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Karin Heimdahl VepsäSenior lecturer

Research projects

Publications

A selection from Stockholm University publication database

  • Polyphonic narratives: The mixing of Alcoholics Anonymous and relapse prevention in stories about recovery and relapse

    2024. Karin Heimdahl Vepsä (et al.). Nordic Studies on Alcohol and Drugs

    Article

    Aim:  This exploratory study analyses the interplay between the treatment philosophies of Alcoholics Anonymous (AA) and Relapse Prevention (RP) in personal stories of addiction. While the basic ideas of AA and RP are compatible in many ways, they also carry some fundamental differences.

    Methods: The data consisted of interviews with 12 individuals recovering from substance use problems, who had experience of both AA and RP. The analysis drew on a dialogical narrative perspective, and the concept polyphony was used to shed light on the interplay between different treatment philosophies in personal stories of relapse.

    Findings: Although sometimes resulting in incoherence, the treatment philosophies were combined idiosyncratically, in ways that appeared productive for the participants’ self-images and recovery journeys.

    Conclusion: The combination of AA and RP philosophies in narratives of relapse and recovery may reflect a new treatment discourse where individualisation and responsibilisation stand in a complicated relationship with collectivism and surrendering to so-called addicting processes.

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  • Atmospheres of craving: a relational understanding of the desire to use drugs

    2024. Josefin Månsson (et al.). Drugs 31 (1), 130-138

    Article

    Aims: Craving is commonly described as an ‘intense desire’ to use drugs. Due to its relevance for addiction theories and treatment, much effort has been put into understanding how and when craving occurs. An undisputed definition of craving is however still lacking. The aim of this article is to explore how craving is experienced and resisted after cessation of substance use.

    Methods: This article analyses interviews with former addiction treatment clients. By analyzing the described event of craving, the study shows the complexities in such narratives.

    Findings: We found that the interaction between temporal, relational and material forces move people toward or away from craving. Craving thus seemed to be both relational and located in-between forces.

    Conclusions: We conclude that craving appeared in the studied narratives to emanate from different atmospheres, with a concurrent focus on settings rather than on substances. A relational understanding of craving can add to the typical, but limited, account of craving as an individual issue. It also avoids stigmatizing ideas that people who do not resist cravings simply fail to say no. We end by asking if craving is a relevant concept within the addiction field at all.

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  • Self‐interpellation in narratives about craving: Multiple and unitary selves

    2022. Mats Ekendahl (et al.). Sociology of Health and Illness 44 (9), 1391-1407

    Article

    The concept of addiction seeks to explain why people actcontrary to their own best interest. At the centre stageof addiction discourse is craving, conceptualised as astrong urge to use substances. This article analyses howtalk therapies such as relapse prevention and self-helpgroups shape identity constructions and understandingsof craving among clients. Drawing upon interviewswith individuals who have engaged in talk therapies inSweden, we analyse how craving is made up through‘self-interpellation’, that is, personal narratives aboutpast, present or future thoughts, feelings and actions.The main ‘self-interpellation’ included multiple selves,where craving was elided by the true self and only feltby the inauthentic self. Less dominant were narrativeswhich drew on a unitary self that remained stable overtime and had to fight craving. The notion of multipleselves appeared as a master narrative that the participantswere positioned by in their identity constructions.We conclude that this multiplicity seems ontologicallydemanding for people who try to recover from substanceuse problems. A demystification of craving, in whichneither substance effects nor malfunctioning brains areblamed for seemingly irrational thoughts and actions, may reduce the stigmatisation of those who have developedhabitual substance use.

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  • Substance use, pregnancy, and parenthood: A study on problematizations and solutions

    2021. Karin Heimdahl Vepsä.

    Thesis (Doc)

    With the starting point in the view that how we interpret a problem is decisive for how we think this problem should be dealt with, the overall aim of this dissertation is to explore problematizations of substance use in relation to pregnancy and parenthood within different settings. 

    The dissertation consists of four studies, based on different empirical materials, that analyze problematizations of substance use, pregnancy, and parenthood from different perspectives. Elucidating how these constructions are made in social work related settings can in the long run contribute to improve the ways that pregnant women and parents with substance use problems are approached.

    Study I analyzes the Swedish discussion on the diagnosing of Fetal alcohol spectrum disorders (FASD). The data consists of a report from a Swedish authority and webpage material from an FASD interest organization. The results show that the interest organization and the authority have different views on whether FASD diagnoses should be used. The analysis suggests that the discussion on FASD is structured by three main discourses; a scientific discourse, a pragmatic discourse, and an ethical discourse.

    Study II analyzes professional accounts of substance-using pregnant women’s transitions into parenthood. Professionals within maternity care were interviewed in focus groups. The results show that the professionals related to two, sometimes contradictory, ideals of, on the one hand, “believing in the patient” and on the other hand “being realistic” when reflecting on the patients’ prospects to function well as parents.

