Comparing Social Service’s Networks for Underage Drug Users: A Cross-National Comparative Study between Malmö and Genoa

Matteo Di Placido, Lund University, Social Work Department


Drug consumption has been traditionally targeted as one of the main concerns of national and international policies (Global Commission on Drug Policy, 2011; 2014). Sweden and Italy are not an exception at these regards (e.g., Edman, 2013; Edman & Stenius, 2014; Ekendhal, 2012; Scarscelli, et al, 2012). In both contexts the consumption of illicit substances is mainly seen through the lenses of the dominant disease model of addiction (Uusitalo, Salmela & Nikkinen, 2013). In line with this model, the mainstream attitude toward substance use and substance users is to understand the first as a cause of biochemical changes in the body structure of the second.  Among the consequences of this model figures a pathologic and deviant understandings of drug consumption in public debates (Goldberg, 2001).

Furthermore, within this framework, underage drug consumption reached a high historical pick in European countries (Eurobarometer, 2012, p. 4) raising old and new public health and societal concerns with obvious repercussion on social workers’ practices. However, as Donna Leight Bliss and Edward Pecukonis (2009) underline, substance abuse issues, including underage drug use, seem to be neglected by non-specialized services, thus calling for the need for further inquiries on this phenomenon.

Thus this paper aims to describe social workers’ perceptions of the influence of organizational, legal and, socio-cultural factors on their relationships with underage drug users and their families in the contexts of Malmö, Sweden, and Genoa, Italy, in the attempt to contribute to the academic discussion on the topic and help to facilitate dialogue among different contexts and social work practices.

The paper starts, in order to contextualize the empirical material here discussed, with a brief presentation of the social welfare models of both Italy and Sweden. Then in the methodology section the paper’s methodology and method are presented. Finally the analysis of the empirics, its discussion and the paper’s conclusions help to unpack and problematize the social workers’ perceptions of the influence of organizational, legal and, socio-cultural factors on their relationships with underage drug users and their families.

1           Welfare models and drug policies: Italy and Sweden

The Italian welfare system could be categorized as a conservative-corporative model (Esping-Andersen, 1990) or as a rudimentary welfare model (Leibfried 1992), if regional differences are taken into account. On the other hand Sweden exemplifies, according to Esping-Andersen, the so-called ‘social democratic model’ and it is also a part of the so called ‘Scandinavian model’, relying on the relationship between welfare regimes and social work practice, as has been explained by Lorenz (1994) (Guidi & Di Placido, 2015).

However, despite representing divergent welfare systems, both Italy and Sweden have a decentralized system of welfare service provision (Scaramuzzino, 2012), meaning that municipalities are responsible for the delivery of social services in both contexts (Guidi & Di Placido, 2015).

Concerning the overall political climate toward drug use and drug treatment the Swedish and Italian discourses are both characterized by a substantial adherence to zero tolerance approaches. As previously emphasized within this framework consumption and possession as well represent a violation of the respective national legislations (for Italy see D.P.R. 309/1990 as modified by L. 16 maggio 2014, n. 79; for Sweden see the Narcotics Drugs Punishment act 1968:64 as modified by SFS 2006:46). Furthermore, in both countries there is a focus on the so-called street-dealing, that, together with the consumer is considered as the fundamental problem that drugs cause to society, contrary to the recent indication of the Global Commission on Drug Policy (2011; 2014).

However it is necessary to mention how recently the Italian Government modified the legislation on illegal substances (D.P.R. 309/1990), reintroducing a difference between “light” and “hard” substances, and further smoothing the administrative and penal measures for possession of illegal substances among the other changes (L. 16 maggio 2014, n. 79)

2           Methodology

The present study is a cross-national qualitative research. The methodological framework used falls within the so called ‘societal’ approaches. Such a position tries to overcome the limits of both universalist and culturalist approaches. In fact the formers claim that the core of a phenomenon lies in its universal characteristics, denying then the importance of the contextual dimension, while, the latter assume somehow an opposite position, “…plac[ing] such great emphasis on social contexts and their specificity, distinctiveness or uniqueness, that meaningful comparisons and generalizations were made very difficult, if not impossible” (Hantrais, 1999, p. 95). Thus, to be in accordance to a societal approach means to consider phenomena in their systemic fashion, accounting for the influences of both, intrinsic and extrinsic factors (Hantrais 1999, p. 96).

