Stakeholders' Arguments for and against Moving Swedish Substance abuse Treatment to the Health Care System: How a Fat Reform Proposal became a Thin Government Bill

Abstract

Background Far-reaching changes in the Swedish substance abuse treatment system (SAT) were proposed by a state-commissioned inquiry in 2011. The proposal implied a break with the social tradition of SAT. It was suggested that the treatment responsibility should be transferred from the municipal social services to the regional-level health care system; and that compulsory treatment in its present form (assessed by/paid for by social services, run by the state) should be abolished and become incorporated into coercive psychiatric care provided by health care. A lively debate arose, and the vast majority of stakeholders sought to articulate their arguments. Aim The study analysed the development of Swedish SAT by examining the policy process from reform proposal to government bill in 2013. Method Content analysis was used to analyse written comments on the proposal submitted to the Ministry of Health and Social Affairs by close to 200 stakeholders. The goal was to empirically chart and examine the arguments for and against as well as advocates and opponents of the reform. With the government bill at hand, we retrospectively sorted out the winning arguments in the now highly contested SAT field and which actors were able to influence the process. Conclusions The article discloses that the mixed response and rather critical voices in most groups, including social/medical professions and government bureaucracy, helped block the responsibility shifts, and that reformations of subsystems like SAT are difficult to carry out as freestanding projects within larger systems of social and health care.