Logics of Legitimation in Swedish Treatment for Youth Cannabis Use

Abstract

Liberal views on cannabis use are widespread in many Western countries, but prohibitionism remains strong in Sweden. According to Swedish drug policy, comprehensive prevention and treatment interventions are necessary because young people are considered particularly vulnerable to cannabis-related harm. In this article, we examine how staff at Swedish outpatient treatment centers for young substance users (called “MiniMaria”) use different logics when legitimizing their work in youth treatment. We also analyze how this legitimizing process contributes to both justifying solutions and constituting the cannabis “problem” that MiniMaria centers are established to handle. This will shed light on what “drug reality” the staff make up through their articulations. Eighteen interviews with social workers from six MiniMaria centers in the Stockholm region were analyzed. To illustrate how staff made sense of their work, we used the concepts of “problem representation”, “legitimation”, and “logics”. We identified four logics: A scientific and a structural logic linked to knowledge claims, policy goals, and organizational setting, and a professional and a procedural logic linked to work experience, client interaction, and therapeutic methods. Participants used logics to emphasize that the character of the cannabis problem demands wide-ranging interventions and to explain how they made youth cannabis users realize they need treatment. The structural logic of drug prohibitionism was only mentioned as a last resort when other logics were not applicable, for example, when a young person refused to engage in treatment and quit using cannabis. The strategic use of logics provided MiniMaria with a moral legitimacy that represented youth cannabis use as a high-profile problem and young people as in need of protection and control. This legitimizes prevention of youth cannabis use in a national setting where cannabis prevalence and harm remains relatively low.

Keywords

cannabis Sweden youth treatment legitimation MiniMaria

Introduction

Political and public views on cannabis are changing in many Western countries. Legalization/liberalization movements have been influential in, for example, Portugal, Uruguay, and parts of the U.S. (Pew Research Center, 2013; Rogeberg, 2015), and cannabis use has, at least according to some scholars, become increasingly normalized (e.g., Measham & Shiner, 2009; Parker, Aldridge, & Measham, 1998). In Sweden, however, all involvement with illicit drugs is prohibited and the prevalence of youth drug use is low compared to many other European countries (Guttormsson & Leifman, 2016; Hibell et al., 2011).

Swedish cannabis policy is defined by continuity in a political and professional climate characterized by international change (European Monitoring Centre for Drugs and Drug Addiction, 2008; Månsson, 2017; Room, Fischer, Hall, Lenton, & Reuter 2010). Politicians, governmental agencies, publicly funded organizations, and the media argue in unison that cannabis use, particularly among young people, is a high-profile problem that requires political, scientific, and public attention as well as generous economic resources (Månsson, 2017; Törnqvist, 2009). In this discourse, the cannabis problem pivots around young users, which justifies zero-tolerance and abstinence-oriented prevention and treatment measures (Månsson & Ekendahl, 2015). In Sweden, this construction of cannabis as a youth problem dates back to the 1950s. Political discussions as well as media images from that time onward link cannabis with young people and have played an extraordinarily important role in driving Swedish drug policy toward strict regulation (Edman, 2013; Olsson, 2008). In this context, it is relevant to ask how professionals working in Swedish prevention and treatment agencies hold the line on prohibition in the face of international liberalization and what complex logics and legitimizations become necessary in order to produce and reproduce prohibition.

Some research suggests that cannabis use is correlated with adverse health effects among young people (Meier et al., 2012) and that low-risk perceptions in this group are related to cannabis use (Andersson, Miller, Beck, & Chomynova, 2009; Bachman, Johnson, & O’Malley, 1998; Chomynova, Miller, & Beck, 2009; Keyes et al., 2011). Still the validity of the findings on the negative effects of cannabis has been disputed (e.g., Hall, 2009, 2015; Schreiner & Dunn, 2012; Witton, 2008), and there is conflicting evidence as to whether legalization of recreational and medical cannabis increases youth consumption (Hasin et al., 2015; Palamar, Ompad, & Petkova, 2014; Salas-Wright & Vaughn, 2016). Thus, we can expect that professional proponents of the Swedish prohibitionist approach to youth cannabis use must necessarily rely on more than scientific findings when answering the question “why we should do this, in this particular way” (Van Leeuwen, 2007, p. 93).

In line with theoretical work on institutionalization and legitimation (Luckmann, 1987), Bacchi (2009) argues that critical examinations of societal solutions to problems also yield important knowledge about the ideological basis and political effects of certain problem representations. In this article, we analyze how a certain solution, the need to treat young people for the “problem” of cannabis use, is legitimized by staff at “MiniMaria”, a network of outpatient treatment centers in the Stockholm region.¹ In Sweden, the recent representation of the cannabis problem has warranted large-scale prevention campaigns to encourage and reinforce cannabis-negative attitudes among young people (e.g., http://www.regeringen.se; Regeringen, 2011) and the local development of MiniMaria outpatient treatment centers (http://www.beroendecentrum.se; Beroendecentrum Stockholm, 2016). Professionals at these centers have firsthand information about youth cannabis use and cater to case managers in social services, school counselors, parents, employers, prosecutors, and the police in making expert assessments on drug “abuse” and delivering interventions. Knowledge is, however, scarce about what goes on in practice. Besides a few local reports funded by government agencies (Almazidou et al., 2014; Anderberg et al., 2015; Berglund & Andersson, 2015; Gripenberg, Tengström, Andersson, & Skårner, 2015), little is known about MiniMaria services and how the staff describe, make sense of, and justify their work.

