Drugs – trends, policy and practices in the Nordic countries

Citation

Klein, A., Asmussen Frank, V. and Nielsen, B. (2013), "Drugs – trends, policy and practices in the Nordic countries", Drugs and Alcohol Today, Vol. 13 No. 1. https://doi.org/10.1108/dat.2013.54413aaa.001

Drugs – trends, policy and practices in the Nordic countries

Article Type: Guest editorial From: Drugs and Alcohol Today, Volume 13, Issue 1

The Nordic countries provide something of a microcosm of global drug policies. In this region of some 20 odd million people, five different states – Denmark, Finland, Iceland, Norway and Sweden – are implementing policies that represent many of prevailing drug policy models from across the world. Nowhere else do we find a geographical concentration of such different attitudes to drugs as between, for instance, Denmark’s harm reduction and Sweden’s zero tolerance. These policies have not evolved in isolation, as drugs are the subject of lively public debate and well-resourced scientific investigation. There is a rich discourse on drug-related issues across scientific disciplines that feeds into policy and practice, though the direction of policy has so far proven impervious to findings that suggest a recalibration of the compass. The discourse on drugs and alcohol issues is not only well informed in the Nordic countries, it also has historic depth.

An important historical trait is the role of temperance campaigners, often linked to protestant churches, campaigning strenuously for restrictions on alcohol availability. A strong Anglo-Saxon influence can already be detected, with such key figures as Asbjorn Kloster, the founder of Temperance in Norway, who was invited by Quaker missionaries to study in England in 1846. Scottish missionaries were also instrumental in the founding of the Swedish Evangelical Society in 1809. Introducing an assertive and revivalist Christianity they laid a spiritual foundation for the rejection of alcohol, the use of which was portrayed as a violation of God’s law. The drunkard was said to have made a pact with the devil for whom “drinking is one of his strongest devices” (Eriksen, 1990).

In Sweden and Norway, just as in Britain and the USA during that era, alcohol became associated with a host of social evils encountered in fast growing, industrial cities. Family breakdown, miserable living conditions and community fragmentation were seen as a syndrome of modern, urban life where alcohol was readily available, and contrasted to an idyllic, rural past where sobriety prevailed. At the same time, fortunes were made and livelihoods sustained by the growth of industrial breweries such as Carlsberg in Denmark. The cultural attitudes towards alcohol in Nordic (but also Anglo-Saxon) countries have therefore been described as ambivalent (Pittman, 1967), but the differences may in part be attributed to the differences consumption patterns. While Denmark belonged to the Northern European beer belt, spirits were the preferred (or only available) tipple in Sweden, Norway and Finland.

As social democracy became the dominant political movement in the early twentieth century, governments had the mandate and the inclination to engineer improvements in social welfare through restrictive and even repressive legislation. Part of such state centred intervention was the introduction of population wide control measures. In Norway, alcohol was prohibited entirely from 1916 to 1927, in Finland from 1919 to 1932, and in Iceland from 1915 to 1922, though beer was banned until 1989. Denmark, with more at stake perhaps owing to its large alcohol industry, followed the general trend with its concern over alcohol related harms, but opted for fiscal disincentives rather than restricting outlets. The prohibitive regimes remained in place until the early 1990s, when EU market harmonisation forced a loosening of controls in Finland, Sweden and Denmark (Norway remains outside the EU).

This opening up of alcohol markets has energised both drugs and alcohol research, and political activism. Whereas many in policy circles were originally worried about the Europeanisation of alcohol consumption patterns in the Nordic countries, there has in fact been a reverse flow in drug polices and an expansion of Nordic restrictive measures across the EU (Uhl, 2008). These discussions overlap with those held in the UK, particularly about alcohol pricing and the restriction of opening hours for licensed premises, and at international level there has been a coming together of Anglo-Saxon and Nordic advocates of restrictive regimes for instance in World Health Organisation funded publications and campaigns (Anderson and Baumberg, 2006; Babor et al., 2003, 2005; Edwards et al., 1994).

The investment in public services addressing illegal drugs across the domains of health, education research and of course enforcement may have evolved from the concerns over alcohol, but they have long since developed a dynamic all of their own. After a brief period of permissive attitudes towards cannabis in the 1960s, the Swedish Government changed course towards the prohibitionist position that it occupies today. The uncompromising stance on drugs may strike external observers as uncharacteristic for a country associated with progressive attitudes, permissiveness and tolerance in many other areas of life. But not when it comes to drugs. At international drug policy gatherings, such as the annual UN coordinated Commission for Narcotic Drugs, Sweden is aligned with the USA, Japan and Russia in its refusal to revise any aspect of the international drug policy treaties. Swedish drug policy, however, combines harsh control measures against consumption with a generous investment in treatment. The objective of policy is public health, not public morality, and the repressive apparatus has not developed its own dynamic, as for example in the USA.

