Drug Abuse

Keeping off, stepping on and stepping off:
the steppingstone theory reevaluated in the context of the Dutch cannabis experience

BY STEPHEN J. SIFANECK AND CHARLES D. KAPLAN

Stephen Sifaneck is a research fellow at the National Development and Research Institute, Medical Health and Research Association of New York City (1I Beach SL, New York 10013).

Charles Kaplan is director of the Drug Use and Abuse Research Division of the International Institute for Psycho-Social and Socio-Ecological Research (IPSER), Maastricht, the Netherlands.

AUTHORS' NOTE: The authors are indebted to a large number of people in both the Netherlands and the United States who took the time to read and comment on drafts of this paper. Simon Stack provided continual editorial input. Dr. Adriaan C. M. Jansen of the University of Amsterdam, Bert Bieleman of Intraval, Groningen-Rotterdam, and Hans Dupont of the International Institute for Psycho-Social and Socio-Ecological Research in Maastricht provided invaluable insight and comments on the Dutch situation. In the United States, Dr. Bruce Johnson of National Development and Research Institutes, Inc., and Dr. Charles Winick of the Graduate Center of the City University of New York were sources of valuable criticism and discussion. Please address comments or reprint requests to: Stephen J. Sifaneck, National Development and Research Institutes, 1I Beach St., New York 10013.

The epidemiology of drug use is specifically concerned with patterns and trends occurring in well-defined populations. The socio-cultural environments that provide the contexts for drug use are an important part of these population definitions. Cannabis use is no exception. These contexts constitute the microsettings or everyday drug use. These settings are largely determined by the interaction of drug subcultures with existing drug policies (Grund et al., 1992).

Recent epidemiological data in the United States indicate a rise in cannabis use among youth for the first time in a decade (Johnston, O'Malley & Bachman, 1994). This rise seems to be associated, in part, with new forms of youth subculture functioning in the environment. The youth hip-hop subculture is widely embracing cannabis use. Expressions can be observed in lyrics of rap songs and in the icons on clothes. In July 1993, Cypress Hill, one of the most prominent cannabis-embracing hip-hop groups, toured the Netherlands, where marijuana and hashish are commercially available and openly used in establishments known traditionally as "coffee shops." Their experience in the city of Rotterdam, which we were able to observe firsthand, overwhelmed these inner-city American youths. "You guys are the luckiest motherfuckers!" B-Real, the main vocalist of the group, screamed to the crowd at a sold-out performance at Rotterdam's Imperium, a venue analogous to Harlem's Apollo Theater. After the show, the group toured some of the busiest coffee shops of Rotterdam. Their expression "lucky guys" recognized that drug policy need not always lead to an environment where subcultures and governments are at odds.

The unique context of Dutch cannabis use is the result of long-term social experimentation with drug policy (Kaplan, 1984). Jansen (1993) recently commented that the Dutch coffee shop phenomenon is an economic and cultural experiment in the social integration of a "forbidden good," making cannabis an integrated drug like alcohol and tobacco. The intent of the Dutch policy of tolerating retail cannabis sales, formalized in amendments made to the Opium Act in 1976 was to separate t e markets for drugs presenting "unacceptable risks" referred to as "hard drugs" (including heroin cocaine, speed, LSD, and MDMA) from those "soft drugs' presenting "acceptable risks," which category has been exclusively restricted to marijuana and hashish (Leuw, 1991). The starting point of the interministerial debate that resulted in the current Dutch cannabis policy addressed two related questions: (1) How damaging is cannabis to individual and public health? (2) Can the progression from cannabis to cocaine and heroin postulated by the steppingstone theory be prevented? (De Kort, 1994:442) Officials at the Dutch Ministry of Justice developed the view that the steppingstone theory was indeed valid in an environment where a single criminalized market existed for cannabis and drugs such as heroin and cocaine. In formulating the current policy allowing the controlled, visible, and public use of marijuana and hashish inside, commercial establishments known as coffee shops, the Dutch government began experimenting with an alternative, aimed at regulating cannabis use and preventing the stepwise progression described by the steppingstone theory. The epidemiological intent of this new policy was that regulated cannabis use could be transformed from a risk factor for hard-drug use into a protective factor in preventing hard-drug use (Van Vliet, 1990).

The situation in the Netherlands today represents the first instance in the modern history of drug policy in which a strategy that attempts to divert the progression from soft to hard drugs has been implemented, and it has been functioning for over two decades. The approach differs from both prohibition and legalization. Cannabis in the Netherlands is not legal in the way that alcohol and tobacco are. Rather it has a "pseudolegal" status, meaning that retail sales of under 30 grams, and the public use of marijuana and hashish inside coffee shops, are tolerated (Jansen, 1989). This "gray" market challenges the notion that drug markets are either black or white, and indicates that there can be real policy options between the rigid ideological poles of prohibition and legalization. This situation provides an optimal natural laboratory for investigating the role cannabis plays in the progression tohard-drug use in a context of policy and market conditions radically different from those that exist elsewhere.

Hard drugs in the Netherlands do not share cannabis's pseudolegal status and are strictly prohibited inside coffee shops and cafes where cannabis is sold and used. Hard-drug users, however, are normally not prosecuted by the criminal courts for personal possession, and the police refrain from using repressive tactics against users and small-time dealers (Leuw, 1991). Places where hard drugs are used and sold on a retail level are tolerated, albeit with a great deal of scrutiny, by the police. The separation of these locales from retail cannabis establishments is rigorously maintained.