In this article, we examine how MiniMaria staff use logics related to four domains (cannabis research, the structural context, professional approaches, and service procedures) when legitimizing their work in youth treatment. We also analyze how their strategic use of logics contributes to both justifying solutions and constituting the cannabis “problem” that MiniMaria centers are established to handle. Following Bacchi’s (1999, 2009, 2018) critical perspective, we thus question the assumption that treatment is merely a natural response to objective problems, and instead we also see it as constructing that which is defined as problematic.

Exploring how MiniMaria workers represent problems, articulate logics, and thereby legitimize their response to youth cannabis use provides crucial insights into how national drug policy, organizational structures, knowledge claims, and professional considerations are translated into local frontline encounters between service providers and those who use drugs. In line with the theme covered by this special issue, the “making of drug realities”, we argue that the MiniMaria discourse constitutes cannabis as a dangerous and insidious drug, and young people as vulnerable, irrational, and unable to handle its use. The making of this reality legitimizes comprehensive interventions to prevent young people from using the drug in a national setting where cannabis prevalence and harm remains relatively low. It also explains why such interventions sometimes fail and need to be repeated.

Legitimacy, Legitimation, and Logics

Dating back at least to the work of Max Weber, social scientists have long been interested in legitimacy (Luckmann, 1987; Van Leeuwen, 2007) and the literature on the topic is vast. Legitimacy is a “‘slippery’ concept” (Hough, Jackson, & Bradford, 2013, p. 245), but in an influential article, Suchman (1995, p. 574) defines it as “a generalized perception or assumption that the actions of an entity are desirable, proper, or appropriate within some socially constructed system of norms, values, beliefs, and definitions”. According to Suchman (1995), there are different types of legitimacy that relate to his main definition. He refers to these as pragmatic, moral, and cognitive. While the first concerns the effects and outcomes of an organization and the latter its comprehensibility and taken-for-grantedness, moral legitimacy reflects “a positive normative evaluation of the organization and its activities” (Suchman, 1995, p. 579).

The concepts of legitimacy and legitimation are closely related, but legitimation has more to do with action, what is done to secure legitimacy (Luckmann, 1987). Legitimacy is thus often perceived as relational (Bottoms & Tankebe, 2012); actors hold or try to obtain legitimacy in relation to something, be it the general public, politicians, or themselves. According to Suchman (1995), legitimation can also be viewed from a temporal perspective. Some techniques are shaped by lasting issues such as policy, organizational structure, and knowledge, while others are shaped by more temporary ones such as personal beliefs, experiences, interests, and specific methods.

Prior research in diverse settings has shown that staff use different techniques to legitimize their activities (e.g., Sanders & Harrison, 2008; Ugelvik, 2016). Ugelvik found that officers in a detention center in Norway claimed legitimacy with reference to aspects such as their own professionalism, the humanity of their center, and the responsibility of the detainees themselves. In relation to this, McPherson and Sauder (2013) call attention to the importance of considering “institutional logics” for understanding how professionals think and act. Institutional logics are seen as “macro-level belief systems that shape cognitions and influence decision-making processes” which serve as “taken-for granted social prescriptions” (p. 167). In their view, professionals use logics when making decisions and justifying what they do. This makes these actors crucial mediators between institutional logics and practice. As a consequence, while actors are conceived of as “embedded in logical frameworks” (p. 166), McPherson and Sauder are not only interested in what “logics do to actors” but also what “actors do to logics” (p. 168). They conclude that it is vital to study how logics are enacted at the ground level, as this highlights a dynamic process of how professionals mediate logics to fit everyday problem-solving and local meaning. Given the close link between legitimation and justification (Reyes, 2011), McPherson and Sauder’s (2013) work should be a useful vantage point from which to look at legitimation at the ground level. In their own study of a drug court, they identified logics related to punishment and rehabilitation, as well as efficacy and accountability. An important conclusion they draw is that logics are similar to “tools” that are used strategically by the actors involved to influence the decision made by the court.

Approach

In this study, we explore the logics articulated by MiniMaria staff when legitimizing their work—that is, why their approach is considered “the right thing to do” (Suchman, 1995, p. 579). In our analysis of the interviews, we define logics that are linked to lasting issues such as policy and national setting as contextual legitimation techniques and logics that are linked to more temporal issues such as individual interactions, experiences, and beliefs as relational legitimation techniques. We can expect our data to echo the styles of legitimation found among medical staff, including doctor–patient relationships, trust, and professional dominance (Richardson, 1985); patient-centeredness and professionalism (Sanders & Harrison, 2008); as well as evidence-based practice (Wike et al., 2014). Therefore, we assume that several logics may be involved in staff articulations, bolstering different aspects of the MiniMaria services and creating tension and competition between them, as well as some overlap. However, the data illustrate that a certain amount of “blurring and blending” of logics (Currie & Spyridonidis, 2016, p. 81) can strengthen legitimation.

