Scholarly article on topic '“Focus on the young ones”: Discourses on substance abuse and age'

“Focus on the young ones”: Discourses on substance abuse and age Academic research paper on "Law"

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Nordic Studies on Alcohol and Drugs
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Academic research paper on topic "“Focus on the young ones”: Discourses on substance abuse and age"

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"Focus on the young ones": Discourses on substance abuse and age



BACKGROUND & AIMS - Previous research has shown that age categories play a vital part in the decision-making processes of counsellors in substance abuse services, yet very little is known about how the meanings of "age" and "substance abuse" are constructed and intertwined. This article aims to provide insights into the dynamic relationship between discourses on age and substance abuse. It explores the narratives of a group of counsellors on age and substance abuse, and looks at the subject positions this intersection produces. DESIGN - The data material consists of interviews with 23 counsellors working for the Norwegian Labour and Welfare Administration (NAV). The analysis is inspired by discourse psychology and intersectional and poststructuralist approaches. FINDINGS - Three positions are constructed: "the vulnerable youth", "the formative youth" and "the agentic adult". The article illustrates how the subject positions reinforce a "focus on the young ones" discourse. Findings are discussed against the background of the concept of ageism. CONCLUSION - The article highlights the significance of examining categories such as "substance abuse" and "age" as dynamic and contextual phenomena. It points out the significance of continually being aware of the influence age categories have in the process of differentiating and categorising substance abusers in social services.

KEYWORDS - discourse, social service, social work, substance abuse, age, ageism, categorisation

Submitted 30.09.2014 Final version accepted 20.01.2015


By examining how discourses on substance abuse are related to discourses on age, this article explores the dynamic relationship between meanings attached to substance abuse and age. Research has shown how the understanding of substance abuse has varied throughout the years and has various meanings also today (Edwards, 2009; Hellman, 2011; Karasaki, Fraser, Moore, & Dietze, 2013; Samuelsson, Blomqvist, & Christophs, 2013; Sulkunen, 2013). Studies of age show how age works as a fundamental structuring principle for how we organise our world (Blaakilde, 2004; Hegg-li, 2004; Lee, 2001) and how meanings at-

tached to different age categories vary in relation to time, society and context (Buchmann & Kriesi, 2011; Hillier & Barrow, 2014; Ulvik, 2005). Substance abuse is one of the contexts in which age as a category comes to the fore. Previous research has revealed that meanings attached to age play a vital part in the decision-making processes of substance abuse services (Järvinen, 2002; Lundeberg, Mjaland, Sovig, Nilssen, & Ravneberg, 2010; Palm, 2006). However, little is known about how the meanings of substance abuse and age are intertwined.

In research, substance abuse and age are often used as statistic variables with inherent and non-contextual qualities. Here,




through a social constructionist lens, I will instead explore substance abuse and age as context-dependent discursive structures. Categories are studied as shaped by history and social events, and through daily interactions between actors (Davies & Harre, 2001; Hacking, 1999). By "substance abuse" I understand the use of substances that violates cultural tolerance limits and is hence perceived as problematic (Nes-vag, 1994). Highlighting the categories of "adult" and "young", I explore the dynamic relationship between discourses on substance abuse and age by analysing narratives told by a group of counsellors working with people having substance abuse problems. The interviewed counsellors work in the Norwegian Labour and Welfare Administration (NAV), which is a major service provider in this field (Hel-sedirektoratet, 2013; Haland, Lie, Nesvag, & Stevenson, 2014). These counsellors play an important role in the assessment processes the users1 are subjected to. The analyses of the counsellors' narratives are complemented with relevant policy documents.

In their talk and perceptions, like any of us, counsellors are affected by the discursive context that surrounds them. Simultaneously they contribute to the development of discourses (Davies & Harre, 2001). Discourses on substance abuse and age contribute not only to the counsellors' scope of action, but also to the positions of both users and counsellors, the way counsellors interpret and explain the users' course of action, and the way counsellors understand the users' responsibility. Thus, discourses on substance abuse and age are significant for substance abuse services in general.