Norway, while emulating many features of Sweden’s drug policy, has also recently developed in directions similar to a very different approach taken across the Kattegat. In Denmark, law enforcement up until the recent past at least, has taken a more liberal approach to drug consumption. There are prominent politicians calling for drug policy reform, and a developed system of harm reduction from needle exchanges to heroin treatment and drug consumption rooms. The most remarkable feature, though, is the debated but until recently somehow tolerated cannabis market in a part of Copenhagen known as Pusher Street in Christiania. From the 1970s onwards, when the former military base was taken over by squatters and developed as an alternative community, drug markets have flourished. Dealers came to organise themselves and determined on a cannabis only policy, very much in line with public health ideals of separating hard from soft drugs. While there have been repeated police incursions, especially in recent years, prompting a replacement of many of the original cannabis traders by motorbike gangs, the open market continues to flourish.

For contrasts and comparisons, therefore, the region offers ample scope for practitioners and drug policy watchers everywhere. Whereas the displacement of semi-regulated traders by organised criminals following the law enforcement crackdown is in line with drug market operations everywhere, the Christiania model is unparalleled in its scope and significance. Just like the coffeeshops of Amsterdam, it has now become one of the biggest tourist attractions of the Danish capital, with organised tours in several languages. It is not just the drugs, but the general antithesis to the daily normality of Copenhagen life which marks this as a special space, where people hang out and many different lifestyles are tolerated. It does attract a fair number of socially vulnerable people, for whom this is another accessible public space.

Carving out a niche where prohibited but popular pleasures can be pursued beyond the purview of public and the authorities is of course a well established method of social management. Marginal spaces in the no man’s land around railway stations or on city peripheries are often used for activities that may offend social mores but are driven by demand. The authorities may therefore exercise restraint as long as the impact is contained, with only the contracting parties – buyers and sellers – affected by the consequences of their own actions.

The policing logic is to expel these infractions from the centre of the polity, to places where they can be contained and ignored. But they also present an exercise of clemency, the desistance by the authorities from enforcing the law in certain places which stretches back at least to the early Christian period. Typically, such refuges were found around shrines or inside a church, provided fugitives with immunity from justice (Shoemaker, 2011). For drug policy and drug policy research, however, it provides a model that is yet to be properly explored and understood, and should be listed alongside the medical marijuana dispensaries found in some US states, Dutch coffeeshop and Spanish Cannabis clubs as a alternative regulatory regimes.

While external observers may celebrate the variety of policy approaches as an opportunity for comparison, there is a shared sense of anxiety across the field. The very revival of the temperance movement in the sense of a more activist alcohol control lobby, is in itself a reaction to the removal of restrictions in the 1990s. In Sweden as in the UK, where the lifting of pub licensing hours during the 1990s was accompanied by an outcry over the scourge of “binge drinking”, public alarm is hardly matched by actual rises in the overall volume of drink.

According to the OECD (2012) databank Swedish alcohol consumption did trend up from 6.0 litres of pure alcohol in 1966 to 6.9 in 2009. But given that it stood at 7.7 in 1977 it could also be said to be on a downward curve. Moreover the composition of beverages has changed, as the consumption of beer and wine, often accompanied by food, has gone up, while that of spirits has fallen. Yet, perception of risk is not necessarily related to an underlying material reality. Fear of crime, for instance, is chronically out of synch with actual crime trends, much to the chagrin of successive home secretaries. The alarm over alcohol consumption by commentators in both Sweden and the UK therefore seems also unrelated to indices of health or social problems but to a general disposition that considers alcohol and drug use as problematic, and particularly the alcohol and drug use of others – such as young people.

There is a sense of unease in the drugs and alcohol field in the UK, and as contributions in previous issues of this journal have shown, other parts of Europe. Drug and alcohol treatment has been severely affected by the need for cutback affecting the medical and social care services all over the continent, and savings have to be made. But in the Nordic countries there is also a critical discourse from within the field about the purpose of interventions, the effectiveness of treatment, the lack of evidence that different activities have any of the desired effects. And the changes to the funding and the delivery of treatment services in particular have brought about fundamental changes in the way that practitioners feel about their work and their relationships with clients. At a time when the delivery of public health is redesigned under pressure of contracting budgets and new conceptions of the patient/practitioner relationship, there are sudden tensions between the call for local autonomy in service design and standards and reporting requirements set by centralised agencies. New drugs arrive and new communities emerge, which shift the definitions of what is meant by drug and how an intervention is to be tailored. As scientific advances increase the knowledge base on risk, the call for protective I measures threaten to erode freedoms hard fought for by previous generations.

These challenges have been taken on in different ways across the Nordic countries. But in every instance, there is a high level of awareness to the decision making, and a quality of debate that has value for counterparts in other countries. The aim of this issue is to bring some of these discussions to a wider audience, and help to create a few links between the policy and practice communities across the continent.

Axel Klein, Vibeke Asmussen Frank, Bjarke Nielsen