Drugs

Cultures, Controls and Everyday Life

Nigel South

• Publisher: SAGE Publications Ltd
• Year: 1998
• Print ISBN: 9780761952350, 9780761952343
• eBook ISBN: 9781446227053
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

This authoritative overview of drugs and society today examines: whether a process of `normalization? of drugs and drug use is under way; the debate over prohibition versus legislation; `drugs? and `users? as `other? or `dangerous?; drugs and dance cultures; drug use among young women; images of `race? and drugs; medical responses to drugs; policing strategies and controlling drug users; drug control and sport; and the question of prohibition versus liberalization.

CONTROLS: POLICY, POLICING AND PROHIBITION

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5

MEDICINE, CUSTOM OR MORAL FIBRE: POLICY RESPONSES TO DRUG MISUSE

Susanne MacGregor

THE PROBLEM OF DRUGS

Social policy responses reflect the way a social problem is defined, which is in its turn affected by the character of social policy in that society.

In an account of historical concepts and constructs of drug dependence, Virginia Berridge has described how one commentator ‘writing about the “discovery” of morphine addiction in the 1870s, awarded praise to those whose views accorded with “modern” and “scientific” views:’

While tools were not yet at hand to dissect the inner character of the addiction problem, there were clinicians who now saw a responsibility for the health professions in prevention, and that the addiction problem involved a medical dimension as well as social custom and moral fibre. (Sonnedecker, 1962). (Berridge, 1990:1)

The three categories of explanation identified can be used to illustrate differing perceptions of the drugs problem and they can be shown to have dominated twentieth-century perceptions of the problem and policy responses to it.

MEDICAL EXPLANATIONS

Criticisms of the médicalisation of social problems were part of the rather crude 1970s debates between ‘medical’ and ‘social’ models of deviance. Medical definitions stress the interplay of psychological, biochemical and biological factors. More socio-medical approaches see these factors as mediated through a social environment. Recently, with the rise of genetics, pre-determined individual characteristics as explanations for behaviour have become more prominent. In the field of drug dependence, some medical explanations give central prominence to the toxicology of drug use, stressing the effects of various drugs on brain functioning, personality change and other physical effects such as liver damage. Important work has been done on the interactions of drugs taken together but this is still an under-researched area. Attention focuses on treatments for drug use utilising alternative drugs, methadone rather than heroin for example, and various treatment regimes to cope with withdrawal. These approaches dominate discussion in some European countries, such as Italy, where pharmacological explanations and interventions play a key role in responses to drug dependence. In Britain and the United States, medical practitioners are more likely to work in partnership with behavioural scientists like psychologists and adopt approaches to treatment which combine drug therapies with interventions based on theories of behaviour as conditioned or learned. So for these theorists, dependence on drugs is partly physical, involving a chemical dependency but is also partly learned. Interventions, which reprogram individuals to recognise signals triggering a desire to take drugs and encouraging them to respond differently to these, are part of treatment programmes focusing on each individual’s reactions to stimuli. Much work in traditional psychiatric departments is patient-centred in this way. These regimes are open to evaluations which follow cohorts of patients over time through a structured programme: outcomes can then be measured and treatment regimes evaluated for their effectiveness (Effectiveness Review, 1996).

Criticisms of these approaches are that they bracket out a range of influential factors, such as the characteristics of those recruited to treatment programmes, the situational and contextual features of the clinical regime, and the strong influence of other variables (including the activities of other health and social agencies) separate from the intervention programme itself. The key difference is between the individualism of the psychological perspective and greater awareness of the influence of social factors. This latter awareness is found among other medical practitioners (like GPs, public health physicians or social psychiatrists) who differ from those working closely with psychologists and pharmacologists in clinical settings. An alternative individualistic approach, often found in psychiatry and in social work, is that based on various forms of psychoanalytic theory. In a strong form, these explain drug dependence in terms of early childhood experiences and, in a weaker form, are the basis of much of the counselling which still characterises the activities of most treatment and care agencies.

The socio-medical type of explanation is found in the field of social psychiatry (a field more concerned with epidemiological research and with debates about the shape of policy and practice than that of the clinical psychiatrists with a special interest in drug dependence). This approach will be illustrated by reference to a collection edited by Michael Rutter and David J. Smith (1995), which focuses on young people, especially teenagers. It asks the fin de siècle question ‘Are things getting worse?’ The writers review the best scientific evidence available and focus on disorders where there is ‘serious malfunctioning of individuals in their social setting’ (Smith and Rutter, 1995: 1).