Unlike McPherson and Sauder (2013), our study does not allow us to illustrate how institutional logics influence actual practice (the data encompass retrospective interviews and not observations). Our rationale is rather that exploring how staff articulate logics will give important clues as to how legitimation responds to and reproduces dominant problem representations, which can be assumed to have tangible effects on the actors involved (Bacchi, 2009). Consequently, we consider the theoretical concepts of logics, legitimation, and problem representation as synergetic; they function as tools for actors to describe practice and present it in a favorable light. This focus can help illuminate taken-for-granted assumptions about the treatment of young people for cannabis use and what is privileged as well as silenced in such discourse.

Method

Setting

MiniMaria outpatient treatment centers are run in cooperation between municipal social services and the health-care system, and the staff are often considered experts in preventing youth substance use in Sweden (Statens folkhälsoinstitut, 2011, p. 62). They are located throughout the country to help individuals up to 25 years of age with problems related to alcohol, other drugs, and mental health. In the Stockholm region, there are 23 such units with similar staff (social workers, nurses, and physicians), counseling methods, and target populations, serving approximately 4,500 youth substance users in 2015 (www.beroendecentrum.se; see Note 3). MiniMaria centers provide information to and counsel both young people and their families. They treat all types of substance use; from problems related to heavy and regular drug use to situations where a young person has tried (or thought about trying) drugs, usually cannabis. There is a variety of ways in which a young person becomes a client at MiniMaria. He or she can seek help voluntarily, be brought there by parents, or be more or less mandated to go there by a court, the social services, or the school. Cannabis use is the primary reason why a young person comes into contact with the services provided by the centers, and several centers claim to use modified versions of “cannabis programs” (Lundqvist & Ericsson, 1988; Petrell, Blomqvist, & Lundqvist, 2005). MiniMaria centers are physically housed both at and outside social service offices, and the premises often consist of a reception area, a toilet for monitoring urine samples, and several counseling rooms.

Sample

In order to establish contact with staff from different settings, we approached a network of MiniMaria treatment centers in municipalities bordering on Stockholm City. Representatives of these units meet formally twice a year to share experiences and develop joint strategies. We were invited to introduce our research project on one such occasion and were able to recruit six treatment centers located in different municipalities. Thus, the sample is not random but self-selected, with no representation of centers whose staff were wholly uninterested in the research project or considered participation too time consuming and disruptive. Eighteen semi-structured, in-depth interviews with frontline social workers specializing in treatment and counseling (including one MiniMaria Agency Director) were conducted during the summer of 2016. We did not interview staff from MiniMaria’s health-care program, as their work with young people appeared to be more routinized and less therapeutic (e.g., monitoring urine tests).

Interviews

Each interview lasted about 1 hour with questions relating to three themes: the cannabis situation (e.g., “How would you describe the situation in this area regarding young people and cannabis?”), work models (e.g., “Can you describe whether there are any particular models or theories that guide your work with young cannabis users?”), and the organizational and societal context (e.g., “How would you describe the influence of the surrounding world on your work and on the attitudes of young people?”). All three authors conducted face-to-face interviews and research assistants transcribed the recorded material.

Ethics

Regarding ethics, we have chosen to anonymize the participants by changing their names, and by omitting information that could make them or the particular MiniMaria center at which they worked, identifiable. We have, however, chosen not to anonymize MiniMaria as an organization since it is one of its kind and can be characterized as a nationwide agency similar to, for example, the social services. The study was approved by the regional ethical vetting board in Stockholm (registration number: 2016/709-31/5).

Analysis

The analysis was conducted in three steps. To obtain an overview of the material, an initial content-based coding was performed focusing on foregrounded and coherent ways of discussing youth cannabis users, the services, and surrounding society (thus corresponding with the interview themes). It was apparent at this early stage of data processing that there was consistency in how staff represented problems and saw their work. Their almost schematic descriptions of MiniMaria services illustrated that cannabis was dangerous and that “substance abuse assessments”, encompassing “urine tests” and “conversations”, were key ingredients in treatment.

In order to raise the analytical level, we subsequently linked legitimation to the concept of logics. With the aim of identifying different logics, we searched for words, expressions, and metaphors (e.g., “insidious drug”, “it is illegal”, “irrational youth”, “the person across the table”, and “assessment first”) that seemed to be “taken-for-granted social prescriptions” (McPherson & Sauder, 2013, p. 167) and pinpointed the logics drawn on in legitimation. Through in-depth readings and discussions, the data were condensed into four, in some cases overlapping, logics: a scientific logic (based on knowledge about cannabis), a structural logic (focused on policy and organizational issues), a professional logic (pivoting around youth and parental characteristics), and a procedural logic (centered on therapeutic models and methods). In line with the ideas of Suchman (1995), the first two logics could be described as more lasting in nature. Their key message was that “We are doing the right thing, both according to the science and the law”, and we referred to them as contextual legitimation techniques. The latter two logics were of a more temporary character and based on individual experiences of interacting with young people and parents in treatment. Their main message was “We do it this way, because we know what people need”, and we termed such logics relational legitimation techniques. This analysis phase was concluded when a point of theoretical saturation was reached, that is, when the majority of articulations mirrored one or more of the logics.