"Substance abuse" and "age" as objects of exploration

A central question in research on meanings of substance abuse is how to understand the abuser's own responsibility. Many professional and lay conceptions can be traced back to the dichotomy about whether substance abusers are regarded as responsible for the abuse or as victims of something beyond their control (Rise, Aar0, Halkjelsvik, & Kovac, 2014; Russell, Davies, & Hunter, 2011). Brickman et al. (1982) emphasise that the way in which the responsibility for a problem is attributed to a person will affect the attempts of others to help them. Research has shown that the majority of professionals working in the area of substance abuse hold abusers responsible both for their drug problem and for how it is to be solved (Jarvinen, 2002; Koski-Jannes, Hirschovits-Gerz, & Pennonen, 2012; Melberg, Henden, & Gjelsvik, 2013; Palm, 2003). By highlighting the abusers' individual responsibility, their willpower and motivation is given a crucial role. Many people feel neither obligated nor able to help (Brickman et al., 1982). It could be argued that the emphasis on the substance abuser's own responsibility is in line with today's neoliberal views on treatment in general (Jarvinen, 2012; Rose, 1999; Villadsen, 2003).

Research based on the typology presented by Brickman et al. provides intriguing findings on how substance abuse is understood by professionals working in the substance abuse field. However, this model does not capture nuances and ruptures in how these professionals regard the inter-twinement between abuse and responsibility. Palm (2003, 2004) found that their statements and responses traversed vari-

ous categories of the typology, and Koski-Jannes et al. (2012) point out that the model does not give any information about the nuances in the respondents' understanding of responsibility. Karasaki et al. (2013) found a significant ambiguity in how the respondents understood substance abuse, particularly in respect to volition. They state that "a greater awareness and discussion of the disagreements at play, and their implications" is needed (p. 203). This paper contributes to the discussion of responsibility, as it shows how the meaning of responsibility is influenced by the dynamic relationship between discourses on substance abuse and age.

Palm (2006) claims that age plays a crucial role in the way treatment staff think about whom to give priority of access to alcohol and drug treatment. Based on questionnaires sent to staff in the social and health care system in Stockholm County, Palm shows that they prioritised young people. Very few wanted to give preference to "heavy misusers" and to "persons who have been misusing for a long time" (Palm, 2006, p. 367). Similarly, Jarvinen (2002) claims that age plays a vital role in the Danish treatment system, where abusers are divided into two categories: those "worth investing treatment resources" in, and those "too old for treatment, too heavily burdened or too badly inflicted by their substance abuse" (p. 5). Andersen (2007) has also examined how substance abusers' responsibility is understood in the Danish treatment system and found that the staff expect the oldest and most marginalised users to take on more responsibility than the younger and less marginalised users. When it comes to involuntarily admitted substance abusers in Norway, statistics

show that young people are overrepresent-ed, even though older substance abusers tend to have used substances for a longer period and even if they are in poorer health (Lundeberg et al., 2010; S0vig, 2007). According to Lundeberg et al. (2010) this

"may indicate that age discrimination exists; older, more chronic substance abusers may be pushed out of specialised health programmes, on the grounds that they are not expected to achieve as preferred" (p. 250, my translation).

They also point out that "there are no indications that older substance abusers cannot benefit from involuntary treatment" (2010, p. 250, my translation).

These Nordic researchers demonstrate that discourses on age play a crucial part in help-giving behaviour. However, little is known of how discourses on substance abuse are related to discourses on age. This article aims to contribute to filling this gap.

Norwegian Labour and Welfare Service (NAV)

The Norwegian Labour and Welfare Service (NAV), which administers about one third of the Norwegian national budget, was established as part of a new social welfare administration implemented between 2006 and 2011. It was one of the largest public sector reforms in recent Norwegian history - a merger of the Norwegian Employment Service, the National Insurance Service and parts of municipal Social Welfare Services (Lffigreid & Rykkja, 2013). The main objectives of the reform were to get more beneficiaries into work and activity, and to make administration



more coherent, efficient and user-oriented. The NAV was designed to function as a single entrance to the various employment and welfare administration services, and multiple service users were a major target group (Lffigreid & Rykkja, 2013). An important task of NAV and the counsellors is to consider measures and services each individual user needs in order to improve self-help, social security and social inclusion. Counsellors perform different tasks such as counselling, administrating economic allowances, referring users to activation measures, conducting meetings with other relevant welfare actors, etc. The different goals of the reform are difficult to combine, and the counsellors must find a balance between the demands of productivity and effectiveness on the one hand and those of individual help and support on the other (Nilssen & Kildal, 2009).

Beyond centrally decided minimum requirements such as financial social assistance, the inclusion of municipal social services in the local NAV office has been made optional. In 2012, 65% of Norwegian municipalities had incorporated all or parts of the substance abuse services into the local NAV office (Helsedirektora-tet, 2013). In addition, people with substance abuse problems are supposed to receive help from ordinary municipal health and care services. This includes services from a number of sectors, including home-based care services, nursing homes, psychologists and municipal mental health units. The municipal social and health service can refer to specialist services if necessary (Helsedirektoratet, 2013).