The persistent question of cannabis use: subcultures, dealing and shifting gateways

The persistent question of whether or not cannabis use leads to heroin use has been a common background theme for researchers, politicians and parents alike, both in the United States and in Europe. To cite just one example, the Partnership for a Drug Free America, an influential media-based interest group, includes marijuana with other drugs in its advertisements, communicating the message that marijuana in fact is a "gateway" to more dangerous drugs.' Another example of the importance of the steppingstone theory for conceptualizing drug policy is the Swedish National Institute of Public Health's (1993) conclusion regarding the country's experience with both restrictive and liberal approaches: "Swedish drug policy is based on the assumption that people trying and using cannabis during their school years constitute a recruiting base for those who later become heavy drug abusers."

Initially articulated in a pamphlet printed by the Bureau of Narcotics in 1965, the fundamental axiom of the orthodox steppingstone theory, that drug users who begin with cannabis increase their risk of involvement with LSD, cocaine and heroin, has been tested and explored by a broad spectrum of researchers. Johnson (1973) was among the first to recognize the central importance of being involved in a specific drug subculture as an intervening variable in the progression from soft- to hard-drug use. Others have concluded that the intervening variable in the progression is not so much the subculture, but a policy and market factor: involvement in illegal drug dealing (Clayton & Voss, 1981; Single & Kandel, 1977; Jacobson & Zinberg, 1975; Wood, 1988). It was the act of selling cannabis in a politically determined "black" market, rather than the patterns of consumptive behavior, that had the greatest influence in the progression from soft to hard drugs. Recent research further underlines the critical importance of drug dealing as a factor in the progression to hard drugs. Dealing in cannabis is not only a necessary antecedent to the use of hard drugs, it is also associated with a whole range of "hard" activities in juveniles, including the possession of firearms (Sheley, 1994). Furthermore, it has been recently observed that marijuana use within a criminalized context can increase its importance as a gateway substance on the path to more serious drug abuse (Golub and Johnson, 1994).

What does the unique experience of the Dutch "gray" market for cannabis tell us about the steppingstone theory? In the Dutch model of marketing, where illegal dealing to the consumer is virtually eliminated, several further specific questions can be posed: (1) Does the progression from soft to hard drugs still happen? (2) If the steppingstone effect is observed, what are the specific dynamics of the progression? (3) Are there any new patterns that differ from the classic steppingstone effect? Our research focused on marijuana, cocaine, heroin and alcohol. With the exception of MDMA, other researchers have found that these are the primary drugs associated with cannabis use in the Netherlands (Leuw, 1991; Korf and van der Steenhoven, 1993).

Methods

l. The exploratory potential of ethnography in the area of drug abuse has often been fruitful in developing hypotheses for further quantitative investigations. For example, in the article "Taking Care of Business: The Heroin User's Life on the Street," Ed Preble and John Casey (1969) employed an ethnographic methodology to investigate the intricate dynamics involved in an addict's everyday existence. This seminal ethnographic study stimulated a tradition of investigating the relationship between drug use and market structures. The following investigation provides similar descriptive data regarding cannabis use patterns, potentially creating hypotheses to be tested and explored by future use surveys.

As with other marginalized behavior, ethnography with drug users provides a research opportunity to avoid the shortcomings of the self-reporting techniques of structured interviews and questionnaires, including biases of memory, self-perception, fear and mistrust. The naturalistic observation of socially deviant behaviors through ethnography is most successful when the ethnographer becomes "part of the furniture" (Grund, Kaplan & Adriaans, 1991). The validity and objectivity of ethnographic data are improved by employing systematic analyses of field notes, specific observational strategies, and non subjective interview procedures. However, as with all methodologies, ethnography has its limitations. It is more suited to the generation of hypotheses than to the testing of them. Thus the ethnographic analysis presented in this paper was geared not to test the truth or falsity of the steppingstone theory, but rather to reevaluate the stages of progression in a novel context.

Over 1,500 hours of fieldwork were conducted, during which fieldnotes were collected. Participant observation involved visiting coffee shops and private homes and recording different life experiences of cannabis use, marketing and culture. Perceptions of coffee shops and lifestyles were written down, and over 500 photographs were taken. Pamphlets, "trade" magazines and other documents were collected and compiled. Informal interviews were conducted with patrons and employees of coffee shops throughout the Netherlands, specifically in Rotterdam, Amsterdam, Den Haag, Groningen and Maastricht. In a conversational manner, users were asked questions concerning their present cannabis use, their drug use career, use of hard drugs, occupation, and lifestyle. Many of these interviews were conducted in English, although some were conducted in Dutch with the assistance of an on-site interpreter. Ethnographic research with hard-drug users and sellers-in Rotterdam was also conducted to investigate the sequence and role cannabis played in their addiction to narcotics.

To augment the qualitative data gathered in the field, focus groups of cannabis users were set up in which personal testimonies of drug-use careers were probed, recorded and organized in a manner similar to that used in a study of Dutch heroin users who had undergone an underground ibogaine treatment (Kaplan et al., 1993; Sisko, 1993). Fifteen focus groups, with a total of 42 participants, were conducted in coffee shops and private residences in Rotterdam. The demographic profile of the focus group participants was representative of the various native (i.e., non-tourist) populations using the coffee shops. Seventy-two percent were male. The youngest participant was 16 years old, and the oldest was 57; the mean average age of the participants was 24. All were residents of the Netherlands, but nine were not naturalized citizens. Sixty percent of the participants were students of a secondary school or university. Participants for the focus groups were introduced by means of a snowball sampling technique: known cannabis users encountered during ethnographic fieldwork systematically introduced us to other users who became participants in the groups. Testimonies were reviewed by respondents for accuracy and greater clarity (Williams, 1989). The focus groups provided more revealing information as the users became more relaxed and open upon hearing the testimonies of other drug users. During the groups, cannabis users were less reluctant to discuss hard drugs. The groups helped to balance the bias of the social undesirability of hard-drug use within the norms of the coffee shop system.