Finally, to study how logics were used in staff articulations, and to understand the participants’ consistent message about the treatment of youth cannabis users, what seemed like a fixed “MiniMaria discourse,” we employed a “trouble case analysis” (Emerson, 2008; McPherson & Sauder, 2013) to identify instances of contestation, indecision, and conflict. We thus went back to the content-based codes and searched for descriptions of young people who were perceived as not complying with MiniMaria services, and other treatment-related circumstances that staff considered problematic. By investigating such points of “trouble”, but also accounts of best practice, we were able to outline three types of strategic use of logics that also related to Bacchi’s (2009) general theory on problem representation. In the first type of strategic use, contextual legitimation techniques were used to emphasize problems, in the second relational legitimation techniques were used to calibrate solutions, and in the third both techniques (and hence all logics) appeared aligned in stories about successful treatment. In the Results section, we focus on some of the participants’ articulations, as they provided good illustrations of the use of logics in legitimation. The extracts have been translated from Swedish to English.

Results

Logics Related to Contextual Legitimation Techniques

The first logic we discerned in the data was based on research evidence on what cannabis is, its negative impact on users, and how knowledge about this ought to be understood and disseminated. This scientific logic provided a basis for the participants to reject other knowledge claims as faulty and unscientific.

The second logic we identified positioned the organization within a framework of national drug policy prohibitionism, which was being challenged by global cannabis liberalization and local ignorance as regards youth cannabis problems. This structural logic constituted MiniMaria as a frontline key player in the government’s fight against drug liberalism, a defender of the belief that cannabis use is incommensurable with a healthy and normal lifestyle, particularly for young people. This logic also posited MiniMaria as a hub in a network of other organizations that try to help young people with problems, an expert agency that maintains the ideals of zero tolerance and that young people must stop using cannabis.

Logics Related to Relational Legitimation Techniques

A third logic centered on the conclusive characterization of the beliefs, actions, and needs of the young people and parents attending MiniMaria. This line of reasoning was claimed by staff to stem from their vast experience of interacting with clients, and we termed it a professional logic. In short, the message was that young people should be regarded as having undeveloped brains, were unable to make rational decisions, and were prone to experimenting with cannabis and experiencing problems. Moreover, the conclusion was that cannabis problems were often linked to, for example, a psychiatric diagnosis or family problems, which warranted parents and other service providers engaging in the treatment process.

The fourth logic we identified was centered on practical tasks related to meeting and treating young individuals. This procedural logic stressed that there are multiple models and methods available for helping youth cannabis users but that it is necessary to individualize them to suit the person “in the room”. The preferred approach boiled down to concentrating on the “here-and-now”, indicating that all encounters with a young person, regardless of problem severity (e.g., “experimenters” or “experienced smokers”) and therapeutic goals (e.g., “assessment” or “treatment”) were considered crucial opportunities when correct information about cannabis could be passed on to facilitate behavior change. This meant that hardly any instances of youth–staff interaction were rejected as superfluous or counterproductive. Furthermore, this logic valorized relationships and reciprocity rather than punishment and control in relation to the young clients.

Using Contextual Legitimation Techniques to Emphasize Problem Severity

In this section, we present staff articulations where the described solution appears as not wholly aligned with the character of the problem. Participants deal with this by employing contextual legitimation techniques. The examples below cover instances where alarmist messages about cannabis attitudes and dangers are somewhat hesitantly questioned, but where the scientific and structural logics bolster the conclusion that they are still worth using in the treatment of youth cannabis use.

In the first extract, Stefan presents his thoughts on the cannabis situation in the local area. Before this passage, he has concluded that cannabis attitudes have become liberalized among young people in the last 10 years, and that MiniMaria nowadays almost exclusively targets cannabis, but that such shifts have not been coupled with a corresponding increase in the prevalence of use among young people. Stefan goes on to state that:

Well, research shows that young people have become more tolerant; they don’t believe cannabis is that dangerous anymore. Most of them still do, but we see an increase here. We talk about it a lot, and why it has turned out this way. I certainly think that young people here are influenced by the world around them, by what’s happening in the U.S., South America, Canada—thoughts about legalization. […] It’s not seen as horrifying, but rather associated with something positive. I think that’s one reason. But I also believe that this shift in the trend, which I mentioned before, is something that has sneaked up gradually. Many adults, it’s only natural, may end up in certain situations…maybe they themselves start doubting that it’s dangerous. So I see this as a very important job that we have to do, since I don’t see legalizing yet another drug as a solution. I see it as a very important job over the next few years to provide alternative information—from safe sources and to learn to resist the other stuff. To show another side, that smoking does have negative effects.

Here, Stefan concludes that young people no longer perceive cannabis as especially dangerous, but in the same sentence he says that anyhow most of them still do. This indicates that efforts to change their attitudes in general might not be either necessary or productive. He subsequently goes on to discuss the problems of the liberalization of cannabis policy, positive images spread through popular culture, and by adults who question the dangers. This structural logic, reinforced by a scientific logic, justifies why MiniMaria should promote “alternative information” and “resist” legalization by referencing “safe sources”. Thus, while it is acknowledged that most young people do not have a liberal view and are not inclined to use cannabis, the reasoning shows how contextual legitimation techniques are used to highlight the severity of the problem, which in turn makes it adequate to target one particular drug and take on the role as proclaimer of drug prohibitionism. A similar argument is made when the participants mention that MiniMaria services are considered necessary even if most young people only experiment with cannabis temporarily and stop using without treatment.

