Disentangling practitioners’ perceptions of substance use severity: A factorial survey

Abstract

The aim of this study was to examine the influence of user, staff and work unit characteristics on addiction care practitioners’ assessments of the severity of alcohol and drug use. A factorial survey was conducted among 489 social workers, therapists, nurses, doctors and executives from 77 addiction care units in the three largest Swedish counties. Staff assessed the severity of 10 fictive scenarios, vignettes (n = 4724), describing persons with varying social characteristics who were users of alcohol, cannabis or cocaine. The effects of user, respondent and work-unit variables on the practitioners’ severity assessments were estimated using multilevel regression analysis. The results show that perceived severity was influenced not only by the substance, the frequency and character of the negative consequences of the use, but also by the age, socio-economic status and family situation of the user. Women, older respondents and respondents with a medical education rather than a social work education were on average more inclined to assess the vignettes as being more severe. Analyses of various interactions revealed that practitioners viewed the drinking of young men as being less severe than that of young women. Doctors saw women's use as more problematic than men's, irrespective of the context. To conclude, alcohol and drug consumption is judged by different norms, depending on various characteristics of the users, of the practitioners and also of their workplaces. To avoid potential negative consequences of the application of such varying standards in addiction care, more individual reflection and workgroup discussion are needed.

• Alcohol and drug consumption
• factorial survey
• multilevel analysis
• practitioners’ perceptions
• severity

Notes

Notes

1. The addiction care organised by the social services involves measures such as inpatient or outpatient treatment, housing, activation and social allowances. The regional healthcare system, which operates at the county level, provides medical and psychiatric care, detoxification and other emergency services, and also specialised programs such as substitution treatment.

2. Among those who declined to participate, the executives stated reasons such as reorganisation processes, lack of time or a limited number of staff in the work units.

3. Due to the high correlation between age and years of experience, these two variables were not simultaneously included in the analyses.

4. A separate HLM analysis of the importance of respondent occupation for perceived severity showed that, by comparison with social workers (who work mainly with assessments), nurses (B  =  0.85, t-ratio  =  2.70, p  <  0.001) rated the severity of the vignettes significantly higher. The variable occupation was not included in Model 3 or 5, due to the high correlation between occupation and education.

5. The intra-class correlation (ICC) is the proportion of the variance in the outcome variable that is due to each level (Kim, 2009). It is computed by dividing the variance components of each level with the total variance of all levels.

6. In this section, only the statistically significant (p  ≤  0.05) results are presented.

7. The number of degrees of freedom in the vignette interaction analyses was 4143–4151 (level 1) and in the cross-level analyses 382–391 (level 2) and 74–75 (level 3), depending on the number of estimated parameters.

8. Swedish men drink twice as much as Swedish women (13 versus 6 litres) on average per year (Ramstedt et al., 2010), while about 23% of men and 12% of women have used narcotics at least once in their lifetime (Swedish National Institute of Public Health, 2010).