The qualitative data gathered during the ethnography and focus groups were flagged and sorted using the askSam information management system. Commonalities and patterns related to the steppingstone theory were identified and extracted.

The microsetting: coffee shops and cafe coffee shops

The patterns of cannabis use that were identified as being relevant to the steppingstone theory cannot be adequately depicted without an auxiliary description of the coffee shop context. Three essential elements constitute the coffee shop context: (1) the different types of retail outlets; (2) the house rules; and (3) the menu. There are two basic types of retail cannabis outlets in the Netherlands: the traditional coffee shop and the cafe coffee shop. A traditional coffee shop provides only nonalcoholic beverages to its patrons, while a cafe coffee shop offers a full alcohol bar along with nonalcoholic beverages. The "house rules" of the coffee shops are often written in English as well as in Dutch and generally run as follows: (1) Everything to do with the sale and use of hard drugs is strictly forbidden. (2) Aggression or other criminal activity (e.g., selling stolen goods) will not be tolerated. (3) No one under the age of 16 years will be admitted.

The coffee shop menu lists the different types of marijuana and hashish presently being sold. A typical menu would include marijuana such as "Skunk," "Congo" and "Super Thai" along with different hashish varieties from Morocco, Turkey and Afghanistan. Cannabis offered is commonly sold in 12.50 guilder (approximately $7.00 US) and 25 guilder ($14.00 US) amounts. Very often coffee shops also sell single prerolled joints and cake, candies and teas made with cannabis.

Three distinct patterns of cannabis use related to the steppingstone theory were identified from within the coffee shop context. Two patterns differed from the progression from soft to hard drugs predicated by the steppingstone theory: "keeping off," never going beyond cannabis use; and "stepping off," going from hard/poly-drug use to use of cannabis exclusively. "Stepping on" to hard drugs, the pattern described by the theory, was also observed in a relatively small percentage of the sample.

Keeping off

Most Dutch cannabis users want nothing to do with hard drugs. They perceive hard-drug users as "junks" ("junkies"), a stigmatized group among Dutch youth. Cannabis use is viewed as a normal part of daily life and as something completely different from the use of substances like cocaine, speed and heroin. Through the commercialized coffee shop system, these cannabis users are given a place in society that is isolated from a hard-drug environment. "Everything to do with the sale and use of hard drugs is forbidden" is the most fundamental house rule. Posted prominently in the coffee shops, the rule is consistent with the policy of vigorously separating hard- and soft-drug markets. Many coffee shops provide literature and display posters discussing the dangers of heroin and cocaine; these provide further reinforcement of the separation of markets policy. Cannabis users have come to see themselves involved in a socially acceptable, normal behavior and do not have to hide from a stigmatizing attitude imposed by the larger society. Hard and soft drugs are placed in distinct and separate microsettings of use, as indicated in fieldnote 1.

1. "In Holland, when you're addicted to a hard drug, you're really an outcast," comments Bas, a 21-year-old art college student. "In Rotterdam, when you look at the real junks at central station, you say that's what I'll become if I use a hard drug. So I don't use it, no, I never used a hard drug." Hak, a 28-year-old music student, replies, "Unless you're sick, I cannot see the point." Hak takes a pull off his joint and exhales, pointing to the lit joint in his hand. "You see, this [cannabis] is very different from hard drugs. Many normal people smoke in Holland. The people who use heroin and cocaine are people with problems, they are sick."

The remarks of these two coffee shop patrons express the negative attitudes toward hard-drug use commonly held by Dutch cannabis users. Bas compares being a "junk" to being an outcast, while Hak views hard-drug users as "sick" and "people with problems." Both are regular cannabis users who express no inclination for other drugs. They even recognize that the microsetting provided for problematic hard-drug users in the "open scene" in Rotterdam is there to remind them of the possible outcome of using hard drugs (for a further description, see fieldnote 6).

The music and environment inside the coffee shops reinforce cannabis users' disapproving attitudes toward hard drugs. Besides displaying anti-hard-drug information, coffee shop interior motifs embrace subcultural Rastafarian icons such as Bob Marley and Peter Tosh. Reggae music, played in many shops, has a long history of delineating "ganga" from the more dangerous drugs. Other subcultural articulations of the distinction between soft and hard drugs have come from hiphop music and iconography. In addition, coffee shops have recently been emphasizing recreational activities such as pool, billiards, darts, table soccer, chess, and other table games, all of which are common activities that accompany cannabis smoking. Apart from the cannabis smoking, the setting is reminiscent of the recreation room at an American summer camp. The blend of recreational activities common to Dutch youth in general with cannabis smoking places drug use within the context of other normal behaviors, as depicted in fieldnote 2.