The next extract exemplifies how a scientific logic is made to blend with and reinforce the procedural logic of getting parents and young people onboard in the treatment process. As in all other interviews, the emphasis is placed on the balance between providing valid information about smoking cannabis and morally condemning bad behavior. The participants claim to know how young people think and behave regarding rules and regulations (oppositional), and a preaching tone is therefore considered ineffective and incommensurable with a professional logic. Ingrid offers this account:

Ingrid:

No, I guess I don’t think it [cannabis use] is worse than other things, but I think you should still convey that it’s a very bad idea to smoke cannabis when you’re young. Maybe you shouldn’t preach, but you have to be clear about what we know about the consequences of smoking cannabis regularly, over a longer period of time. Nothing happens after trying two or three times, but I think that at least parents should know what happens when a young person smokes regularly, and the kids themselves should know.

Interviewer:

So, how do you tell them?

Ingrid:

I usually draw on the whiteboard, for example, the THC [tetrahydrocannabinol] release curve. I talk about it being fat soluble, that it stays in the body a bit longer. I talk about chronic intoxication, although I don’t use that word. But I talk about the fact that if you smoke regularly for a long period of time, you’re under the influence even when you’re not high, so to speak. To the parents, at least, I show brain images demonstrating where in the brain it sticks, the cannabinoid system and things like that. […]

Interviewer:

Don’t parents get very worried when they hear that?

Ingrid:

Some do. Some aren’t worried enough I would say. But it’s also like, you want some parents to be more worried since you want them to be committed to preventing this from continuing.

In this extract, Ingrid acknowledges that sporadic experimentation with cannabis is not as likely to cause the same level of harm as regular use but that the professional logic still insists that young people must be informed about cannabis being a “bad idea” that may lead to negative consequences, and that parents need to be “worried enough”. The link between the effects of regular use and those of sporadic use serves to emphasize problem severity and fuel the concern that is so crucial for legitimation at MiniMaria. According to the participants, treatment is usually initiated through a “notification of concern” made formally by the municipal social services (Socialstyrelsen, 2014). In other cases, when a young person comes in voluntarily, teachers and parents represent the “concern”. It is also stated throughout the interviews that “substance abuse assessments” are conducted to “rule out” cannabis use and thereby “concern”. This concern for younger generations is built into the prohibitionist drug-policy context, can be supported by referencing specific research evidence, and is used by staff to start intervening and to determine when services are needed. The extract also exemplifies that “concern” is built up by presenting biomedical phenomena (e.g., the effects of substances on brain function) to young people and parents through pictures and charts that stress the dangers of cannabis. In this way, the participants draw on contextual legitimation techniques in the form of structural logic (all cannabis use is bad) and scientific logic (some cannabis use is bad), and distil them into individualized and digestible messages that young people and parents need, even if they cannot act rationally on them. This process has two effects: it constitutes cannabis as particularly dangerous for young people and, in doing so, constitutes young people as a group with great needs.

Using Relational Legitimation Techniques to Soften Treatment Resistance

The following section illustrates how different logics can collide and create trouble in day-to-day interactions between staff and young people. The participants seem to be able to handle such tensions by highlighting relational legitimation techniques focusing on work experience and adequate therapeutic methods. In the extract below, the structural logic of forced urine tests is claimed to make establishing rapport with a young person more difficult:

Olivia:

It’s as if, at those times, I play a role and I get a lot of transference, like projections. It’s as if I’m not a person but I also become the State. There is this young person and every time I see him he talks about it like: “You all force me to come here and leave urine samples, you all force me to do this!” And I go: “It’s me, who is sitting here as a person talking to you, and I want you to take a drug test.” But all the time it’s just “You all…”

Interviewer:

OK, so you always get to be a representative [of the State]?

Olivia:

Yes, but when I meet someone else’s client I think I can be a bit different, I don’t have to maintain a curative role, and can be a bit softer and more open.

Here, Olivia describes how a young person complains about being forced to comply with treatment, which pinpoints the structural logic that has made him the subject of MiniMaria services. According to Olivia, she is reduced to a symbolic representative of the state, and her relationship with the client risks being perceived as one of master/servant rather than helper/helped. Since urine tests are a routine part of “substance abuse assessment”, they cannot be skipped without breaching the procedural logic, and this young individual’s noncompliance makes it difficult for Olivia to meet him in the “here-and-now”. To solve this dilemma, she tries to make him acknowledge that it is not “You all force…” but rather “I want you to…”, thus downplaying the structural logic of the situation and instead trying to build a relationship between them. In the extract, she also associates a “curative role” with something stricter than being “soft and open”, which exemplifies that routinized problematizations and condemnations of cannabis use can sometimes be skipped by staff. Or, as Johan puts it, when speaking about approaching unwilling young people: “The services we offer here are free of charge for you…take this chance while you’re here!” This indicates that he strategically tries to redefine the situation from one of compulsion to one of opportunity. Elsewhere in the interview, he describes another way to divert attention from the structural logic of service provision, by claiming that an assessment of a young person’s situation is never conducted as a “crusade” (where the dangers of cannabis are taken for granted and campaigned against) but is rather interrogative and “searching”. This suggests, in line with a procedural logic, that problems are identified in the individual rather than presupposed.