Discourses on substance abuse and age: Material and methodology

The 23 counsellors I interviewed were selected from three NAV offices located in three different municipalities in Western Norway with 4000 to 14,000 inhabitants. I chose NAV offices from municipalities with a certain degree of substance abuse problems which also had incorporated all or major parts of the substance abuse services into the local NAV office. The three offices were organised in different ways, and the counsellors who dealt with substance abuse were employed in various departments and had different tasks. My only selection criterion was that the interviewees counselled users who suffered from substance abuse problems. Hence, the group of counsellors I interviewed is very heterogeneous. Not all of them were "counsellors" in their official job title, though I will stick to this term for all of them. Nineteen of them were women; four men. Two counsellors were in their twenties, two in their thirties, fourteen in their forties, three in their fifties and two in their sixties. One of them worked with as many as 130 users, another had as few as thirty. Some of the counsellors had studied social work or health care, some economics or political science, and some had no degree but qualifying work experience. Some interviewees saw themselves as experienced substance abuse workers; others as rather inexperienced. The study was conducted in accordance with ethical standards and regulations and was approved by NSD (Data Protection Official for Research).


If possible, the counsellors were interviewed twice, and therefore my material

consists of 41 interviews. The interviews were conducted in 2012 and 2013; they are about an hour long and were audio-taped and transcribed verbatim. Inspired by the concept of the teller-focused interview, which is based on a dialectical way of thinking about the relationship between interviewer and interviewee (Hyden, 2000, 2014), I tried to create a framework and a relationship in which the counsellors could feel free to talk about their experiences, thoughts and feelings. I strove to hear and explore the counsellors' interpretations, reasoning and reflections on their experiences. Prior to the first interview, I prepared two questions: "What led you to work here, in this office, with the tasks that you have?" and "Can you tell me, in all anonymity, about your work with a user with substance abuse problems?" The counsellors explained that the cases they chose to tell me about were in some way or another "interesting", "time-consuming at the moment", "positive" or "difficult". When I conducted the second interview, approximately six months after the first one, I asked: "Can you tell me what has happened since we last met? Are there any changes?" I also used the second interview to elaborate on reflections and understandings that were shared in the first interview, to get thicker descriptions of the topics. For example, when I analysed the first interviews and became aware of the significance of age, I could explore the meanings of age more extensively in some of the second interviews. Since I focused on descriptions and reflections on specific incidents, the material is saturated with detailed and varied reasoning and understanding - and consequently offers an opportunity to explore meanings-making processes.


Inspired by discourse psychology and by intersectional and poststructuralist approaches, I applied different analytical questions and concepts in my first round of analysis (Crenshaw, 1991; Haavind, 2000; Staunffis & Sondergaard, 2006; S0nder-gaard, 2002; Ulvik, 2007). In order to examine the complex and shifting dimensions of the category of substance abuse, I looked for contradictions, ambiguities and variations in how substance abuse was narrated. I explored the categories and interpretations that occurred in the material, and analysed the discursive premises of these interpretations (S0ndergaard, 2002). The concept of discourse, defined as "a multi-faceted public process through which meanings are progressively and dynamically achieved" (Davies & Harre, 2001, p. 4), is used as an analytical tool to expand the understanding of how the counsellors relate to substance abuse and age.

Originally, age was not a primary issue in this study, but it became a focus as a result of this first round of analysis. Although age was not a topic in all the interviews, the empirical material and the intersectional perspective I applied made me gradually aware of the significance of discourses on age, in particular discourses on "youth" and "adult". More categories are to be found in the empirical material, such as "gender" and "time"2. An intersectional perspective invites to include several categories in the analysis, but it is a difficult task in practice to include all the complexity (Staunffis, 2003). In this article I found it most beneficial to focus on age although it entails a delimitation of the categories involved in the meaning-making processes.

In the second round of my analysis I ex-


plored the dynamic relationship between discourses on substance abuse and age in more detail, and how this intersection produces specific subject positions. Although discourses on substance abuse and age are mutually entangled, I concentrate on how discourses on substance abuse are related to discourses on age. I use the concept of subject position as closely related to the concept of discourse. In this sense, discourses are the ways in which people think, talk and act define the position they place themselves in, the position they ascribe to others, and the agency they dispose of to act (Davies & Harre, 2001). In my analysis, I constructed different discourses accompanied by corresponding subject positions which I categorised as "the vulnerable youth", "the formative youth" and "the agentic adult". I will elaborate these positions below by adding interviews ex-cerpts3. When I recognised the relevance of the categories of "youth" and "adult" in my empirical material, I read relevant policy documents of the NAV, including those on substance abuse, with renewed interest. I wanted to see how the discourses found in the counsellors' narratives were related to discourses in the official policy documents. This comparison is presented at the end of the results section.