2. "When I listen to the lyrics of old reggae songs, I hear the messages in the songs about drugs. Ganga is holy, the rest is evil," comments Peter, a 19-year-old student attending a technical college. He comes to this coffee shop after a full day of classes and before his bus ride home to a small town in the north of Holland. To the back of the street level coffee shop are two full size pool tables; both are busy. One is occupied by a group of four Dutch males, all between 18 and 20 years of age; one is Moroccan, one is Surinamese, two are native Dutch. A girlfriend of one of the boys watches the game and sips a glass of tea. At the other table two men about 30 years old are playing a more serious game of "8-ball." Looks of determination overcome their faces. Around a table soccer game are three boys meeting after school to play a series of games; none has purchased drinks and none is smoking cannabis—they have come in solely to play table soccer. Around the counter of the coffee shop sit three people; one talks to the proprietor and rolls a joint, another reads a newspaper, and one smokes a cigarette and peers out the front window, which looks out onto the street. Reggae music plays at moderate level, and the bass resonates deeply. Peter pauses to continue building his joint and goes on to explain how he was introduced to cannabis at a reggae concert in Rotterdam. "Someone said 'Here,' and I smoked it and liked the feeling— it made the music sound even better."

Peter is a typical young Dutch cannabis smoker. He prides himself on knowing everything about Bob Marley and is influenced by the Rastafarian ideology, in which cannabis is the only acceptable drug. Note that fewer than half of the patrons in this particular shop have come to smoke cannabis. There are three separate games taking place simultaneously, involving a total of eight people.

Along with selling marijuana and hashish, part of the function of the Dutch coffee shop is to provide a safe and appropriate setting for cannabis smoking. Proprietors must make their shops safe l(i.e., free of hard drugs, aggression, petty crime, etc.) as well as comfortable and inviting. This is the crux of a successful shop. Very few shops survive without providing activities such as table games, pool, billiards and table soccer. Cannabis smoking is usually not the sole reason why people patronize coffee shops. The coffee shop serves as an environment for recreation, listening to music, and socializing, as well as for cannabis smoking.

For some cannabis users in the Netherlands, the drug is an alternative to alcohol. Alcohol is often viewed as a "harder" drug, with more harmful consequences than those of cannabis. Cannabis is sold in coffee shops, where alcohol is not served, and in cafe coffee shops, where a full bar is usually available. Fieldnote 3 begins with a description of a cafe coffee shop that offers a full alcohol bar.

3. "A few years ago I used to drink 30 glasses of beer, and think nothing of it," remarks Otto. Alongside him to the far side of the old wooden bar sit three Dutch males. The first, about 25 years old, drinks a "pilsje"—a small (25 cc) draft beer; the second, an athletic-looking schoolboy, drinks a glass of fresh-squeezed orange juice; his friend of the same age drinks coffee. They both have rolled and are smoking their own joints. They drink slowly, while talking. They finish their drinks and joints in about 25 minutes and then head to the back of the cafe for a game of table soccer. When Otto, a 28-year-old music student, enters the shop, the bartender/dealer greets him with a cappuccino and a prerolled joint of "Skunk."2 "I don't smoke when I'm working on my music, only afterwards.... Smoking for me is relaxing, and I don't feel terrible the next day, like I did when I was drinking." Otto's friend Mark also prefers cannabis to alcohol. He explains, "I come from the south of Holland, where drinking is big, but I'm not a drinker. I preferred smoking, and I'm still not a drinker."

Fieldnote 3 provides an example of how Dutch youth recognize the dangers of alcohol through comparing its consequences with those of cannabis. Out of the five patrons observed in this cafe coffee shop, which provides a full bar, only one chooses alcohol, and the choice is beer. The conversation between the two smokers includes anti-alcohol sentiments. Mark comments on how cannabis is a socially acceptable alternative to alcohol, while Otto explains how he uses cannabis after a full day of music practice. He finds that cannabis interferes less with his music career than his former heavy beer drinking did.

In summary, the pattern of "keeping off" is one in which many cannabis users in the Netherlands do not progress to harder-drug use for ideological reasons. The coffee shop microenvironment reinforces this attitude in several ways. First, the house rules clearly affirm the social undesirability of hard-drug use and signal the separation of markets policy. Second, cannabis is placed in the context of normal recreational activities. In the coffee shops, cannabis is strongly associated with alternative non-drug-use activities, and in a manner that can be compared with alcohol. Thus the microsetting of the coffee shop can provide a barrier to the tendency to progress to more potent drugs.

Stepping on

Even with the barrier of the coffee shops, some users do indeed "step on" to harder drugs. Cannabis users with harddrug experience accounted for fewer than 10% of the participants in our focus groups. Cocaine was the drug most likely to succeed cannabis among users who demonstrated the stepping-on pattern. Cocaine is used by two distinct and separate groups: in the club and cafe scene, where partying young adults like to dance and socialize within intimate friendship circles; and within the chronically addicted population, where cocaine is smoked and injected and is often used in conjunction with heroin (Bieleman et al., 1993). For cannabis users who do step on to harder drugs, cocaine sniffing or snorting was observed to be the "intermediary step."

When cocaine use accompanies cannabis smoking, the setting is usually that of a "sniffer's cafe," described in fieldnote 4.3. A "sniffers' cafe" is not a normal type of coffee shop or café coffee shop, but an aberrant one that deviates from the rules of the system. If the police are aware of its existence, it is subject to increased scrutiny. The cafe described in fieldnote 4 offers a full bar and sells prerolled joints, but most patrons buy their marijuana or hashish in neighboring coffee shops and bring it in.

