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Korhonen M, Komulainen K. Individualizing the burnout problem: Health professionals' discourses of burnout and recovery in the context of rehabilitation. Health (London) 2023; 27:789-809. [PMID: 34856833 PMCID: PMC10423436 DOI: 10.1177/13634593211063053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This discourse analytical study explores how health professionals (HPs) construct burnout as a form of mental distress in the context of Finnish burnout rehabilitation framed with a particular rehabilitation ethos. Burnout is a fuzzy concept and lacks a disease status. Therefore, it calls for context-specific definition and justification. By highlighting the socially and interactionally produced character of categories of mental distress, the study investigates the kinds of discourses HPs use to formulate "the problem" and its solutions, and how people dealing with burnout are categorized in these discourses. The data consists of field notes from the observation of group discussion sessions in two 1-year burnout rehabilitation courses. As a result of the analysis, five partly overlapping discourses were identified: psychological, evolutionary, healthy lifestyle, biomedical, and welfare. Within these discourses, people who experience burnout were categorized as over-conscientious employees, "good girls," "primitive people," self-responsible rehabilitees, patients, and (aging) employees with social and legal rights. Burnout rehabilitation and HPs' views reproduce a cultural and clinical discourse around burnout in which work-related problems are treated as individual-level problems and individuals are responsibilized for the management of mental distress. Based on the results, it is concluded that the hybrid type of interventions that attempt to influence both individual- and work-related problems behind burnout would help to prevent people dealing with burnout from being over-responsibilized for solving problems at the workplace.
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Affiliation(s)
- Maija Korhonen
- Maija Korhonen, School of Educational Sciences and Psychology, University of Eastern Finland, PO Box 111, Yliopistokatu 7, Joensuu80101, Finland.
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Savic M, Barnett A, Pienaar K, Carter A, Warren N, Sandral E, Manning V, Lubman DI. Staying with the silence: Silence as affording care in online alcohol and other drug counselling. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104030. [PMID: 37148620 DOI: 10.1016/j.drugpo.2023.104030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 05/08/2023]
Abstract
As the name 'talk therapy' suggests, a key aim of alcohol and other drug counselling, psychotherapy and other talk therapies is to discuss issues, concerns and feelings with a health professional. Implicit here is the therapeutic value of talking through issues with a trained professional. But as with all interactions, therapeutic encounters involve silences and pauses as key aspects of the communicative process. Despite their ubiquity in the therapeutic encounter, research tends to either dismiss silences as inconsequential or as having undesirable effects, such as generating awkwardness or even disengagement from treatment. Drawing on Latour's (2002) concept of 'affordance' and a qualitative study of an Australian alcohol and other drug counselling service, we explore the varied functions of silences in online text-based counselling sessions. For clients, these include the role of silence in affording opportunities to engage in other everyday practices, such as socialising, caregiving or working - practices that can generate comfort and reduce distress, which in turn may support the therapeutic encounter. Similarly, for counsellors, temporal silences provide opportunities to confer with other counsellors and provide tailored care. However, protracted silences can raise concerns about the safety and wellbeing of clients who do not respond promptly or who exit encounters unexpectedly. Similarly, the sudden cessation of online care encounters (often associated with technical difficulties) can leave clients feeling frustrated and confused. In tracking these diverse affordances of silence, we draw attention to its generative potential in care encounters. We conclude by exploring the implications of our analysis for conceptions of care that underpin alcohol and other drug treatment.
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Affiliation(s)
- Michael Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC.
| | - Anthony Barnett
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC
| | - Kiran Pienaar
- Deakin University, Sociology, School of Humanities and Social Sciences, VIC; Monash University, Sociology, School of Political and Social Sciences, Clayton, VIC
| | - Adrian Carter
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne
| | - Narelle Warren
- School of Social Sciences, Faculty of Arts, Monash University, VIC
| | - Emma Sandral
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC
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A matter of craving-An archeology of relapse prevention in Swedish addiction treatment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 101:103575. [PMID: 34990982 DOI: 10.1016/j.drugpo.2021.103575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
This article concerns how craving is approached and handled, how it is 'made up', in the practice of so-called relapse prevention (RP) for addiction problems. There is a lack of research on what RP in general, and craving in particular, 'is' and can become across settings. Drawing upon science and technology studies (STS) and critical addiction research, we analyze how craving is enacted in manuals and training material related to the intervention, and in interviews with professionals in the Swedish treatment system. Adopting an archeological approach, we scrutinize different layers of craving enactments in RP, in search of assumptions that give rise to what John Law refers to as 'collateral realities'. We identified three collateral realities: 1) 'The materialization of craving'; 2) 'The transcendence of the individual' and 3) 'The merging of treatment and everyday life' The data show that the brain, cognition, emotions and behavior are enacted in RP as demarcated targets of intervention that the individual can transcend and control. This approach, in turn, relies on the more foundational tenet that there are no clear-cut boundaries between different identities (I/me/self; body/brain/cognition), between different settings (inside/outside treatment; real/imagined situations) or between different points in time (now/then/before). We discuss the relevance and usefulness of addiction treatment realities where craving is approached as a stable object that can be effectively treated, and where interventions inaugurate neoliberal governance of responsibilized individuals.