These analysts look at the interconnection of ‘individual factors (including the process of individual development) and social structures and conditions’ (1995: 1). They rely on a notion of dysfunctionality, arguing that disorder is most often (with rare exceptions) a sign of individual and social failure. Social context plays a part in the explanation. Contemporary contextual features which, it is hypothesised, have influenced the rise in rates of disorder among young people in late twentieth-century Western societies, include: changing patterns of adolescence; increase in life expectancy; a reduction in the proportion of young people in the population; improvements in general health and living conditions; increase in leisure; and the growing instability of family units. Concepts utilised in the most recent of this literature and coming increasingly to influence the design of intervention strategies are ‘risk’ and ‘opportunity’.

Currently social conditions exhibit rapid transformation in ‘populations, migration and social institutions . . . [change in] family’s shape and structure [and] . . . rapid technological advances [which] have transformed the meaning of work and the roles associated with it’ (Hess, 1995: 104). The family is seen as crucial in affecting human psychosocial development. Changes include more divorce, remarriage, cohabitation, lone living and lone parenting. These trends are most evident in northern Europe (Hess, 1995:172–3) and are sources of stress to which individuals have to adapt. Different individuals respond differently to these stresses – some are more resilient, others more vulnerable.

This approach has informed recent social policy responses to a wide range of problems. Such accounts typically conclude that ‘young people embedded in families characterised by high levels of conflict or by parents who are not able to provide adequate supervision, effective discipline and emotional support, have an increased risk of experiencing a range of psychosocial disorders’. (Hess, 1995:173). At the same time, it is acknowledged that there is evidence that some young people seem to have a resilience that protects them from adverse effects, in spite of being subject to these influences. Protective factors include:

1. the use of external sources of support: Peer groups can be very influential: the culture of the peer group is an important influence. Schools and relationships with teachers can be crucial. ‘[I]ncreased involvement in social institutions outside the family – whether structured through youth organisations, schools, sports clubs, churches, local businesses, or community agencies – may increase adolescents’ interactions with supportive peers and adult role models and can decrease feelings of isolation and marginality’ (Hess, 1995: 174–5);
2. close affectional ties to family members: ‘Regardless of family constellation, low family conflict and high family cohesion is most conducive to healthy adolescent adjustment, including positive self-esteem and motivation to achieve academically, high goal-directedness, and low severity of psychopathology’ (Hess, 1995: 175, quoting from Kurdek and Sinclair, 1988);
3. other protective factors: These are personality-based, like temperament (activity level and reactivity) intelligence and cognitive abilities, and social and communicative skills. ‘These intra-individual characteristics modify the effects of contextual conditions’ (Hess, 1995: 175).

One chapter in the Rutter and Smith collection focuses specifically on alcohol and drug abuse (Silbereisen et al., 1995). The authors review changes in the availability of illicit drugs through the twentieth century, noting rises in the range, amount and accessibility of illicit drugs since the 1960s. As many commentators have suggested, this development was interwoven with the cultural revolutions of that decade (youth culture, hedonism, challenges to and declining respect for authority, etc.). Silbereisen et al. also point out that Europe is the continent with the highest alcohol consumption, with consumption in central and eastern Europe growing rapidly in recent years. These authors note that American data has monitored a massive increase in illicit use of drugs there between the 1950s and 1970s. There was something of a decline in the 1980s (apart from cocaine use). The data still show a high level of use (Silbereisen et al., 1995: 501–3): ‘data from drug shipment seizures, mortality statistics, and clinic attendance all confirm that the rise in occasional or regular recreational drug use was closely paralleled by a similar marked increase in substance abuse and dependency (1995: 503). European countries experienced a comparable although slightly later upsurge in both drug use and abuse and the phenonemon of ‘recreational’ drug use is now a recognised aspect of the lifestyle of a large minority of young people in Britain.

A key principle of this type of explanatory framework, which rests on carefully collected social data, is that ‘the medical and social ill-effects of alcohol [and use of other substances] tend to increase and decrease in line with changes in overall levels of consumption’ (Silbereisen et al., 1995: 518). This fundamental public health/epidemiological finding informs policy responses: policies which can effectively reduce overall levels of consumption in a society will reduce the rate of ‘problems’ or ‘disorders’ encountered. This view has recently been challenged by researchers like Eric Single, who has argued that the overall level of consumption is too crude a factor on which to base public policy (Single, 1996). Measures of the overall level of consumption disguise important factors, such as whether consumption follows regular but moderate patterns or whether the pattern varies substantially and frequently, i.e. where ‘binges’ are present. Binge use is most likely to cause harm to the individual’s health and to the safety of others. Policy responses, Single argues, should therefore be more subtle and focused, aiming to control and regulate patterns of substance use and, especially, to modify/regulate the environment in which substance use takes place (by reducing potentially harmful features like access to vehicles and the presence of dangerous objects, like glasses which smash or furniture with sharp edges, and increasing protective factors, such as availability of trained service personnel, in clubs and pubs for example, or providing plenty of free, clean water and cooling-off areas). These ideas are already being developed in practice, particularly in the alcohol field, and are often being applied to environments in which illicit drug use takes place.

