treatment on a voluntary basis, ensuring an end to their dependence on drugs. Studies have shown that although the treatment system largely focuses on promoting abstinence, about two-thirds of client’s relapse into substance use within one year after completing treatment. This dissertation focuses broadly on clients who repeatedly enter and use treatment for substance use disorders in the Swedish addiction treatment system. The aim of this thesis is to examine and identify the population groups who are repeated treatment users of the Swedish treatment system for substance use disorder, including both the voluntary treatment and compulsory care. This thesis was based on three national level databases. The results showed that clients with a higher degree of problems and problems in different areas of life also had an increased risk of having treatment for substance use disorder repeatedly. Clients who were older, men, reported more years of polydrug and alcohol use to intoxication, reported more compulsory care episodes for substance use, had ever been charged with crime, had ever been in inpatient mental health treatment, and had a higher ASI mental health symptom composite score, were significantly more likely to report more voluntary addiction treatment episodes. The strongest significant association with the number of treatment episodes was the number of compulsory treatment episodes for alcohol and drugs. Individuals who experienced prior compulsory care including mandatory treatment through LVU (law (1990:52)), been in prison, and had children mandated to out-of-home care, were more likely to have two or more entries in the compulsory care system for substance use disorder. In addition, this analysis showed that 59% of clients mandated to compulsory care dropped-out during their compulsory care episode, and that younger clients were significantly more likely to drop-out. Those who drop-out were significantly more likely to experience negative outcomes, i.e. additional sentence to compulsory care and higher risk of mortality. A hierarchal logistic regression model also identified that individuals with riskier childhood conditions were more likely to have had repeated entries to compulsory care for substance use disorder. The indirect effects showed that a family history of substance use disorder and psychiatric problems are both associated with higher probability of institutional care as a child i.e. LVU, and that in turn, mandated childhood institutional care is related to repeated compulsory care intakes as an adult. Individuals who use treatment for substance use disorder repeatedly have a higher degree of problems i.e. an exposed and problematic group of individuals characterized by problem in several different areas of life. Growing up in a home environment with unfavorable conditions, mandated care before the age of 18 (LVU), compulsory care for substance use disorder as an adult, children taken into out-of-home care, and crime are the factors that are primarily associated with repeated treatment for substance use. A change in the view of treatment for clients in need of repeated use of treatment seems important, and access to adapted continuous care efforts are crucial to counteract the risk of relapse after a treatment episode of voluntary or compulsory care. Further, it seems important to motivate the client to complete the compulsory care without any deviation, since this seems to have positive effects on their substance use disorder.
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| 13. |
- Hall, Taylor, et al.
(författare)
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Mortality among a national population sentenced to compulsory care for substance use disorders in Sweden : Descriptive study
- 2015
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Ingår i: Evaluation and Program Planning. - : Elsevier. - 0149-7189 .- 1873-7870. ; 49, s. 153-162
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Tidskriftsartikel (refereegranskat)abstract
- Sweden's compulsory addiction system treats individuals with severe alcohol and narcotics use disorders. Merging data from three national level register databases of those sentenced to compulsory care from 2001 to 2009 (n = 4515), the aims of this study were to: (1) compute mortality rates to compare to the general Swedish population; (2) identify leading cause of mortality by alcohol or narcotics use; and (3) identify individual level characteristics associated with mortality among alcohol and narcotics users. In this population, 24% were deceased by 2011. The most common cause of death for alcohol users was physical ailments linked to alcohol use, while narcotics users commonly died of drug poisoning or suicide. Average age of death differed significantly between alcohol users (55.0) and narcotics users (32.5). Multivariable logistic regression analysis identified the same three factors predicting mortality: older age (alcohol users OR = 1.28, narcotic users OR = 1.16), gender [males were nearly 3 times more likely to die among narcotics users (p < .000) acid 1.6 times more likely to die among alcohol users (p < .01)] and reporting serious health problems (for alcohol users p < .000, for narcotics users p < .05). Enhanced program and government efforts are needed to implement overdose-prevention efforts and different treatment modalities for both narcotic and alcohol users. (C) 2014 Elsevier Ltd. All rights reserved.
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| 14. |
- Padyab, Mojgan, 1976-, et al.
(författare)
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Demografiska skillnader i utfall
- 2023
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Ingår i: Effektiv insatsplanering vid svår substansanvändning. - Lund : Studentlitteratur AB. - 9789144155180 ; , s. 111-120
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 15. |
- Scarpa, Simone, 1976-, et al.
(författare)
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Compulsory care of individuals with severe substance use disorders and alcohol- and drug-related mortality : a Swedish registry study
- 2023
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study used 17 year of Swedish registry data (2003–2019) for 25,125 adults assessed for their severity of substance use to identify the baseline factors predicting the risk of being court-ordered into compulsory care and examine the association between admission to compulsory care and mortality risks due to alcohol- or drug-related causes.Methods and materials: Addiction Severity Index (ASI) assessment data were linked to register data on demographic characteristics, compulsory care, and alcohol- and drug-related mortality. Cox regression models were used to identify baseline factors predictive of post-assessment admission to compulsory care in the 5 years post-substance use assessment. Discrete-time random-effect logistic regression models were used to examine the association between compulsory care duration and alcohol or drug-related mortality risks. Propensity score matching was used for validation.Results: The first models identified that younger age, female gender, and ASI composite scores for drug use, mental health and employment were significantly associated with the risk of placement in compulsory care for drugs other than alcohol. Female gender and ASI composite scores for alcohol, drug use and employment were significantly associated with compulsory care treatment for alcohol use. The second models showed that older individuals and men were more likely to die due to alcohol-related causes, while younger individuals and men were more likely to die due to drug-related causes. Length of stay in compulsory care institutions significantly increased the likelihood of dying due to substance use-related causes. Propensity scores analyses confirmed the results.Conclusion: In Sweden, a significant concern is the higher likelihood of women and young individuals to be court-ordered to compulsory care. Although compulsory care is often advocated as a life-saving intervention, our findings do not provide strong support for this claim. On the contrary, our findings show that admission to compulsory care is associated with a higher risk of substance use-related mortality. Factors such as compulsory care often not including any medical or psychological therapy, together with relapse and overdose after discharge, may be possible contributing factors to these findings.