Institutional use of age categories The NAV offices are obliged to meet numerous and complex needs and have to offer several different services. The users are assigned to a counsellor on the basis of specific user characteristics. One of them is age: "We have separated those users younger than twenty years" (Ingrid); "We offer work training for the youths" (Evy);

and "I deal with people younger than thirty years of age" (Kari). Here, age is used as a relevant factor for the office's decision of who is to receive what kind of help. Implicitly, the meanings attributed to age say something central about the users.

My data material shows that age takes precedence over other categories. A general pattern is that counsellors who counsel younger users have fewer clients. Subsequently, these users receive more attention than do older clients. Randi and Vibeke state:

Those who have users older than thirty, have many users. Sixty to seventy. It's obvious that their span is limited. [...] In my opinion, these users aren't seen to that often. They don't get that much attention. (Randi)

In the NAV system, we're supposed to focus on the young ones - those under thirty years of age. [...] I can't say that we've focused equally on users who are closer to fifty, and that's questionable. You sort of play them against each other. They drift. They are definitely not given priority. (Vibeke)

Mari works with "youth", defined as "those under thirty years of age". She is supposed to attend to some thirty young people, and approximately ten of these have substance use problems. Morten is one. Mari explains: "It's complicated. He has a child to care for. The child's mother is a substance abuser too. The child welfare service have been there the whole time". Morten is older than thirty and therefore does not really belong into the group Mari works with, but she is reluctant to move him elsewhere: "I

worry that if he's moved he won't get any help at all, because the other group is too big". By keeping Morten in her group, Mari negotiates age meanings. She challenges the discourse in which age is a defining differentiating axis, and, according to her interview, attracts criticism from her colleagues: "Why do you hold on to those over thirty years of age? It prevents us from using our capacity on the youths". In this narrative, Mari's colleague reproduces age as a defining priority axis, and the statement contributes to constructing an antagonism: "those older than thirty" versus "the youths". Morten is positioned as not one of "the youths". In this narrative "age" overrules other categories such as "parent". Consequently, Morten's age alone excludes him from being given priority.

I also found that age affects the procedure of setting targets. Vibeke says:

"You must focus on the youngest ones - those under thirty. You have to get them through the system. They must become independent. With the older ones it's different; you have to clarify their situation, so that they don't have to sit around and wonder. It's more likely to turn the youngest ones around". (Vibeke)

The terms "turn around" and "clarify" indicate the different tasks counsellors have. They have to both assure, or "clarify", the user's entitlement to financial support, and offer help and support for them to become self-sufficient, or to be "turned around". In this narrative, "the youngest ones" are to be "turned around", while cases in which the user is older than thirty, are to be "clarified". The two different expressions betray

two different objectives, and the category of "age" is used as a differentiating tool in deciding whether the goal is to either "turn around" or "clarify" a case.

The discourse of "focus on the young ones" In my material, the age limits for grouping and differentiating between users vary between 20, 26, 30 and 40 years. When a user younger than 20, 26, 30 or 40 is given priority, the terms "young" and "youth" are expressed as categories of meaning which classify the prioritised group. This is certainly true for Mari's case; her colleagues criticise the fact that she gives precedence to Morten who is not "youth". Evy, who works in a NAV office which has applied for and received extra resources to start a work training programme for youth, explains: "We said that youth are those younger than forty years". The statement "we said that" indicates that Evy sees the category of "youth" as flexible and negotiable. The age limit Evy and her colleagues apply to the work training programme could be seen as reproducing the discourse of "focus on the young ones". Yet, at the same time, they expand the discourse and fill it with new meaning.

While the NAV system encourages the counsellors to focus on the young ones, the interviews suggest also that this prior-itisation is taken for granted. The counsellors give no reasons why they differentiate between adults and youth and why they prioritise the latter. Thus, the "focus on the young ones" discourse claims a self-evident position, and makes it worthwhile to have a closer look at the meaning of the category of "youth". In my data material, I have identified two discourses about youth which are a part of and underpin


the "focus on the young ones" discourse: "youth as an age of risk" and "youth as an age of formation".

