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Rationalities of Choice and Practices of Care: Substitution Treatment in Denmark

As in many Western countries, notions of active, free, and self-managing citizens have become key concerns in Danish social policies. This article describes how these key concerns have made their inroads into laws and guidelines for delivery of social welfare services and how these laws and guidelines are intended to be implemented in social work practices. In the first part of the article, we analyze how policies envision drug users as active, free and self-managing citizens. In this view, citizens are assumed to have the desire to become more involved in their treatment and to choose the goals of their own treatment. In the second part, we focus on how this rationale changes under actual conditions of social work practice. Drawing on ethnographic fieldwork among social workers and drug users, we show how their daily encounters are not based on the presumption of individual choice. Rather, the life situations and problems of drug users conflict with the predominant idea that drug users are self-managing citizens who should be “empowered.” Instead, we argue that daily treatment encounters are not so much about individual choice and self-management, but rather, about improving the overall situation of drug users.