4. "These days I hang out with my other mates in a cafe. Drinking lager, a whiff here or there, and maybe smoke a joint to break things up a bit," Chris boasts with slurred speech. Inside this cafe, located on the city's busiest thoroughfare, one is greeted with a faceful of smoke and an earful of blues. The conversation is stifled by the loud music, but what cuts through the decibels is thick layers of varied accents from Great Britain. The regular clients who frequent this cafe are from either England or Ireland, and are here in Holland working at manual labor jobs in the vibrant construction industry. The clientele is all male, approaching or over 30 years of age. The patrons use the heavily frequented bathroom as a place to snort powdered cocaine. Here we find Chris, a 37-year-old male from a small town in northern England. "My initiation to Rotterdam was in a night store where this bloke came up to me asking me what I needed, coke or heroin—he was sporting both." Chris comments on his previous drug use. Before coming to Holland he smoked poor-quality marijuana and hashish, usually available in Great Britain. "The stuff they sell in England is shit, man. They mix it with tea." Chris would sporadically take speed during weekend long alcohol binges. Today cocaine accompanies his cannabis and alcohol use "especially on the weekends, that's when I get my pay."

Chris's cocaine use is determined by how much cash is at his disposal. Before coming to Holland, Chris was already a polydrug user, using more speed than cocaine, drinking more alcohol, and smoking weaker cannabis. He had stepped on before coming to Holland. Once in Holland, he found cocaine of better quality, which was easier to purchase than in England, and he continued his polydrug use in the context of a deviant cafe.

Mohammed, an 18-year-old Moroccan second-generation immigrant to Holland, is representative of the role drug dealing has in making the progression from soft to hard drugs, as illustrated in fieldnote 5.

5. "I need to make money, man. In this world you need to make money. I make it selling white [cocaine]." Two years ago, Mohammed was attending school and smoking hashish with his friends after school in a local shop. "I would smoke with friends, play football, and talk about girls. That's when I was young.... When you are young you don't think as much about money. The older you get, the more important money becomes." Mohammed has since quit school, and works as part of a loosely structured street-level dealership, selling powdered cocaine to furtive tourists and addicts. "Runners" approach Mohammed at regular intervals, procuring small amounts of cocaine for themselves and acting as liaisons for people from other parts of Holland and from other countries, including Belgium, Germany, France, Spain and Italy. These customers wait anxiously in their cars on the avenue. Foreign plates abound. Mohammed's boss sits a block away inside a cafe, in case he needs to procure more wares. "People know me in Rotterdam. They know my shit is good."

It was not the pharmacology of cannabis, but the profits that could be made by selling cocaine that attracted Mohammed to the hard-drug scene. Mohammed's drug dealing must be seen in the context of a greater and more complex problem in the Netherlands: the integration of second-generation immigrants into the larger Dutch society (Wijngaart, 1988). This is especially problematic in schools and in the workplace. After quitting school and searching for a job, Mohammed found a niche of employment in the hard-drug market. His earlier activities in the coffee shop were no barrier to the lure of money in a situation of blocked opportunity.

When Gerrit, a 35-year-old native Rotterdammer, began smoking cannabis, the hard- and soft-drug markets were not separated. He is a member of a previous generation of poly/hard-drug users, a group whose mean age has increased steadily over the past ten years (Leuw, 1991). In fieldnote 6, the microenvironment of hard-drug use is described.

ó. "I don't know how I became a shooter, but I did start with grass," Gerrit mumbles. Adjacent to Rotterdam's central station, 30 meters directly across from the police station, is an outdoor area separated by bus stop partition walls. The eyes of one police officer peer out the window, fixing on the activity transpiring inside the enclosed areaknown as "Perron Nul" or "Platform Zero." Inside, addicts openly smoke heroin and cocaine on foil, known as "chineesing" or "chasing the dragon," or in small handmade pipes. Two addicts, are crouched low against the partitioned wall, using it to block the strong gusts of wind. They prepare their heroin to shoot, melting it down in a spoon. The woman of the couple comments (in Dutch) that she is shooting here only because she came to get some "new spikes." There is a needle exchange and methadone program operating from a trailer inside Perron Nul. Her partner, Gerrit, continues to answer my question about his drug history. "When I started to smoke back in the 70's, we also did all kinds of drugs. Whenever someone had them. We were like the Freak Brothers, man; popping pills, smoking joints, snorting powder." Gerrit was 20 when he injected heroin for the first time. "Then one day I tried dope, and that was it. I've been hooked ever since. Most kids I meet in Holland these days are very much afraid of dope—and for good reason." Presently Gerrit takes methadone during the day, but by evening he usually has the urge to inject heroin.

At first glance, the scene transpiring inside Platform Zero might be shocking. The location, however, is indicative of how hard-drug markets and microenvironments of use are visibly separated from the coffee shop context. Gerrit is a drug user of a past generation, one that used all types of drugs, soft and hard, without making a distinction between the two categories. When Gerrit began his heroin use, hard drugs were not separated or "partitioned" from either soft drugs or the rest of society, in the way the walls of Platform Zero separate it from the rest of the city. Gerrit brings up "the Freak Brothers" when describing his drug career. The Freak Brothers are a 1960s/70s comic strip about a hippie group of so-called "garbage heads," drug users who will take any type of drug, grass, cocaine, pills, heroin, glue, and alcohol. This was the dominant ideology of many drug-using subcultures of the late 1960s and early 1970s. Gerrit began his drug-using career in much the same way. In his reference to the Freak Brothers, Gerrit is indicating his membership in an aging generation of drug users.