"Youth as an age of risk" When talking about the work training her NAV office offers, Evy explains that participants with a history of substance abuse must pass a urine test when they participate in this group, because "We have a few youth here. When I employ persons with substance abuse problems, I can actually end up introducing young people to substance abuse" (Evy). Here, she draws on meanings of the categories of "substance abuse" and "youth" that are accessible to her. Her narrative seems to maintain that substance abuse is contagious, and that having participants with substance abuse problems in the work training group is risky. However, not all participants are at risk; only the "youth" are in danger. Hence, in her reasoning, she interprets "youth" in a different way than she did when she referred to "youth" who were "those under forty years of age". She now considers "youth" a smaller group unified by special needs and separated from other participants solely by their young age which makes them vulnerable. Implicitly, the "youth" are positioned as prone to danger and temptation.

The understanding of "youth" as being vulnerable seems to be widespread. In this context research has shown that a young age is generally regarded as risky in modern society. The teenage years are frequently depicted as years of agitation, experimenting and rebellion (Fr0nes, 2011; Room, 2012). While using alcohol or drugs in this period of life is a sign of maturity, young people also enter a danger zone in their efforts to mature (Demant & Jarvinen, 2006; Rolando

& Katainen, 2014; Room, 2012).

The discourse of "youth as an age of risk" offers certain subject positions. Within this discourse young NAV users are positioned with limited responsibility, while the counsellor is positioned with responsibility for the young, vulnerable user. This understanding justifies a prioritising of young users. Dorte, for instance, says this about her work with David, who was "young, in his mid-twenties" and under treatment in a substance abuse clinic:

He had a big relapse. He went to the city and took drugs. And it could've cost his life. He's very uncritical in what he takes. He doesn't move around easily, and so the city is large, in his eyes. We tried to trace him. He needed to go into rehab, after all, so we had to get him back into the institution. Now that he dropped out, there was so much I had to do. I just had to put everything else aside, and get hold of him. (Dorte)

Expressions such as "he had a big relapse", "it could've cost his life" and "he's very uncritical" reveal that David is a user who is communicated as prone to risk. In her narrative Dorte positions him as vulnerable, and as long as he is vulnerable, it seems important to act. David is positioned without agency, whereas Dorte as his helper positions herself as responsible and capable of agency. She is the one who must "trace him", "get him back" and "get hold of him".

"Youth as an age of formation" Taking drugs is narrated as an act that may lead to severe consequences for the young. Vibeke says:

Those who waste years taking drugs don't learn what others learn when they're young - everyday routines and just doing what you do in life. They just skip it. And it's so obvious, they just fail. (Vibeke)

Kari elaborates:

Youth who have taken drugs such as marijuana - just imagine how it affects their attitude and drive. Poor people, they're so indifferent, you know, and lethargic. There's so much they haven't experienced. They haven't experienced the joy of making money. And when you look at the long road they have ahead of them. (Kari)

In these narratives Kari and Vibeke position "youth" as formative and discursively constructed as a very important period in life. The youth who abuse substances are being juxtaposed with those who do not abuse substances, and a clear dividing line is drawn between them. Those who take drugs "just fail", as they are positioned as "indifferent" and "lethargic", and they have a "long road" ahead of them. Also, these narratives construct normality: it is normal to perform "everyday routines", to have a certain "drive", and to experience the "joy of making money". And in this constructed normality it is crucial that the "formative youth" achieve ordinary skills. Vibeke and Kari's narratives reproduce a discourse where the years of youth are seen as an active, critical period. This is when attitudes, values and personality are formed; these years have a significant impact on a person's life and future.

When I interviewed Ida, she talked about Isac:

We've been working on his case for a long time. And now I've become impatient. Now and then he seems to think that I'm unpleasant. I don't like being unpleasant, but I'm not willing to let a young man - thirty years of age - just sit idle. He's not happy where he is. He's very kind and able, and could have a much better life. It's not right, I feel, letting people just sit about. Especially not the young. They have their whole lives ahead of them. (Ida)

In this narrative, Ida positions Isac as a "young man", linking his "youngness" with potential, for he has his "whole life ahead" of him. Ida's perspective is oriented towards development and future. In order to change Isac's future, one must act "now". The discourse Ida speaks and acts from influences the challenges and dilemmas she encounters here. In this sense Ida's statement reveals that she has a conscience, i.e. a moral responsibility to "act" on Isac's behalf.

