title: Excusing exclusion: Accounting for rule-breaking and sanctions in a Swedish methadone clinic.
abstract: BACKGROUND
  Methadone maintenance treatment has been subjected to much debate and controversy in Sweden during the last decades. Thresholds for getting access are high and control policies strict within the programmes. This article analyses how professionals working in a Swedish methadone clinic discuss and decide on appropriate responses to clients' rule-breaking behaviour.
  
  
  METHODS
  The research data consist of field notes from observations of three interprofessional team meetings where different clients' illicit drug use is discussed. A micro-sociological approach and accounts analysis was applied to the data.
  
  
  RESULTS
  During their decision-oriented talk at the meetings, the professionals account for: (1) sanctions, (2) nonsanction, (3) mildness. In accounting for (2) and (3), they also account for clients' rule-breaking behaviour. Analysis shows how these ways of accounting are concerned with locating blame and responsibility for the act in question, as well as with constructing excuses and justifications for the clients and for the professionals themselves.
  
  
  CONCLUSIONS
  In general, these results demonstrate that maintenance treatment in everyday professional decision-making, far from being a neutral evidence-based practice, involves a substantial amount of professional discretion and moral judgements. Sanctions are chosen according to the way in which a deviance from the rules is explained and, in doing so, a certain behaviour is deemed to be serious, dangerous and unacceptable - or excusable.
authors.affiliation: Department of Social Work, University of Gothenburg, PO Box 720, SE 405 30 Gothenburg, Sweden. Electronic address: frida.petersson@socwork.gu.se.
authors.forename: Frida J M
authors.initials: FJ
authors.lastname: Petersson
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003617:Dangerous Behavior; D003657:Decision Making; D055030:Drug Users / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006556:Heroin Dependence / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D010348:Patient Care Team; D010349:Patient Compliance; D016730:Program Development; D015397:Program Evaluation; D011678:Punishment; D012008:Recurrence; D012941:Social Responsibility; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone
keywords: Accounts analysis; Discretion; Involuntary discharge; Methadone maintenance treatment