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Yamaguchi S, Lencucha R, Brown TG. Control, power, and responsibility: a qualitative study of local perspectives on problem drinking in Peruvian Andean highlands. Global Health 2021; 17:109. [PMID: 34538262 PMCID: PMC8451138 DOI: 10.1186/s12992-021-00758-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Alcohol control has emerged as an important global health challenge due to the expanding influence of alcohol companies and limited control measures imposed by governments. In the Peruvian Andean highland, the ritual function of collective drinking is reported to have been weakened in response to the increased availability of alcohol and the experience of political violence. This study seeks to merge the broader political economy with local experience and culture to provide a deeper understanding of the dynamic between global processes and local realities. Methods We used purposive sampling to recruit participants. We conducted in-depth interviews (n = 28) and focus group discussions (n = 19) with community participants, teachers, health workers, alcohol vendors and police officers. Thematic analysis identified patterns of individual and collective meaning situated in relation to social, political and economic factors. Results Local perspectives and behaviour regarding loss of control over alcohol are shaped through the complex patterns of power and meaning exerted and experienced by different actors. Participants’ emphasis on parents’ lack of control over alcohol use by “abandoned” children reflects the structural vulnerability of some Andean families struggling with economic hardships. Participants also emphasized how alcohol consumption was tied to forms of control exerted by men in households. Participants expressed that some men demonstrated their masculine identity and symbolic power as the breadwinner through spending on alcohol. The third emphasis was tied to the market economy. Participants expressed that the expansion of the alcohol market and perceived absence of government control coupled with macroeconomic conditions, like poverty, shaped patterns of alcohol consumption. Conclusion Our findings illustrate how problem drinking is shaped not simply by an individual drinker’s lack of self-control but also by a regulatory environment that enables the unrestrained marketing of alcohol products and the creation of a culture of consumption. Harmful consumption is mediated by the reshaping of the Andean cultural practice of collective drinking. Attending to local perspectives is essential for policies and interventions that connect structural dynamics with the cultural and experiential aspects of alcohol consumption.
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Affiliation(s)
- Sakiko Yamaguchi
- Department of Psychiatry, Division of Social and Cultural Psychiatry, McGill University, Montreal, Canada.
| | - Raphael Lencucha
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Thomas G Brown
- Department of Psychiatry, McGill University, Montreal, Canada.,Department of Community Health Sciences, University of Sherbrooke, Quebec, Canada
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Barnett A, Savic M, Pienaar K, Carter A, Warren N, Sandral E, Manning V, Lubman DI. Enacting 'more-than-human' care: Clients' and counsellors' views on the multiple affordances of chatbots in alcohol and other drug counselling. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 94:102910. [PMID: 33059955 PMCID: PMC7550115 DOI: 10.1016/j.drugpo.2020.102910] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 01/08/2023]
Abstract
Forms of artificial intelligence (AI), such as chatbots that provide automated online counselling, promise to revolutionise alcohol and other drug treatment. Although the replacement of human counsellors remains a speculative prospect, chatbots for ‘narrow AI’ tasks (e.g., assessment and referral) are increasingly being used to augment clinical practice. Little research has addressed the possibilities for care that chatbots may generate in the future, particularly in the context of alcohol and other drug counselling. To explore these issues, we draw on the concept of technological ‘affordances’ and identify the range of possibilities for care that emerging chatbot interventions may afford and foreclose depending on the contexts in which they are implemented. Our analysis is based on qualitative data from interviews with clients (n=20) and focus group discussions with counsellors (n=8) conducted as part of a larger study of an Australian online alcohol and other drug counselling service. Both clients and counsellors expressed a concern that chatbot interventions lacked a ‘human’ element, which they valued in empathic care encounters. Most clients reported that they would share less information with a chatbot than a human counsellor, and they viewed this as constraining care. However, clients and counsellors suggested that the use of narrow AI might afford possibilities for performing discrete tasks, such as screening, triage or referral. In the context of what we refer to as ‘more-than-human’ care, our findings reveal complex views about the types of affordances that chatbots may produce and foreclose in online care encounters. We conclude by discussing implications for the potential ‘addiction futures’ and care trajectories that AI technologies offer, focussing on how they might inform alcohol and other drug policy, and the design of digital healthcare.