In summary, the pattern of stepping on to hard drugs was most prevalent with users who began their drug careers before the separation of the hard and soft markets was realized in the Netherlands. Stepping-on was also observed to occur under two other special conditions. The first is through tourists and foreign workers who come from countries where soft- and hard-drug markets are not separated. The positive attitudes toward polydrug use developed in other contexts may result in defiance of the rules of the coffee shop system, as illustrated by Chris in fieldnote 4. The second condition involves drug dealing. Hard-drug dealing in the Netherlands remains particularly attractive to children of immigrants whose economic opportunities are limited. Thus hard-drug dealing becomes the pathway to hard-drug use.

Stepping off

"Stepping off" from hard- or poly-drug use back to using cannabis exclusively is a pattern largely obscured by the steppingstone theory. Conventionally, as a result of the dominant prevailing ideology among drug researchers and treatment practitioners, the steppingstone theory is invoked to explain the pathways to addiction. But, as has been emphasized in the literature on natural recovery, there are pathways out of hard-drug addict6ion that do not involve institutionalized treatment programs (Granfield & Cloud, 1994; Biernacki, 1986; Winick, 1963). We encountered former hard-drug users who consume marijuana and hashish in the context of the "harddrug free" environment of the coffee shop. For these harddrug users, cannabis served as a means of breaking the cycle of hard-drug use and addiction. Cannabis use was not only a prologue to hard drugs, but also an epilogue. It was a means of stepping off.

Brief or sporadic experiences with cocaine prior to abstaining from it is one variation of the stepping-off pattern as illustrated in fieldnote 7. Anko, a 24-year-old coffee shop dealer, explains his brief experience with cocaine sniffing, his present-attitudes toward it, and his reasons for refraining.

7. "Yeah, I've tried cocaine, but after a few nights of sniffing, and sniffing, maybe 200 guilders' worth in one night, I'd say for what? When I did sniff, I sniffed a lot and drank more. The next day I feel like shit. Now I'm satisfied with just smoking. Cannabis and a little beer, those are the only drugs for me now." Anko keeps a close eye on the clientele in the coffee shop in which he works. Occasionally he must throw someone out of the shop. He explains, "Everybody here in this shop is a smoker only. Junks are not allowed, not for coffee, not for hash, and especially not to use the bathroom."

Today, besides not using cocaine himself, Anko also takes a very active role in preventing cocaine use in the coffee shop in which he works. Aside from not enjoying the hangover the next day, part of Anko's motivation for stopping cocaine was economic: his habit was costing him too much money. This is not true of his cannabis use. Cocaine in Rotterdam costs an average of 100 Dutch guilders (approximately $65 US) per gram, which is higher than the recently deflated price of a gram ($30~$50 US) in New York City. The cost of cannabis, in contrast, averages 300% higher in New York City than in Rotterdam, depending on the variety. These price differences reflect trends in the American market, which since 1981 has seen a steady decline in the price of hard drugs, with a concomitant rise in cannabis prices (Rhodes, Hyatt & Scheiman, 1994). The Dutch market shows exactly the opposite trend.

Jenny, a 30-year old Swedish woman, came to Holland over six years ago, already experienced in cocaine and heroin use. Her initiation to heroin was in Stockholm, the city where she was born. Her case, described in fieldnote 8, provides an example of how drug tourism and "maturing out" can lead to a favorable outcome through the coffee shop environment.

8. "One day I said, - Enough of this,' stopped drinking, stopped coke, stopped dope. Today I relax with a joint and a coffee." By the age of 21 Jenny was snorting cocaine and heroin simultaneously. "I liked that speedball effect; it made me feel completely numb. I would make a cross on the mirror, snort the coke first, then the heroin, and just fall backwards. At that point nothing in my life mattered." Today Jenny works in a coffee shop in Amsterdam, and chooses to use cannabis exclusively. "When I used to work at the bar, I'd be taking drugs and drinking. Now you see what I'm drinking." Jenny lifts up a glass of mineral water. Jenny works in a coffee shop/art gallery that features "smart drinks" and a "brain machine." "Yeah, I speak Dutch 'een klein beetje' (a little bit), but most people who come in here are tourists either from the States or other European countries—everyone usually speaks English to me. . . . I like working here—I meet many far-out people from all over."

Jenny has "matured out" of her previous pattern of drug use, no longer desiring her former lifestyle. Even though she never felt physically addicted, she got to the point where she found her drug-using routine problematic. Today Jenny uses only cannabis, while refraining from both hard drugs and alcohol, and works in a coffee shop/art gallery, allowing her to stay in touch with the music and art scene that once was associated with her previous Swedish drug routine. The difference today is that her work environment and reference group are Dutch and tourist cannabis smokers and artists, and not the users of cocaine and heroin with whom she associated inside artistic circles in Stockholm.

Addicts in the Netherlands apprehended for nonviolent crimes such as burglary are very often offered drug treatment instead of a jail sentence. According to the Dutch Ministry of Justice, one-third of the imprisoned population were identified as problem users of hard drugs before they were incarcerated (Leuw, 1991). Ron, a 36-year-old native Rotterdammer, was formerly into heavy drinking, and smoking cocaine and heroin. His habit for hard drugs was supported through criminal activity, usually breaking into parked cars. In fieldnote 9, the role of cannabis in the transition away from a criminal hard-drug lifestyle is illustrated.

9. "I used to be a criminal, ya know, the hard stuff leads you that way." Drinking jenever (Dutch gin) would accompany his cocaine and heroin smoking. Ron has been in jail several times, usually caught selling stolen goods to support his habit. "Ya know, the jails in Holland aren't so bad. The last time I was in they offered me treatment instead of time in jail. That turned out to be a very good decision.... Now I just smoke a little and drink beer." Ron spends much of his time hanging out inside the coffee shops, and sees himself at a transition point in his life. "Now that I've kicked my addiction, I'll be starting my own business soon with a loan from my family—they're happy to see me on a different path."