Ida, Kari and Vibeke seem to have adopted the prevailing comprehension of the "youth". In so doing, they follow one of the most fundamental ideas of the dominant development paradigm according to which human development is a process towards independence and autonomy (Heggli, 2004; Room, 2012). As Lee (2001) points out, it is a widespread tendency to think of adults and children as fundamentally different types of human being. The "adult" is understood to have all the properties of an independent human being, while "children" are seen to have


all the properties of human becomings. Within this frame of thinking, the youth years are crucial, as this is when children develop into adults - the persons they are to be. However, Lee (2001) argues that this understanding is increasingly being questioned.

"The agentic adult" discourse Pal counsels 130 users who are temporarily or permanently unemployed and who do not fit into a preference-given age group. He talks about his efforts to help Patrick, an alcoholic nearing fifty years of age:

He's been to treatment institutions quite a few times now, he comes and goes. Every time he's left, he's gone downhill. He goes directly from here to the liquor store. He doesn't show much initiative or desire to stop drinking. (Pal)

In their last meeting Pal made a new attempt: "I wanted to find out if he was motivated to try again". "If he doesn't accept the measures we offer, he may actually lose his benefits" (Pal). The narrative on Patrick differs from the narratives on Isac and David: when Pal talks about Patrick, the generational position is not marked, while in Isac's and David's case, "young" and "youth" are central categories. In my interview material the category of "adult" is rarely mentioned, and accordingly, my study corresponds with other studies which state that "adulthood" seems to be less marked than "childhood", "youth" and "old age". The category of "adulthood" is constructed as "normal". It is "just there", and its cultural substance is

implicit (Heggli, 2004). Pal says that he has lost faith in Patrick. A liver function test has shown that the organ is severely damaged.

He's quite ill now, it seems, and he may not last long. He may realise that this is serious, but he still doesn't really want to make the great effort it takes. (Pal)

When I asked what options he had in Patrick's case, Pal replied:

I could attend more closely to him. Have him coming in more often. But that will affect some of the others who also ... And when I don't have much faith in him, how much time should I spend on him, when I have other people I may actually be able to help? It's a difficult decision. It sure is. (Pal)

While Mari described how the institutional framework and feedback from colleagues made it difficult for her to give priority to Morten, Pal talks about his precedence as based on his own decisions, and about the fact that he should give precedence to users he "may actually be able to help". While Ida seems to focus on the future, Pal's narrative refers to what has happened in the past: Patrick "has gone downhill". And the problem is that Patrick "doesn't really want to make the great effort it takes". Like Isac, Patrick does not show any will to change. In Isac's case his "youth" gives him precedence and development potential, whereas in Patrick's case the question is how much time the NAV should spend on him. Patrick is not given a position he could benefit from; in order to make up for this he has to show

something else, and that is, according to Pal's narrative, motivation and volition. By asking whether Patrick "is motivated to try again", Pal positions Patrick with agency. Yet the dilemma is that Patrick "doesn't show much initiative or desire to stop drinking". Within this discourse, which may be called "the agentic adult" discourse, the users' volition is seen as a premise for change and therefore for the counsellor's efforts to help. If Patrick is to change, he must be willing to do so. As a consequence, it is important to elucidate his intention. When Pal says that Patrick "goes directly from here to the liquor store", he attributes Patrick with a position as being active and able to make decisions: Patrick has agency, but does not exercise it the way he should do. Moreover, it is one of Pal's tasks to check Patrick's eligibility to financial support. Pal's narrative illustrates that Patrick's position as being agentic also influences Pal's consideration of Patrick's rights. Here rights and duties are linked to lack of capacity. When Patrick is positioned as capable of doing the right things, which he does not want to do, he may not be eligible, and "may actually lose his benefits".

In Pal's narrative Patrick's health is at risk, just like David's. While David's big relapse could have cost him his life, Patrick's liver is damaged. While Dorte's narrative positions her with the responsibility for solving the situation, Pal positions himself as less responsible for Patrick's situation. Within the framework of an "agentic adult" discourse the helper-user relation is based on equality; both helper and user must make an effort. They relate to each other as adults or as two sovereign associates. The user is positioned with the re-

sponsibility to change, and while will and involvement are seen as important factors, vulnerability and inequality are toned down. Substance use is woven into this process of meaning-making and is regarded as a choice. By positioning Patrick as being agentic, Pal positions himself - the helper - with a limited scope of action. If the user "doesn't want any help', there is -within "the agentic adult" discourse - not much the helper can do. Besides, Pal's narrative is also drawing on the cost-benefit discourse according to which the helper's efforts are justified by the prospect that users will definitely benefit from them. This in effect underpins the discourse of "focus on the young ones".

