From disruption to empowerment: Young people’s narratives of substance use treatment trajectories

Background Youth substance use is considered a high-priority issue in Sweden, yet research on youth treatment trajectories remains limited. This study adopts a narrative approach to explore how young people interpret substance use treatment, and how treatment aims, assumptions, and language resonate with their identity-work.Methods We conducted 25 interviews with participants aged 15–20 years who had recently been enrolled in treatment. The data was interpreted using narrative thematic analysis.Results Four treatment trajectories were identified: (1) the disruptive, focused on leaving treatment; (2) the misdirected, dominated by coercion and mismanaged interventions; (3) the empowering, emphasizing personal growth; and (4) the supportive, centered on improvements in mental health. The participants drew on different narrative resources to navigate tensions between organizational imperatives such as control and responsibilization, cultural narratives about youth and substance use, and their own evolving identities. While most participants eventually quit using substances, some reported experiences of stigma, distress, and coercion in treatment. The findings highlight the diversity among youth in treatment and the importance of individualized, agency-promoting interventions.Conclusion More differentiated approaches are needed. We suggest that Swedish youth substance use treatment would benefit from a stronger focus on self-care, acceptance of gradual change, and client-defined goals.