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Affiliation(s)
- Anthony Barnett
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia.
| | - Michael Savic
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Kiran Pienaar
- School of Humanities and Social Sciences, Deakin University, Melbourne, VIC, Australia; and School of Social Sciences, Monash University, Melbourne, VIC, Australia
| | - Adrian Carter
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia and University of Queensland Centre of Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Narelle Warren
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, VIC, Australia
| | - Emma Sandral
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, VIC and Turning Point, Eastern Health, Richmond, VIC, Australia
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‘It’s good being part of the community and doing the right thing’: (Re)problematising ‘community’ in new recovery-oriented policy and consumer accounts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 80:102450. [DOI: 10.1016/j.drugpo.2019.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/30/2019] [Accepted: 04/24/2019] [Indexed: 01/09/2023]
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Dilkes-Frayne E, Savic M, Carter A, Kokanović R, Lubman DI. Going Online: The Affordances of Online Counseling for Families Affected by Alcohol and Other Drug Issues. QUALITATIVE HEALTH RESEARCH 2019; 29:2010-2022. [PMID: 30931830 DOI: 10.1177/1049732319838231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Online counseling can overcome barriers families face when accessing support services for issues such as a relative's alcohol or other drug use. However, little research has explored how online counseling platforms assist family members to improve their well-being and support their relative. We thematically analyzed 90 transcripts of online counseling sessions with family and friends of people who use alcohol, opioids, and amphetamines in Australia between 2015 and 2016. In our analysis, we drew on the concept of affordances to articulate how online platforms afford or constrain potentially therapeutic encounters with families. We found online counseling enabled families to make first contact, relieve distress, plan appropriate action, improve communication, regain direction, and connect with local services. Sessions were constrained by Internet access, web-chat communication, counselors' focus on referral, and limitations in addressing the wider concerns of families. The findings present opportunities for improving online services for families.
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Affiliation(s)
- Ella Dilkes-Frayne
- Monash University, Clayton, Victoria, Australia
- The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael Savic
- Monash University, Clayton, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
| | - Adrian Carter
- Monash University, Clayton, Victoria, Australia
- The University of Queensland, Herston, Queensland Australia
| | | | - Dan I Lubman
- Monash University, Clayton, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
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Social inclusion from on high: A poststructural comparative content analysis of drug policy texts from Canada and Scotland. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:19-28. [DOI: 10.1016/j.drugpo.2019.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/01/2019] [Accepted: 03/02/2019] [Indexed: 01/11/2023]
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Barnett A, Dilkes-Frayne E, Savic M, Carter A. When the Brain Leaves the Scanner and Enters the Clinic. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/0091450918774918] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Addiction neuroscience promises to uncover the neural basis of addiction by mapping changes in the “diseased brains” of people with “drug addictions.” It hopes to offer revolutionary treatments for addiction and reduce the stigma experienced by those seeking treatment for a medical, rather than moral, condition. While the promises of addiction neuroscience have received considerable attention, relatively few studies have examined how neuroscientific discourses and promises play out in drug treatment settings. Instead of asking how neuroscience might measure or treat a preexisting addiction “problem,” we draw on poststructuralist ideas to trace how neuroscientific discourses produce addiction as a certain type of “problem” and the effects of these particular problematizations. Based on interviews with a range of different types of treatment providers working in Victoria, Australia, we discuss three themes that reveal neuroscientific discourses at work: (1) constituting pathological subjects, (2) neuroplasticity and “recovery,” and (3) the alleviation of guilt and shame via references to the “diseased brain.” On the basis of our analysis, we argue that dominant neuroscientific discourses produce patients as pathologized subjects, requiring medical treatment. We also contend that the intersection of neuroscientific and recovery discourses enacts “recovery” in terms of brain “recovery” through references to neuroplasticity. Further, when neuroscientific and moral discourses intersect, addicted subjects are absolved from the guilt associated with immoral behavior emerging from a “hijacked brain.” We conclude by emphasizing the need for future critical work to explore the complex ways in which neuroscientific discourses operate in localized care ecologies.
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Affiliation(s)
- Anthony Barnett
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Ella Dilkes-Frayne
- School of Sociology, Research School of Social Sciences, The Australian National University, Canberra, Australia
| | - Michael Savic
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Adrian Carter
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Melbourne, Australia
- University of Queensland Centre of Clinical Research, University of Queensland, Brisbane, Queensland, Australia
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Savic M, Lubman DI. An argument against the implementation of an ‘overarching universal addiction model’ in alcohol and other drug treatment. Drug Alcohol Rev 2018; 37:721-722. [DOI: 10.1111/dar.12704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Savic
- Eastern Health Clinical School; Monash University; Melbourne Australia
- Turning Point; Eastern Health; Melbourne Australia
| | - Dan I. Lubman
- Eastern Health Clinical School; Monash University; Melbourne Australia
- Turning Point; Eastern Health; Melbourne Australia
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Savic M, Dilkes-Frayne E, Carter A, Kokanovic R, Manning V, Rodda SN, Lubman DI. Making multiple ‘online counsellings’ through policy and practice: an evidence-making intervention approach. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:73-82. [DOI: 10.1016/j.drugpo.2017.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/30/2022]
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