Using the words of Linda Hantrais, the present cross-countries comparison “…aim[s] to demonstrate the effect of the national context on the object of study, but with the purpose of determining the extent to which the generalizations can be made from the theoretical models and hypotheses that the researcher is seeking to test empirically” (Hantrais, 1999, p. 96). In other words this is operationalized describing social workers’ perception of the influence of organizational, legal and social factors on their relationship with underage drug users and their families, thus considering how these may affect social work practice.

Furthermore, this work has characteristics of both a comparison based on models of social policy and a practice oriented comparison, although it is the analysis of the latter which is diffusely described in the presentation and analysis of the empirics. For a more thorough discussion of the topic see Anna Meeuwisse and Hans Sward (2007).

The comparison based on models of social policies, even if not complete and exhaustive, it is an intrinsic characteristic of cross-national comparisons within the social work field. In fact, in order to define the legal framework in which the relationships addressed are embedded and to fully comprehend social work practice in a given area, requires an understanding of the different models of social policies (Guidi & Di Placido, 2015).

Furthermore a practice-oriented comparison has been used because an “[a]nswer to some of the questions about similarities and differences in social work in different countries can only be obtained by investigating what actually happens in social workers’ practical exercise of their profession” (Meeuwisse & Sward 2007, p. 491).

Finally, the mainstream approach to comparative cross-national research traditionally refers to countries as units of analysis. As emphasized by Sulkunen an alternative is to account for geographies as components of comparisons, defining geographies as places characterized by a certain mixture of inhabitants, and historical, institutional, political and normative factors (2013).

However, in order to competently compare social workers’ perceptions of the influence of organizational, legal and, socio-cultural factors on their practice a national comparison, and in particular a comparison based on two cities has been embraced. Furthermore such an analytical zooming appears particularly suitable since, as previously mentioned, in both Italy and Sweden the welfare service provision is primarily taken care of at a municipal level (Scaramuzzino, 2012; Guidi & Di Placido, 2015).

Malmö and Genoa have been chosen because display as particularly interesting unit of analysis considering their relatively similar patterns of economic development, demographic constitutions and respective role as big cities in their national contexts (Scaramuzzino, 2012). However despite these similarities, comparing Malmö and Genoa signifies also to follow a comparison based on “the most different logic” considering how the Swedish and Italian welfare systems are substantially different (Guidi, Meeuwisse, & Scaramuzzino, 2014) belonging respectively to the so called democratic and conservative-corporative models (Esping-Anderson, 1990), despite both substantially enforce zero tolerance policies toward narcotics (e.g., Edman, 2013; Edman & Stenius, 2014; Ekendhal, 2012; Scarscelli, et al, 2012).

Finally, there is an already existing body of work that concentrates on the explorations of the similarities between these two realities with specific reference to the social work policy and social work practice (Guidi & Di Placido, 2015; Scaramuzzino, 2014). In this sense, this article aims to pursue further this line of research and further informing social work practice in these two countries.

3           Method

According to the aim of this work, social workers and experts in the field of drug use and drug treatment have been interviewed. As emphasized by Shaw and Holland (2014) qualitative research in social work is primarily about the understanding of what a phenomenon means to people and how these meanings emerge as arising in a specific context, from the research process and the data analysis.

The interviews have been based on a non-standardized technique of interview with a little degree of structure (Firmin, 2008, p. 908). The shortest questionnaire was composed by 6 questions, the longest by 19 questions. The duration of the interviews varied between a minimum of 40 minutes to a maximum of one hour and a half. The empirical material consists of twelve (12) interviews for a total of fifteen (15) informants involved among which four (4) were experts.  The interviews have been carried out between the 24/02/2012 and the 23/11/12. Common feature of all the key informants is their engagement in the field of drug use and drug treatment. Concerning the social workers, at the moment of the interview they were all employed in municipal public services working with the underage. Concerning the experts, the Swedish ones were employed in higher education while the Italian ones were employed in services working in the field drug treatment. Snow-ball sampling (Noy, 2007) was used in order to access available informants.

The interviews have been integrally transcribed and the material selected for the analysis proposed in this paper amounts to the systematization of the common themes detected in the interviews. I regarded the material here analyzed as sufficiently reliable and with enough descriptive power once themes started to repeat in the informants responses. I then accounted for data saturation logic.

