A study of the professional action in the heroine treatment in Denmark: A critical discourse analysis
Translated title
En belysning av den faglige innsatsen i heroinbehandlingen i Danmark: En kritisk diskursanalyse
Author
Mykland, Elin
Term
4. term
Education
Publication year
2016
Submitted on
2016-08-01
Pages
96
Abstract
Dette speciale undersøger, hvordan den professionelle indsats i den lægeordinerede heroinbehandling i Danmark balancerer mellem medicinske og sociale tilgange. Med udgangspunkt i tendenser til medikalisering og i krav om bedre sammenhæng mellem lægelig og social behandling analyseres, om en dominerende medicinsk diskurs påvirker den sociale indsats i praksis. Studiet anvender Norman Faircloughs kritiske diskursanalyse som teoretisk og metodisk ramme og bygger på en tekstanalyse af Sundhedsstyrelsens vejledning om ordination af diacetylmorphin (2013), kvalitative interviews med ledere og medarbejdere fra tre heroinklinikker (Valmuen i København, KontaktHuset i Aarhus og klinikken i Odense) samt et interview med Socialstyrelsen. Analysen peger på en tendens til, at den medicinske diskurs dominerer i vejledningen og i klinikkerne, selv om der tilstræbes en samlet bio-psyko-social indsats. Der ses et dialektisk forhold mellem vejledningen og klinikkernes praksis, men Sundhedsstyrelsens position giver den medicinske tilgang en særlig gennemslagskraft, hvilket ofte prioriterer medicinske handlinger over sociale. Interviewet med Socialstyrelsen indikerer en diskurskamp mellem det medicinske og det sociale felt, hvor det sociale står svagere; de nationale retningslinjer fra 2016 søger at styrke den sociale behandling. Samlet peger undersøgelsen på et behov for stærkere integration og prioritering af den sociale indsats i kommunal regi for at opfylde intentionerne om sammenhængende behandling.
This thesis examines how professional practice in Denmark’s physician-prescribed heroin-assisted treatment balances medical and social approaches. Motivated by evidence of increasing medicalization and calls for closer integration between medical and social care, the study explores whether a dominant medical discourse shapes practice and constrains the social component. Using Norman Fairclough’s critical discourse analysis as the theoretical and methodological framework, the research combines a text analysis of the Danish Health Authority’s guideline on diacetylmorphine (2013) with qualitative interviews with leaders and staff at three heroin clinics (Valmuen in Copenhagen, KontaktHuset in Aarhus, and the clinic in Odense) and an interview with the National Board of Social Services. The analysis indicates a tendency for the medical discourse to dominate both the guideline and clinic practices, despite an expressed intention to deliver a comprehensive bio-psycho-social intervention. A dialectical relationship exists between the guideline and clinic practice, yet the Health Authority’s position gives the medical approach particular weight, often prioritizing medical actions over social support. The interview with the social sector highlights a discourse struggle in which the social field is comparatively weaker; new national social treatment guidelines issued in 2016 seek to strengthen this dimension. Overall, the study points to a need for stronger integration and prioritization of social support at the municipal level to realize the envisioned coherent treatment.
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