Ron's recovery is an example of the success of the integration of law enforcement with treatment programs. However, the role of cannabis use in the coffee shop context in the social reintegration of the criminal hard-drug user is seldom recognized. For Ron, the environment of the coffee shop serves as a place of transition, after treatment and before his complete integration into the larger society, a way station before embarking on a different path.

These three "stepping off" cases illustrate that cannabis use within the microsetting of the coffee shop may provide an aid to social integration in the difficult transition away from hard drugs. They also show that the progression of actual drug-use patterns does not necessarily take the form of a uni-directional, linear movement. The steppingstone theory is usually employed to conceptualize the pathway to hard drugs through cannabis use by teenagers, without taking into account situations where cannabis may play an important function in the pathway away from hard drugs for older users.

Discussion

In reevaluating the steppingstone theory after two decades of Dutch cannabis policy, two distinct patterns often ignored have been described: keeping off and stepping off. Keeping youths off hard drugs by separating the criminalized markets was an express aim of Dutch policy. Evidence of this success is supported by the low prevalence of heroin (0.2%) and cocaine (0.3%) use during the last four weeks, reported by Dutch students over the last four years, and the similarly low monthly prevalence of heroin (0.1%) and cocaine (0.7%) use reported by the household survey conducted in Amsterdam in 1994 (de Zwart, Mensink & Kuipers, 1994; Cohen, 1994). Less obvious, however, has been the way in which this policy has also influenced alcohol use. In many American studies, problematic alcohol use has been consistently found to be a pharmacological steppingstone to hard drugs. For example, Greene (1980) found that problematic alcohol use preceded heroin use in 94% of his study population, compared with 30% whose marijuana use was a precursor to heroin. A sequential model for stages in adolescent involvement in drug use, tested in two cohorts a generation apart, has shown that the first two stages of use involved the legal drugs, alcohol and tobacco, before cannabis use appeared as the third, "gateway" stage (Kandel, 1975; Kandel & Yamaguchi, 1993). Further evidence of the decisive influence of alcohol in the steppingstone sequence is found in the epidemiological literature (Anthony, 1991). In the National Institute of Mental Health Epidemiologic Catchment Area Survey Program, 85% of those respondents who qualified for a current cocaine dependency diagnosis also qualified for an earlier alcohol dependency diagnosis. Furthermore, the current prevalence of alcohol dependency was lowest in the cannabis group (46%), compared, for example, with the amphetamine (62%), opiate (69%) and cocaine (85%) groups.

An unanticipated effect of the Dutch cannabis policy on steppingstone phenomena may be a result of the modifications in the environments of adolescent alcohol use. Varying the microsettings of both alcohol and cannabis, both recognized as gateway drugs, may increase the possibilities of the promotion of self-regulated use of both cannabis and alcohol. Cannabis is sold both in commercial coffee shops, where there is an express policy that alcohol is not served, and in cafe coffee shops, which, on the other hand, usually offer a complete alcohol bar and sometimes food. In a sample of 115 Amsterdam coffee shops, 45% were found to serve alcohol (De Loor, 1993). The environments inside these establishments are markedly disparate, with alcohol being the differentiating factor. Youths can choose from alcohol-serving or alcohol-free cannabis environments. Even with a full bar available in cannabis cafes, beer is clearly the most popular beverage, and many patrons also freely choose nonalcoholic beverages, including coffee, tea, soft drinks and fruit juice. Out of this environment has grown a new generation of cannabis smokers that radically differs from previous generations of "garbage heads," whose cannabis use became embedded in a polydrug-using lifestyle. The new generation is likely to use cannabis instead of alcohol, and often to have attitudes derived from religious and/or subcultural sources (e.g., Islamic beliefs, Rastafarianism, vegetarianism, hip-hop) that reinforce a pattern of drug use tied to diet and health. De Loor (1993) terms this new generation of coffee shop customers as the "blauwe knopers," a label originating during the l9th century Dutch anti-alcohol movement; it translates-literally to "blue knobs" and is similar to the term "teetotalers."

The pattern of "keeping off" signifies a specific way of controlling the availability of drugs to youth that blends legality with pseudolegality to create a new environment based on controlled use and self-regulation of both alcohol and cannabis. Availability has been shown to be critical in the formation of harmful use patterns and subsequent epidemics (Hamid, 1992). In the Netherlands, the sale and use of cannabis have been transferred to a new market, one in which the "morality" of a socially acceptable drug like alcohol, as opposed to the "immorality" of heroin and cocaine, is characteristic. This moral ordering is consistent with the norms of Dutch society: If society is kept, cannabis users (and retail dealers) are perceived as "no problem."

The critical role of markets and availability on the sequence of the steppingstone theory is further illustrated by the follow-up assessment of the heroin use by American soldiers in Viet Nam (Robins, 1993). Heavy alcohol use, not marijuana, preceded heroin use before combat. In Viet Nam, strict rules existed against selling alcohol to soldiers under 21 years of age. This lack of availability of alcohol for these young soldiers, who already had begun their careers of heavy drinking, virtually guaranteed that they would constitute a ready market of heroin consumers. In Viet Nam, because of specific market restrictions and the reinforcing moral context known as "the Nam," things were tolerated that were not permitted in "the World" (America). A new moral context had been created that shifted the pathways of the steppingstone progression (Ingraham, 1974). These shifts in the relationship between use patterns and market availability also occurred in the United States; as a result of the government's interdiction policy of 1969, which created a shortage of marijuana, many users switched to heroin and LSD (Gooberman, 1974).