Explanatory factors for rises in illicit drug consumption found in this type of socio-medical account include: economic factors (such as increased personal disposable incomes, increased availability/supply of drugs, changes in the ecology of work); beliefs, attitudes and values (the growing influence of peer groups, lessening of disapproval in the general culture); demographic and economic conditions (age cohort size – baby boom and baby bust – combined with the expansion or contraction of the demand for labour); family structure; status transition to adulthood (changes in the meaning and experience of adolescence); and conduct disorder.

This socio-medical approach is probably still the most influential one in social policy in the English-speaking world and possibly elsewhere. It is informed by social epidemiological data and utilises the concept of ‘risk’ as a key explanatory variable. Related concepts are those of ‘lifestyle’ and ‘problem’. The core of observation is the behaviour of categories of individuals, with the category ‘young person’ featuring prominently. The link between human behaviour and ill-health/social problems is meticulously analysed. The outcome (including problem drug taking) is seen to result from a complex interaction of psychosocial and cultural factors. Policies have to be, it is argued, well informed about these complex interactions if they are to have any chance of being effective. The aim is a rational, scientific approach to policy-making.

Whether such views actually inform policy-making will reflect the extent to which rational, scientific discourse is well regarded and respected in policy-making circles. In the mid-twentieth century (on the whole the high point of the scientific-managerialist approach to policy) the views of professionals and experts weighed quite heavily in the process, albeit always subject to constraint from other influences. With the end of the welfare state era, one effect, seen in Britain particularly, has been the relative decline in the influence of such technical experts and scientific discourse, compared to the rising influence of other forces, with the mass media being the most important growing influence on policy through its direct impact on the ideas and priorities of politicians and civil servants in an era of mass electoral politics.

SOCIOLOGICAL EXPLANATIONS

There are two drug problems in America. One is the drug problem of the affluent. . . The other one is the drug problem of America’s have-nots. (Currie, 1993: 3)

Sociological accounts at present focus on the problems of the ‘inner city poor’. To say drug misuse is endemic is to say that it is ‘deeply entrenched in a population and stubbornly resists eradication’ (Currie, 1993: 4). In his recent book on social policy and drugs, Currie castigates American drugs policy because it has been based on a false reading and analysis of the problem. He argues that ‘drug abuse on the American scale reflects deeper structural problems in our economy and society’ (1993: 4). He stresses that drug abuse is far worse in the US than in any other country in the developed world (cf. Pearson, 1995). The scale of the problem should be at the centre of attention: a problem of this magnitude cannot be explained adequately in terms of individuals’ malfunctioning. Serious drug abuse runs along the fault lines of society: ‘it is concentrated among some groups and not others and has been for at least half a century. Recognising these realities is the first step in coming to grips with the drug crisis in America,’ argues Currie (1993: 5).

Drug use is a social problem: to address it, policy has to confront its social roots. Currie argues that the search for quick-fix solutions is self-defeating and wasteful and observes that a high proportion of prisoners in America’s gaols are there simply because of the ‘war on drugs’. Other social critics in America (Priven and Cloward, 1993; Gans, 1995) have seen such policies as part of wider wars on welfare and on the poor. Some political activists have gone so far as to describe these practices as constituting a genocidal war on the black race.

The structural roots of drug problems are those associated with the collapse of inner city neighbourhoods: the consequences are decay, lawlessness, drug-related violence, crime and gun warfare. Other features highlighted in numerous sociological ‘social problems’ accounts are the links between drug use and AIDS and the strain on the American criminal justice system – ‘the largest and most costly apparatus of surveillance and confinement in the world’ (Currie, 1993:14). ‘Today the United States incarcerates a larger proportion of its citizens than any other country, having surpassed South Africa and the Soviet Union by the end of the 1980s’ (1993: 14) an achievement partly propelled by the escalation of the criminal justice response to drugs, both ‘hard’ and ‘soft’: (the implications of the ‘three strikes and you’re out’ policy is that a drug offence can result in incarce...

Table of contents

• Cover Page
• Title
• Copyright
• Dedication
• Contents
• Notes on contributors
• Introduction
• Cultures: Forms and Representations
• Controls: Policy, Policing and Prohibition
• Conclusion
• Index