NAV counsellor Oline talks about Odd, a former "heavy substance abuser". For a long time they did not know what to do with him, but now he has changed for the better:

He's had work training for some time now, and he's doing well. I believe he's forty something, so he's growing up, I suppose. He's always at work. He shows up every day. And he's motivated. He wants this. This is his chance, he says. The training, the possibility of getting a proper job ... That's certainly important, but I think what plays the biggest part is the fact that he's made up his mind: it's now or never. He's come to this decision himself. In my opinion, we're not the ones to tell them what to do. They have to decide for themselves. (Oline)

Like Patrick, Odd is positioned as agen-tic, but contrary to Patrick, Odd is "motivated". "He wants this", and "he's come


to this decision himself". In her narrative, Oline considers Odd's motivation the key to success. While Dorte had to "do" things and take responsibility for David's wants, Odd "is doing well", and has "come to this decision himself". The counsellor's help is seen as a factor that "plays a part" in Odd's development, but what is far more decisive is Odd's volition.

"Substance abuse" and "age" in policy documents

The "focus on the young ones" discourse is also visible in relevant policy documents. For example, in the draft budget of the Ministry of Labour (Arbeidsdeparte-mentet) for 2012/2013, "youth" and "immigrants" and "people with limited working abilities" are presented as "a vulnerable group demanding particular attention" (Prop. 1 S, (2012/2013), p. 11). The term "youth" is often used without referring to a specific age group. When it is specified in the proposition, it refers to "youth under twenty years of age" (p. 17), "youth aged 20 to 24" (p. 17) and "youth (15-24)" (p. 28). The terms of reference used by the Ministry of Labour to outline the task field of the NAV are also unambiguous: "Among people with limited working abilities, those under thirty years of age are to be given precedence" (Arbeidsdepartementet 2013, pp. 9, 12). "Housing policies are to be focused on youth and young adults" (p. 18). "The focus on youth must be intensified" (NAV, 2013, p. 2). In the White Paper on drugs and alcohol policy (Meld. St. 30 (2011-2012), p. 8), "young people" are seen as "a particularly vulnerable group" that will be given priority in treatment and substance abuse services (Meld. St. 30 (2011-2012), p. 8).

Young people are also positioned as vulnerable in policy documents. They are portrayed as "exposed" and they "require special attention" (Prop. 1 S (2012-2013), p. 11). The White Paper argues that "there are several reasons to protect the young", one reason being:

The part of the brain that controls the need to experiment and seek sensation develops faster than the frontal lobe, which controls self-regulation and impulse control. Therefore, young people are more prone to risk when under the influence of alcohol or drugs. (Meld. St. 30 (2011-2012), p. 40)

This reasoning is tied to a neuroscientific discourse and underpins the view of youth as being particularly vulnerable and in need of priority.

The draft budget of the Ministry of Labour states furthermore: "In particular, it is critical if young people, on the brink of their working career, are unable to establish themselves, and end up without a job" (Prop. 1 S (2012-2013), p. 65). "It is important to intervene at an early stage, resolve the need for support and subsequently prevent that the young person is left out from education and work" (p. 111). Why it is particularly critical if a young person ends up without work and why it is important to intervene at an early stage, is not elaborated. Nevertheless, such arguments position youth as formative and justify a higher priority for young people. Similarly, the White Paper also considers youth as formative: "Young people are particularly prone to risky use of drugs and alcohol, and hence, one may assume that consuming large amounts of alcohol

will have a permanent negative effect on a person's learning ability and memory" (Meld. St. 30 (2011-2012), p. 40). The terminology with expressions such as "critical", "establish", "end up" and "permanent" reflects the idea of a process with an "early" and a "late" state. On the whole, such statements both represent and constitute a discourse in which substance abuse problems are seen as gradually developing over a period of time. The longer the period, the more severe the problem. This line of reasoning taps into a long-established concept of disease, in which the disease -the substance use - is irreversibly progressive and cannot be altered by the individual user (e.g. Jarvinen & Andersen, 2009; Russell, 2011). As maintained by this concept, the substance abuser ends up positioned without control and deprived of agency. Consequently, it is "important to intervene at an early stage", before the problem becomes "permanent".

Summary: A case of ageism?