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| 16. |
- Scarpa, Simone, 1976-, et al.
(författare)
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Hur fungerade kursen Effektiv Planering av Insatser/EPI : Baslinje- och uppföljningsresultat
- 2023
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Ingår i: Socialmedicinsk Tidskrift. - 0037-833X. ; 100:5, s. 655-665
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Denna kvantitativa studie utvärderar kunskapsförändringar hos deltagare i EPI universitetskursen. Majoriteten av deltagarna var socialsekreterare inom miss-bruksområdet. Kursen resulterade i betydande förbättringar av deltagarnas kunskap, särskilt vad gäller insats- och vårdkontinuitetsmodeller samt använd-ning av motivationshöjande intervjutekniker. Kunskapen om äldre personer med beroendeproblem och fördelarna med ASI-uppföljningar för socialarbe-tare och klienter förbättrades också.
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| 17. |
- Svenlin, Anu-Riina, et al.
(författare)
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En vetenskaplig genomlysning av missbruksbehandlingen på HVB-hemmet Avstampet i Norr
- 2024
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Rapport (refereegranskat)abstract
- Syftet med den vetenskapliga genomlysningen var att undersöka hur, varför och under vilka förutsättningar HVB-hemmet Avstampet i Norr uppnår sina behandlingsresultat. Studien fokuserade på den primärbehandling mot missbruk enligt tolvstegsprogrammet och Recovery Dynamics som bedrivs vid Avstampet. Behandlingen är drog- och medicinfri. Studiens design byggde på en programteoriansats med inslag av en måluppfyllelsemodell. Programteoriansatsen användes för att ta fram en lokal och verksamhetsspecifik teori som beskriver, och i viss mån förklarar, hur och varför Avstampet uppnår sina behandlingsresultat. Med hjälp av en måluppfyllelseanalys granskades verksamhetens avsedda och uppnådda mål. Studiens teoretiska referensram bestod av KAIMeR-teorin och den kontextuella modellen vid terapeutisk behandling. Studiens data bygger på tre fokusgruppsintervjuer med personalen som genomfördes under perioden september 2019 till februari 2020.Det övergripande resultat Avstampet eftersträvar är en långvarig stabil förändring och drogfrihet i klientens liv. Klienterna ska klara av motgångar och utmaningar utan att falla tillbaka i missbruk. I resultatbeskrivning kan man identifiera både kort- och långsiktiga resultat som kan ha en yt-, processuell- eller djupaspekt. Recovery Dynamics och manualbaserade insatser utgör centrala delar i behandlingen men kompletteras av informella och situationsanpassade insatser samt gruppinsatser. De informella insatserna baserar sig på medlevarskap och är oftast icke-uttalade. Fyra olika typer av informella insatser kunde identifieras: bemötande och omtanke, fysisk beröring, upplevelser och att agera pedagogiskt opedagogisk. Situationsanpassade insatser skräddarsys på basis av klienternas behov och de kan vara informella eller formella. Gruppinsatser grundar sig i den manualbaserade behandlingen där användningen av gruppsessioner är ett uttalat inslag.I behandlingen ingår utomterapeutiska faktorer, dvs. behandlingselement som sker utanför Avstampets väggar. Klienterna deltar i AA/NA-möten som ordnas i närområdet. Personalen hjälper klienten med saker som hör till klienternas privatliv. Man uppmuntrar också både klienten och handläggaren att ha kontakt under tiden klienten är på behandlingshemmet. Dessutom är utomterapeutiska faktorer ”inbyggda” i tolvstegsbehandlingen, i och med att de sista stegen (efter primärbehandlingen) innebär att gå ut i samhället och stötta andra individer i aktivt missbruk.Personalen har en klar uppfattning om vilka antaganden som styr behandlingen och som formar deras förhållningssätt till klienterna. Man utgår från att beroende är en sjukdom med fysiska, mentala och känslomässiga inslag och att behandlingen ska vara fri från mediciner och droger. Personalens handlingar utgår från ett relationellt förhållningssätt och medlevarskap och varje klient har en egen kontaktperson. Ett centralt antagande är att klienten ska lära sig nya verktyg under behandlingen, vilket personalen undervisar om, och att klienten förväntas ta ansvar för sin förändringsprocess, men med vägledning från Avstampet. Klienterna förväntas också stötta varandra under processen och delta i matchningsprocessen av nya klienter. I studien identifierades fyra främjande kontextuella faktorer: 1) att det på Avstampet finns strikta regler och en tydlig vardagsstruktur som stödjer klienternas förändringsprocess; 2) verksamhetens småskalighet, dvs. att det endast finns 10 platser; 3) personalens starka sammanhållning, laganda och gemensamma synsätt på beroendevård och relationens betydelse för en lyckad behandling; 4) att personalen har god kännedom om, och förståelse för, den kontext klienterna kommer ifrån och att klientens livsvärld utanför behandlingshemmet beaktas vid behov under behandlingen. I studien identifierades inga kontextuella faktorer som direkt motverkar behandlingsresultaten.
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