Another dilemma the participants deal with in their articulations concerns the young people who do not seem to be helped by the services and who continue using cannabis during and after treatment. These stories suggest that the procedural logic of MiniMaria suits and helps only certain groups, although the mandate according to a structural logic is to treat a wide variety of young people and make all of them stop using cannabis. According to the participants, good results are mainly reached with those who can be characterized as “experimenters”, while “experienced smokers” are often more difficult to help due to the severity of their social problems and affiliation with a lifestyle centered on cannabis use. As described in the next extract, from the interview with Ingrid, young people who do not seem to benefit from the services may be redirected to other organizations that offer other interventions:

But sometimes, after a while, we tell the [social service] case manager that this [treatment] isn’t working, that there isn’t any point. Maybe it would be better if this person were assigned a contact person, or had other leisure time activities, or just did something else completely. This is why we sometimes terminate contacts, because we feel there’s no point. Sometimes we think it’s easier to involve the family a bit more, and we work with families or parents only. Sometimes we may become more of a control unit where urine tests are taken and we do a check up without much talking, for those who don’t fancy talking. And that can be good enough. They have other plans as well. A lot of them have plenty of other contacts. And sometimes there are so many professionals involved that it becomes chaotic for the young person. Sometimes we have to back off, and sometimes someone else needs to back off, for it not to get too fragmented.

This extract exemplifies those situations in which MiniMaria is described as being ill-suited for certain individuals; “there’s no point” and there is a need for “something else”. Ingrid emphasizes the importance of knowing when other interventions may be more suitable. Her statement indicates that redirecting a young person to other services does not mean a lack of resources or treatment options but rather is presented as an advantage for clients who might otherwise experience the help provided as “chaotic”. Consequently, relying on the professional logic of knowing the young person and when to “back off” becomes vital in articulations where the aims and outcomes of MiniMaria are discussed and questioned. This reasoning illustrates how participants use relational legitimation techniques to articulate instances when it is inappropriate to position cannabis use as the main problem (structural logic) to characterize a situation where other aspects of the life of the young person in question are believed to be more important.

Combining Relational and Contextual Legitimation Techniques to Tell “Success Stories”

In this section, we draw attention to staff perspectives on best practice and stories with happy endings. The focus is not on trouble and tension and on how problems and solutions are calibrated to prove certain points. Instead, we target what type of problem representation the participants convey when talking about cases where young people are compliant with MiniMaria services and wish to stop using cannabis. The quotation below from Stefan illustrates how contextual and relational legitimation techniques (and hence different logics) work in harmony to produce “success stories”:

There was this one guy we worked with for an extended period of time, but who wasn’t able to quit his substance abuse. But one day, a couple of years after we ended the contact, he rang on the door himself and said “Now, I want to change my life. My friends have jobs, driver’s licenses and I’m falling behind. Now, I’m ready to change.” Since he wasn’t ready before, this time it happened incredibly quickly. We saw a change…. I mean earlier, we’d been working with him for years, but this time change came within a few weeks. And that’s how it is, we had the chance to build a decent relationship, and he thought we were OK here [at MiniMaria], which made it possible to sow a seed…. The relationship is one thing, but there is also the belief that things can change if you want to, and that you can choose to come back later.

While Stefan elsewhere in his interview acknowledges that MiniMaria may have difficulties in helping “experienced smokers” stop using cannabis, this young person’s voluntary return yields a powerful legitimation that iterates all logics. This description of events suggests that the previous treatment episode was probably mandatory, but still not in vain (structural logic). It substantiates the idea that youth cannabis use is linked to a lack of motivation and ability to achieve life goals (scientific logic) and that young people need time to mature out of an oppositional stance and to act rationally (professional logic). It also shifts attention from short-term positive treatment outcomes to “sow[ing] a seed” that might grow later (procedural logic). Thus, if the question were why staff at MiniMaria “should do this, in this particular way” (Van Leeuwen, 2007, p. 93), Stefan’s answer emphasizes the need to build relationships rather than to make a young person stop using cannabis.

In the next extract, Dan describes two typical cases of service provision, one in which the contact ends after the assessment and one in which the process is prolonged and involves family issues. His account shows how different logics are drawn upon to articulate accounts of successful interventions, where young people compliantly stop using cannabis:

Most people come here because they have been caught smoking cannabis. So we collect information and then we have a follow-up meeting where we determine whether there’s a need to continue the contact, and then we get to work. But it can also be like, OK, there’s no need to continue here because things look good, it looks stable. There was something here, but we’ve moved on and we can end this now. This is how we perform our substance abuse assessments. […] I try to have an approach where I play it cool. Because I want to put things in perspective. There is often a crisis in the family. I mean parents, moms, dads, are very upset. I think it’s easier to reach them at times like that, and they should want to come here. My approach is to try to be the one who calms things down a bit. They get support, they get help, and they get to talk about the situation. And then they usually see, OK, the drug tests show negative results. And we see this over a period of one, two months. And then, generally, family members start finding their way back to each other.