My analysis shows how discourses on substance abuse are related to discourses on age. The meanings of substance abuse shift; a "young substance abuser" is different from an "adult substance abuser". The counsellors' narratives illustrate how the meanings of substance abuse in those positions vary and how this affects the strategies applied by the social system. Researchers have emphasised that professionals looking to solve a substance abuse case tend to attribute the substance abuser with a high degree of responsibility (Jarvinen, 2002; Koski-Jannes et al., 2012; Palm, 2004). Yet the question remains whether the "young substance abuser" and the "adult substance abuser" are credited with the same

degree of responsibility. My article aims to contribute to an understanding of how discourses on age create important premises for how users' and counsellors' responsibility is understood, and it emphasises the relevance of exploring such constructions as "responsibility" and "vulnerability" as dynamic and contextual phenomena.

The American psychiatrist Robert Neil Butler (1969) used the concept of "ageism" in order to describe systematic stereotyping and discrimination based on age differentiation, and the concept is well-established in age research. My analyses demonstrate that it is reasonable to employ Butler's concept when discussing age differentiation discourses in the field of substance abuse services. I have illustrated how both subject positions and institutional guidelines reinforce a dominating discourse of "focus on the young ones". Several of the counsellors I interviewed had many users to attend to, and prioritising is unavoidable. Both policy documents and institutional structures seem to suggest that age is seen as a differentiating axis for prioritising between different groups of users. Hence, whether a user is included in the position of "youth" or "adult" gives directions to the counsellor's scope of action. Moreover, the "focus on the young ones" discourse is underpinned by tapping into a long-established understanding of substance abuse as a disease where the progress of the substance abuse problem is seen as irreversibly progressing. Hence, one must act before it is too late. The presented discourses on age and the understanding of substance abuse as irreversibly progressing leads us to believe that meanings attached to the number of years with substance abuse are also signifi-


cant and in need of further exploration.

My analysis suggests that normativities which emerge from the age categories of "youth" and "adult" create premises for the respective positions of user and counsellor. The identified discourses position "youth" as being vulnerable and formative, while the counsellor is positioned with responsibility and potential to influence the young user's substance abuse. The situation is somewhat different for adult substance abusers. By seeing them as "agentic", the counsellors position themselves with less responsibility and less ability to influence the users' situation. If such interpretations are taken for granted they may prevent a counsellor from noticing and supporting a young person's agency and independence, or an adult's vulnerability and dependence. However, my analysis also shows that counsellors are not entirely determined by these discursive structures. They can, as seen in Mari's case, focus on and even prioritise users who are positioned as "adults", but this may be demanding, as it challenges the hegemonic "focus on the young ones" discourse.

The meanings attached to age and the age differentiating processes found in my material seem to be taken for granted, as theoretically naturalised. A similar differentiation based on gender or ethnicity would most probably be considered less justifiable. Ageism research has indeed emphasised that it is quite common to overlook and to be unaware of ageism (Ivey, Wieling, & Harris, 2000; North & Fiske, 2013). It is important to explore and discuss meaning-making processes that have become naturalised. Most ageism research, however, focuses on elderly people

and their situation. My analyses indicates that the age perspective should not be limited to a single age group. Instead ageism is to be seen as a discriminating way of differentiating between people based on age in every aspect of life.

The presented discourses are based on detailed narratives from a selection of counsellors. My findings are contextual-specific and apply to the new social welfare administration NAV, but beyond that, they confirm tendencies identified in research on substance abuse and age. Discourses make practices possible, and practices may reproduce, challenge or change discourses. Hence, knowledge of discourses is practically relevant. The discourses I have identified seem to be related to the idea that the categories of "youth" and "adult" are marked with characteristics, needs and rights which are essentially different. This points out the significance of making naturalised discourses related to age visible and to discuss them, both in the field of substance abuse services and in other fields of social practice. The field of substance abuse services may offer a specific context for exploring age meanings, for substance abuse violates cultural tolerance limits and thereby challenges the normativities based on age. In this context the discourses on age and their consequences may become more visible and in this manner, substance abuse research and ageism research can be mutually beneficial.

Declaration of interest None.

Lillian Bruland Selseng, PhD candidate Sogn og Fjordane University College Sogndal, Norway E-mail:

1 In this article, "user" refers to individuals that make use of the Norwegian Labour and Welfare Service (NAV). It is a literal translation of NAV's term "bruker".

2 Other categories were the generational positions "child" and "old" and thecategories of "gender", "ill", "time" and "working capacity". Gender is highly relevant, but

as I see it, it is more explored than age as a

significant category in the substance abuse field. As for time, the majority of counsellors I interviewed chose to talk about users who had a long history of substance abuse, and after all, it is quite likely that age and the number of years of abuse are connected.

3 The counsellors and users were given fictitious names, and the interview excerpts have been edited.


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