4           Results

The empirical material presented is divided according to the most recurrent thematic areas that emerged accounting for the social workers’ perceptions on their relationships with underage drug users and their families. These thematic areas are: (a) the influence of the organizational and legal context; (b) the social workers’ role; (c) social workers’ perceived satisfaction; (d) the level of social acceptance versus labeling toward underage drug consumption and underage involvement with the social services

It is important to underline how (a), (b), (c) and, (d) were thus not predefined lenses through which approach the empirical material but on the contrary emerged as the primarily aspects in influencing social workers’ perceptions of their relationships with underage drug users and their families.

4.1     The influence of the organizational and legal context

According to the empirics gathered, the major point of distinction between Malmö and Genoa is the different services’ coverage of underage drug users and their families. In other words the context of Malmö is characterized by a set of services, specialized and not, spread over the whole city area, in which underage drug users can find support both spontaneously and after a referral from other services.

Within Malmö’ s services network are found both services designed for young people with problems of drug consumption, and others where the focus is centered on the whole family. Thus, in this context, dealing with the problem of drug use, whether merely in relation to the consumer or also together with the family of the consumer is possible thanks to the statutory mandate of the service.

On the contrary, the context of Genoa, while providing a diverse range of services for the underage and the family does not seem to provide sufficient service coverage for the specific group of underage drug users. In other words, on the one hand there is a lack of specific services to accommodate this particular sector of citizens; on the other hand the services territorially present lack a targeted preparation to work with this particular group of clients. In fact, the services present on the territory do not seem to be able to respond adequately to the needs expressed by underage drug users and their families. It is clear that this institutional and organizational contingency create problems with the networking between Genoa’ social services. In fact, as shown by an informant “...when it comes to the underage the problem is that when the underage is reported the problem are the resources. There is none. That’s it” (Italian social worker, 2).

Such organizational contingency influences the kind of emphasis that in the two municipalities is given to preventive measures. For example in the municipality of Genoa attention toward prevention is lacking. As an informant pointed out “…a strategy is lacking still, a preventive strategy at the national level is completely lacking. We are one of the few European countries where it is missing. This is still a major limitation of Italy…So here it is talked about a lot but there is not a real shared culture of prevention, of health promotion” (Expert 1, It.).

4.2     The role of social workers

In both municipalities the social workers’ role is primarily one of protection and support of the citizens. These features permeate the implementation of actions and projects of the services. However, the primary role of the social workers in both contexts is to build effective relationships, the prerogative of any plan for substantial help.

As a Swedish social worker puts it in fact,  in a sensitive area such as underage drug use, “sometimes it is precisely the relationship between you and me which is the key” (Swedish social worker, 6). As further emphasized by one of the Swedish experts regarding the importance of the relationship

“[f]or a young person that is going through a problem, maybe drugs, it’s important that the social worker is not just doing his job…they have to do a little bit extra, and then they are making a change for the young person” (Expert, 2, Sw).

Yet, despite the importance of the relationship between social workers and clients, as underlined by an Italian informant “ is not so obvious that we can have it...” (Italian social worker, 3).

Furthermore, a common element emerging in both contexts is the difficult task of overcoming the client’s barriers towards authorities. In fact not all the clients know exactly the implications of their contacts with the social services. As exemplified by an Italian informant it follows that sometimes “ spend a good part of your time to make him understand what is your role” (Italian social worker, 1).

Moreover, the cultural belonging of the clients has been emphasized as a further barrier, not only in linguistic terms - interpreters are available in both contexts - but also in terms of the relational practices. At the same time demographic variables such as gender and age seems to influence much the possibility to establish an effective relationship. As stated by a Swedish informant

“…there is an aspect of for example me working here, as a young woman, and that I don’t have any kids on my own…[this] Influences their view, because some do not have a problem at all with it, but some have a problem with a young woman with no child telling them what to do…” (Swedish social workers, 1).

Concerning the differences, the municipality of Malmö guarantees due to the structure of its municipal services, a focus on working with both underage and their families. This enables social workers to have a more stable and lasting positioning within the family. The duration of the intervention process is around one year, with weekly or even daily contacts, varying from service to service and in accordance to the situation. However, as emerged in the previous area of analysis, what characterizes the central role of social workers in the context of Malmö is the particular structure of the services that focuses on the needs of both the underage and the family.