The first part of the extract shows that young people who have been caught using cannabis (structural logic), are assessed (procedural logic), provided with information about cannabis (scientific logic), and subsequently released because further help is considered redundant (professional logic). This could have been put forward by Dan to argue that MiniMaria services are sometimes superfluous. Here, it instead emphasizes that all young users are crucial targets of interventions and that the staff is capable of determining when and for whom further interventions are needed. The second part of the quotation suggests that parties involved other than the young person himself or herself can also benefit from services, and this legitimation relies on the harmonization of logics as heavily as the first one. Youth cannabis use causes a crisis in the family because it represents deviant behavior (structural logic), which warrants parents to engage with MiniMaria and staff to “play it cool” (professional logic) and to allow the parties involved to “talk about the situation” (procedural logic). Subsequently, the young person stops using cannabis and the family situation settles down again. This account might indicate that targeting casual cannabis users (“experimenters”) risks distressing young people and parents alike, but through a combination of different logics, it instead indicates that the whole family benefits from this attention. Also, by not including users other than compliant young people who wish to stop using, these “success stories” fail to acknowledge that other treatment options and goals (e.g., harm reduction, safer consumption) are potentially rational for these other groups (e.g., a young person who perceives other problems in life as being more acute or who wishes to continue with recreational cannabis use). The subject constituted through such articulations thus seems to be aligned with the problem representation emphasized by the structural and scientific logics; it is a young person troubled by cannabis use and no other issues (e.g., family crisis, psychiatric diagnosis, poor school results, and boredom).

In the final extract, Gunilla draws on all four logics to explain how social work with young people can be legitimized in the light of questions about the effectiveness of treatment. This quotation is taken from a passage in her interview in which the relatively “light” problems of young people presenting at MiniMaria are discussed:

I think it’s very interesting, when we talk about social work in general. It’s like, what would be the difference from doing nothing? But I think this is exactly where we can make a difference. I think what we do here is in one way preventive. Many will wake up from just being watched over. And that makes a difference, and there’s nothing wrong with that. You show them that you see what’s going on, that you’re concerned, and that you care. So this is how we usually talk about it: “We are doing this because you’re important!” like that. […] Everything is done with care all the time, for our children, so I think we make a difference.

Surveillance of young cannabis users is described by Gunilla as an important component in the efforts to prevent problems, avoid the dangers of cannabis and show concern for “our children” (structural, scientific, and procedural logic). If the measures taken are perceived to be too harsh by young people, staff can make them comprehensible by highlighting that the measures are based on care and good faith (professional logic). This, in turn, makes it possible to regard the services provided by MiniMaria as benevolent and effective without recourse to treatment outcomes. It also makes other approaches (e.g., to target only problematic use) seem undesirable as they can be interpreted as “not caring.” In the same vein, by focusing on good faith and care, concerns that surveillance might also be seen as an intrusion by young people are silenced (as in the quotation from Olivia above).

Discussion

Our results show that the process of legitimation is ongoing even in an organization well adapted to influential political goals such as the “early discovery of youth substance use” and “cooperation between different agencies” (Statens folkhälsoinstitut, 2011, p. 62). To illustrate how frontline social work with young people is made sense of by key actors, we used the concepts of problem representation, legitimation, and logics. We were able to identify four logics: scientific and structural logics that illustrated contextual legitimation techniques, and professional and procedural logics that illustrated relational legitimation techniques. The participants blurred and blended logics strategically in legitimation (Currie & Spyridonidis, 2016, p. 81) to align problems with solutions. They either represented the cannabis problem as acute enough to warrant wide-ranging interventions (calibrating the problem to a fixed solution) or represented services as more nuanced than could be expected in a framework where all cannabis use is considered problematic and must be prevented (calibrating the solution to a fixed problem). Through such problem representations (cf. Bacchi, 2009, 2018), the participants constructed a drug reality where cannabis becomes a high-profile problem and where its users are young, vulnerable, and irrational and in need of societal measures.

Prior research shows that health professionals are prone to justifying their work by referencing science, expertise, patient-centeredness, and caring (Sander & Harrison, 2008). A significant finding in our study is that participants also included political concerns through contextual legitimation techniques that focus on the well-being of the whole society. MiniMaria was described as a counterweight to cannabis liberalization, as a link between prohibitionism, valid research and the citizens, and as a body that expresses and handles society’s concern for youth. The staff did not highlight how services contributed to changing youth beliefs and behavior. They also appeared hesitant to explain precisely what “treatment” consists of in practice (e.g., promoting abstinence from drugs or building relationships, ruling out “concerns,” or suggesting interventions). Instead, their main message was that the character of the problem—cannabis as dangerous, vulnerable young people, drug liberalism—necessitates an organization that specializes in handling young people in need and in countering the erroneous ideas about cannabis they and parts of society hold. In this line of reasoning, the organization was portrayed in a positive way as an “effort of good faith” with a moral legitimacy (Suchman, 1995, p. 580), which relied more on trying to stop youth cannabis use than actually doing it. Hence, the staff did not concentrate mainly on the legitimacy types that Suchman (1995) calls pragmatic (targeting positive outcomes) or cognitive (targeting comprehensible measures).