    Study III is carried out as a scoping review aimed to give an overview of research on psychosocial interventions targeting parents with substance use problems. It has a focus on underlying assumptions motivating these interventions. The results show that all studies but one focused on women as parents. Most of the interventions were primarily concerned with the psychological deficits of these mothers, while only seldom addressing broader social and structural factors.

    Study IV aims to explore how parents with previous substance use problems narrated their experiences of becoming and being parents. The study participants were all active in the 12-step movement. The results show that the way they narrated their experiences of substance use problems, recovery, and parenthood was structured by a classic 12-step storyline. The participants described how their recovery processes had made them more emotionally present and skilled in handling their own feelings – competences they described as important resources for them as parents. 

    The four studies, taken together, show some patterns in how substance use, pregnancy, and parenthood were problematized in relation to each other. The problematizations tended to portray parents, and especially mothers, with substance use problems as posing risks towards their children’s psychological and physical wellbeing. Furthermore, there was a tendency to define these parents solely based on their substance use problems, without acknowledging potential individual variation in parenting capacity. Finally, the solutions presented had a clear individualistic focus, emphasizing, for example, the importance of individual motivation and the willingness to comply with treatment, but only occasionally taking contextual and structural factors into account. 

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  • Is it FASD? And does it matter? Swedish perspectives on diagnosing Fetal Alcohol Spectrum Disorders

    2020. Karin Heimdahl Vepsä. Drugs

    Article

    Fetal alcohol spectrum disorders (FASD) is an umbrella term covering a range of conditions related to prenatal alcohol exposure. In Sweden, only the most severe of these conditions, Fetal alcohol syndrome (FAS), is used as a medical diagnosis. The aim of this study was to analyze the Swedish discussion on whether or not FASD conditions (other than FAS) should be actively diagnosed/identified. The data consisted of a webpage material from a FASD interest organization and a report from a Swedish authority. The analysis was informed by Fairclough’s critical discourse analysis and strived to pay attention to which discourses that were drawn upon, and how these discourses related to each other, and to a broader social context. The discussions on whether or not FASD should be actively diagnosed/identified were structured by three main discourses. These were: a scientific discourse, a pragmatic discourse, and an ethical discourse, with the scientific discourse taking a special position, often being present also when other discourses were drawn upon. Taken together, there is not yet any consensus around what the status of the FASD conditions should be in Sweden, neither regarding the usefulness of diagnosing/identifying, nor regarding the causality between prenatal alcohol exposure and FASD.

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  • Balancing Between Hope and Realism

    2018. Karin Heimdahl. Contemporary Drug Problems

    Article

    Pregnancy for women who use substances has sometimes been referred to as a “window of opportunity” for lifestyle change. In this article, the aim is to analyze professional accounts of the transition of substance-using pregnant women into parenthood. Focus groups were carried out with professionals working at specialized maternity care units in Sweden. The analysis is guided by the discursive psychological concept of “ideological dilemma” and focuses on contradictory elements of commonsense-making in the participants’ discussions. The results suggest that professionals articulate two, partly contradictory, ideals: on the one hand, “believing in the patient” and, on the other, “being realistic.” In their descriptions of their work with patients, professionals emphasize the significance of adjusting the self-image of the patients and increasing their awareness of their “abuse” problems in order to prevent future clashes between high expectations and reality. At the same time, they also underline that interacting with and treating those patients with the most serious problems as individuals with unforeseen strengths and resources is a matter of professional duty.

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  • Psychosocial interventions for substance-abusing parents and their young children

    2016. Karin Heimdahl, Patrik Karlsson. Addiction Research and Theory 24 (3), 236-247

    Article

    The aim of this scoping review was to give an overview of efficacy research on psychosocial interventions aimed at substance-abusing parents with children of up to the age of three. Throughout the overview, there was a focus on underlying assumptions and how the problem descriptions motivating the interventions corresponded with the solutions, i.e. the interventions in question. The data consisted of peer reviewed intervention studies (n = 22) identified through literature searches in online databases. Randomised controlled trial studies as well as quasi-experimental and pre-post studies were included. The results showed that all the studies included bar one focused exclusively on women as parents. Moreover, while the problem descriptions in the studies tended to be quite broad, framing parental substance abuse as a problem influenced by social and structural conditions, the solutions presented in the form of interventions generally had a narrower focus, addressing the individual parent from a psychological perspective only. In conclusion, the review points out the need for developing and evaluating interventions aimed at substance-abusing fathers as well as mothers, and also underscores the importance of these interventions being focused on a broader range of factors rather than just addressing deficits at the level of the individual.

    Read more about Psychosocial interventions for substance-abusing parents and their young children

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