In the services’ network of Malmö in fact, underage substance consumption is not only included within the statutory mandate of the services, but, contrary to the situation found in Genoa, represents even the only and specific mandate for some of the services of the network.

4.3     Social workers’ perceived satisfaction

The social workers interviewed, underlined in both contexts, as an element of satisfaction, their colleagues’ dedication and fellowship. This element, according the informants, helps to create professionally satisfying relationships with underage drug users and their families. However, beside this positive note two aspects of dissatisfaction emerged in both contexts: (a) more families-oriented work. (b) high workload.

Behind these initial notes, it is possible to extrapolate from the interviews a general differentiation of perceived satisfaction in the two contexts. In fact, the Swedish context seems characterized by a widespread satisfaction, as underlined in previous cross-national comparative research among Nordic countries (Meeuwisse, Scaramuzzino and Swärd 2011, p. 11).

Such satisfaction seems linked to the availability of multiple operational possibilities and the continuous effort in terms of trainings and updating new methods of intervention that happens in the context of Malmö municipality (Swedish Social Worker, 1). Furthermore, working close and for a long period of time with and within the families were listed as elements that contribute to professional satisfaction (Swedish Social Worker, 3).

However, the Swedish contexts seems characterized by a strong bureaucratization and thus by long intervention procedures.  At this purpose it is interesting what emphasized by a Swedish informant: “I have a high workload. There is so much pressure, so much stress. I would also like to see more the clients. Here I am, always in front of the computer…I work with people but unfortunately I never see them” (Swedish Social Worker, 7).

Considering the perceived satisfaction of the social workers employed in the services of Genoa, three major unsatisfactory factors have emerged: (a) a prevalence of emergency-oriented interventions; (b) a severe lack of preventive interventions and; (c) the social representation that people have of social workers and their profession.

Taking in account the first of these three factors an informant underlined that “... the individual social worker bears a heavy burden of cases for which you are always a little hurried” (Italian Social Worker, 2). Furthermore, as emphasized by another informant, “You have to face the biggest issues that stand out and cannot do a little more relational oriented kind of work” (Italian Social Worker, 1). Consequentially, it follows that the need to deal with the situation when the threshold of the problematic has already been crossed involves setting up a relationships that born mutilated. In fact, as stressed by the same informant “…working on the urgency, means to engage with people in a time when, unfortunately, something already happened” (Italian Social Worker, 1).

Regarding the third point of perceived dissatisfaction, It has been further underlined how the social representation that social workers have among the general population does not only influence the practitioners’ satisfaction in egocentric terms but it effects the very same relational character that the professional relationship may assume with the clients (Italian Social Worker, 3).

4.4     The level of social acceptance versus labeling toward underage drug        consumption and underage involvement with the social services

Regarding both contexts, the stigma seems to be an unavoidable consequence of the underage drug users’ involvement within the social services’ system. As noted earlier, the political discourse is oriented toward a zero tolerance approach in both contexts. It is interesting to note that among those that are considered the unintended consequences of the implementation of zero tolerance policies, the Global Commission on Drug Policy recognizes “The perception and treatment of drug users, who are stigmatized, marginalized and excluded” (2011, p. 9). As underlined by one of the Swedish informant interviewed “…the stigmatization is one of the costs of the Swedish system. Because here the society is supposed to be taught on drugs, which means that quite a few people will not use drugs because is seen as bad in general…”  (Expert 1, Sw).

The Italian system seems characterized by a similar take, as emerges from the account provided by one of the expert interviewed: “...actually to come here to the Sert[1] means that maybe you are one whom smoked the first joint in his life and already you have become an addict” (Expert 1, It).

However, in the context of Genoa there seems to be, a growing normalization of drug use, as emerged from the interviews. For example, as an informant stated, “…the use of the substances is become somewhat syntonic to the culture. Today we tend to consume to stay inside the society not to get out, not to challenge it (Expert 1, It). This cultural phenomenon of the normalization of drug use is accompanied by an even more risky sociological phenomenon. In fact, as pointed out by another expert in the field, “…we have passed from the demonization of substances to the trivialization of the use of substances, completely omitting critical thinking on substances” (Expert 2, It).