Illegal drug dealing is another way market forces may influence the dynamics of "stepping on" to harder drugs. This effect is well documented in the literature, and we were also able to discern it in a context where hard- and soft-drug markets were separated. In the United States, Williams (1989, 1992) observed that for a youth with limited economic opportunities thel lure of quick money is a temptation difficult to resist. When Williams studied the teenage cocaine ring in Washington Heights, Manhattan, he found talented and enterprising young people who became involved in the cocaine trade because other, legitimate opportunities were scarce. This pathway to hard drugs also exists in the Netherlands, as is indicated by the case of Mohammed in fieldnote 5.

The "stepping off' pattern, also identified in our data, seems to suggest that cannabis may have a specific function as a sort of folk medicine to help hard-drug addicts recover in the absence of suitable alternative medications (Grinspoon & Bakalar, 1993). In a nationwide evaluation of the effectiveness of community-based drug abuse treatment programs in the United States during the 1970s, the percentage of post treatment marijuana use was shown to increase steadily from 13% in the pretreatment period, growing incrementally to 27% in the fourth year of post treatment (Simpson & Tims, 1981). This suggests that the "stepping off pattern among former hard-drug users that we observed in the Netherlands is also operative under other conditions. There are recent indications that the phenomenon of "stepping off" to a cannabis only drug use pattern is occurring in the United States. Rap musicians, who have become the cultural spokespersons for a forgotten generation of urban youth that has suffered the ravages of both the crack epidemic and the drug war, have filled their latest albums with messages that specifically attack cocaine use while embracing the use of cannabis. For example, "Hey man, get the fuck off the caine, brown!" is a line from a song in Cypress Hill's debut album. The sentiment expressed by this particular piece of street vernacular is one that is critical of cocaine use ("caine" meaning cocaine, "get the fuck off" means stop using, and "brown" is a term for a

Latino cohort of the street). This advice seems largely derived from these youths' experience of the effects of hard drugs on people's lives, and not from any official policy or educational efforts. Could it be that the urban youth culture in the United States has matured to a point at which it can make the rational distinction between hard and soft drugs? Fergusson (1993) reports on Ilchuck, a 32-year-old Latino who is a lifetime resident of Manhattan's Lower East Side and a former six-year crack addict: "Just about nobody in hip hop circles smokes crack or cocaine anymore. In the last two years, I've seen ganga make a big difference in terms of less kids smoking crack, angel dust, and all other dangerous drugs."

Recently the Netherlands Institute for Alcohol and Drugs reported a steady rise in cannabis use among school populations across the Netherlands for the period 1984 to 1992 (de Zwart, Mensink & Kuipers, 1994). The rate of increase was particularly high from 1988 through 1992. Taken together with the most recent results of the Monitoring the Future Study, which reports an increase in cannabis use among secondary school and college students over the last two years, we may be observing a global shift in youthful cannabis use that would add new variations to the keeping-off and stepping-off patterns we observed in our reevaluation of the steppingstone theory (Johnston, O'Malley & Bachman, 1994).

This global increase in cannabis use should be a cause for concern. However, in light of the destructive effects of both hard drugs and alcohol on youth, this increase should be carefully monitored by qualitative research of the sort we have presented here. The rise in youthful cannabis use may be a sign of a positive change toward a healthier lifestyle in contemporary youth and an indicator of a "keeping off" response to an environment in which hard drugs are increasingly available. If this is the case, the rise is more an occasion for attention than for alarm. Strategies need to be developed to protect the youth of the present generation from the steppingstone progression to hard drugs. Understanding whether young people in both the United States and the Netherlands are really saying "yes to cannabis while at the same time saying "no" to hard drugs is important, because it is a distinction that their parents could never effectively make. Future policy development in the Netherlands is moving to better define the mechanisms of a mode of cannabis self-regulation that is firmly placed in a context of legally available drugs (Robbe, 1994). This research interest also involves rigorous prevention efforts targeted toward youths, who could benefit from a group-focused course on the self-regulation of cannabis use (Bourghuis, 1994). In Europe, the Dutch system of drug regulation is no longer an isolated case. Germany recently ruled in a Federal Constitutional Court decision that cannabis should be decriminalized, and Italy is moving in the same direction after the results of a national referendum (Arnao, 1994). These mutually reinforcing shifts in both cannabis subculture and use patterns and government cannabis policies should provide interesting variations in the theoretical accounting of drug-use patterns that were formerly addressed by the steppingstone theory.

Notes

1. A full-page advertisement in the New York Times on September 24, 1992, included the following text: "It [marijuana] has also been called the 'gateway' to harder drugs, as users are at a substantially higher risk of going on to use cocaine and other illegal drugs."

2. Skunk, a variety of cannabis-indica, is the most popular marijuana sold and consumed in the Netherlands. The name is derived from its strong, pungent smell. Its effects are powerful. Skunk is sold under a number of differently named varieties. It is grown hydroponically indoors throughout the Netherlands. In the United States Skunk is known by the same name as well as by others, including "the Kind" and "the Chronic."

3. It is interesting to note that this local setting of cocaine use is frequented almost exclusively by foreigners from Great Britain, a country where the drug policy does not make the distinction between soft and hard drugs. Anthony, lames C., 19 91. The Epidemiology of Drug Addiction. In: Miller, Norman S., ed.Comprehensive Handbook of Drug and Alcohol Addiction. New' York: Marcel Deleker.

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