The moral legitimation illustrated in this study is congruent with the Swedish policy goal of a “drug-free society” (Tham, 1998) and with Sweden’s social democratic, paternalistic, and universalistic approach to health and welfare (Moore, Fraser, Törrönen, & Tinghög, 2015). It also corresponds with dominant discourses that constitute young people as vulnerable and in need of protection and control (Öhlund, 1997; Selseng, 2015) and help to manage risk (Phoenix & Kelly, 2013). However, drug prohibitionism is often also associated with significant control costs such as violations of personal integrity (via, e.g., urine tests and police raids), mandatory interventions, unmotivated clients, and increased harm for people who use drugs (ALICE RAP, 2014; Goldberg, 2011; Inciardi, 1999). These control costs are incompatible with MiniMaria’s therapeutic and humanitarian goals, so the staff claimed to downplay the structural logic in practice and to emphasize relational legitimation techniques. The structural logic was only used as a last resort to legitimize services when other logics were not applicable. Examples of this included when the need for general prevention appeared exaggerated in relation to the relatively low prevalence of cannabis use in Sweden or when young people were noncompliant regardless of how ambitious staff were in tailoring interventions to suit individual needs.

This cohesive legitimation of MiniMaria may have been influenced by a certain self-selection in our sample. Staff with deviant opinions on working methods or views on cannabis may not have felt comfortable discussing these with researchers they did not know. Hence, what our results show is probably the acceptable way to talk about MiniMaria services in the field. Yet, since similar views on cannabis and treatment also dominate other professional arenas in Sweden (Månsson & Ekendahl, 2015), this discourse is probably well established. From the perspective of national drug prohibitionism, it would be enormously transgressive for professionals to accept that cannabis could be used relatively unproblematically or to promote harm reduction as a treatment goal.

It should also be noted that different results might have emerged if the interviews had focused on “hard data” about treatment outcomes as in, for example, the number of young people becoming drug free every year. Still, when the interviews did touch upon such questions, the participants had difficulties providing clear answers. This suggests that they favored moral rather than pragmatic legitimacy. In an attempt to verify our results outside the sample, we returned twice to MiniMaria network meetings to present our ongoing analyses. This further corroborated the existence of a strong “MiniMaria discourse” permeating the talk about the services provided.

Needless to say, our intention in analyzing MiniMaria staff’s use of logics in legitimation is not to denigrate their work. On the contrary, participants appeared serious, competent, and perceptive regarding the treatment of young cannabis users. What our study shows is how legitimation relates to, for instance, policy, organization, knowledge claims, and professional considerations. In effect, it also shows how the making of cannabis as a particularly dangerous and insidious drug and the comprehensive measures taken are intertwined and reinforce each other in discourse on social issues (Bacchi, 2009). Thus, we recognize how the described problems with cannabis, its use, and its users also constitute that which is to be addressed.

Conclusion

We can conclude that social workers in Swedish treatment for youth cannabis use highlight the severity of the drug problem and the problematic situation of drug users. The attempts analyzed to frame MiniMaria services as benevolent and relevant echo other, mainly political, attempts to justify interventions in a social domain where scientific evidence on treatment outcomes meets political ideals about healthy lifestyles (Brook & Stringer, 2005). Silencing a discussion on the mandatory and sometimes intrusive interventions, and framing them in terms of care and good faith when applied to youth cannabis use, resembles how other methods have been discussed in the Swedish field of substance abuse treatment. Strict regulation of opioid substitution and needle exchange, for instance, has been depicted as medically sound and aligned with users’ needs rather than as manifesting a treatment philosophy that rejects drug use per se (Ekendahl, 2009; Eriksson & Edman, 2017; Johnson, 2007; Tryggvesson, 2012). Similarly, Sweden’s long-standing tradition of compulsory substance abuse treatment has, over time, been portrayed as a humanitarian attempt to save lives and facilitate lifestyle change rather than a form of disciplining drug users who do not comply with social norms (Edman, 2013; Edman & Stenius, 2014).

This history suggests that efforts to legitimize MiniMaria are very Swedish in that prohibition is always the backdrop. Such a policy determines the primary aim of interventions (to achieve abstinence from drugs), how this should be achieved (greater enlightenment about drug dangers, building relationships with those deemed vulnerable), and safeguards the inflow of clients (ongoing drug use is not a valid option for those who enter the system). Prohibitionism, however, and the sole reliance on research that explicates the dangers of drugs also become double-edged swords. Our results show that staff need to play down the controlling and lecturing aspects of service provision in order to achieve treatment goals. It was not until they had exhausted the professional and procedural logics that they took refuge in the ultimate message that cannabis is illegal. In this way, they were also able to present a multifaceted response to the liberal views on cannabis they encountered in their day-to-day work.

While the organization appears to make every effort to be supportive, the staff’s tendency to legitimize their work on moral grounds does not sit well with the focus in recent years on “evidence-based practice” in social work and health care (Morago, 2006; Proctor et al., 2009; Wike et al., 2014). It can be expected that MiniMaria in the future will be pressed to show positive treatment outcomes that strengthen its pragmatic legitimacy too (Suchman, 1995). Still, as the organization is often seen as a frontline extension of a hegemonic Swedish prohibitionist drug policy, we find it hard to believe that governmental authorities will question the relevance of this drug reality and of representing youth cannabis use as a high-profile problem and to unreservedly examine the pros and cons of different solutions to it. This, in turn, suggests that the ongoing legitimacy of MiniMaria’s approach will be maintained rather than challenged.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work was funded by Forte (Grant 2015-00283).

Note

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