5               Discussion and conclusion

In the previous sections it has been shown how, according to the social workers’ perspective, a few factors seems to contribute to shape their perception of their relationships with underage drug users and their families. These factors are: (a) the influence of the organizational and legal context; (b) the social workers’ role; (c) social workers’ perceived satisfaction; (d) the level of social acceptance versus labeling toward underage drug consumption and underage involvement with the social services.

Overall it could be stated that organizational and legal factors, alongside with cultural and social ones contribute to shape in a different manner the very same relationship between social workers, underage drug users and their families in the two different contexts of Malmö and Genoa.

However, despite a few crucial similarities, in organizational, ideological and normative terms, the social workers’ relationships with underage drug users and their families are perceived by the social workers themselves in a different manner. In organizational terms in both contexts the main level of intervention happens at the municipal level, while in ideological and legal terms in both Sweden and Italy there is the predominance of a zero tolerance take on illegal substances and their consumption. 

Yet, again in organizational terms, the social services’ network of Malmö provides widespread institutional coverage for underage drug users’ needs if compared with the reality of Genoa. In fact, although in both the municipalities the relationship with the underage drug users and their families is a fundamental part of the professional mandate of social workers, the institutional mandate sensibly differs.

The Malmö landscape is characterized by both specialized and non-specialized services directed towards consumers and their families, while the picture for Genoa seems characterized on the one hand by a variety of services that may be mobilized by the social workers but on the other by no specific service that is institutionally intended to take care of underage drug users and their families.

Such organizational difference it displays as the most influential difference among the two realities, thus deeply influencing social workers’ perception of their relationships with underage drug users and their families. In fact, as a consequence of such different organizational and institutional layout, social workers’ role is further differentiated in the two contexts.  Swedish practitioners have a more central role, allowed by the organizational structure of the services they operate in: this implies the opportunity to work with underage drug users within the framework of well-established institutional practices and well-defined working spaces. Furthermore, networking between services is not up to social workers’ discretional power, but it is a foundational part of the services’ structure. It is exactly this organizational structure that allows the social workers to work with families and with underage with a systemic approach, whether with a different accent from service to service.

The role of social workers in the Genoa municipality is influenced as well by the particular organizational structure displayed. In fact, as previously said, a substantial lack of services directly targeting the needs of underage drug users and their families drastically influences not only the role that social workers may or may not assume, but their professional practices and perceived satisfaction. 

Social workers have to work creatively and have to rely on their own networks rather than plan their work on the basis of well-established institutional practices and specialized services. The Sert, the only available public service for the treatment of addiction is in fact not tailored to take care of underage consumers but it is considered by the informants as a service tailored for long-term and problematic consumers. As a consequence the social workers are left with little or none chance to rely on the institutional network already present.          

A further element of difference among the two contexts is the social representation that social workers have respectively in Sweden and Italy. In fact in the Swedish context social workers benefit of a certain social status (e.g., Meeuwisse & Sward 2007, p. 485; Hallam, 2010), further strengthened by the traditional trust that citizens have in the Good State (e.g., Goldberg, 2005; Hallam, 2010), or perhaps exactly for this.          

The Italian informants on the contrary lamented the need to cope with a social representation that depicts them not as positively among the general population, and in particular their clients, thus contributing to create a sense of distance between institutions and citizens.

Finally, accounting for the national legislations of both Italy and Sweden emerges a strong stress on consumption and on the consumers. However, while in Sweden illegal substance consumption is rejected not only by the legislation but by the overall societal take on drug and drug use, in Italy, and in particular in the reality of Genoa, beside an institutional rejection there is an opening up for a normalization of drug use or even a normalized trivialization, as named by one of the informants (Expert 2, It.). Thus, this last element, coupled with the different organizational structures here discussed naturally brings to the different consideration of both underage substance consumption and underage involvement with the social services. In fact, the availability of a highly structured social services’ network for underage drug users might partially explain the highest level of social stigmatization that users are required to face in the Swedish context.

Concluding, this article has shown how social workers’ perception of their professional practice, and in particular of their relationships with underage drug users and their families, is among other factors, primarily influenced by the local network of services and services organization. 



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Author´s Address:
Matteo Di Placido
Lund University
Social Work Department



[1] Public service for the treatment of addictions