Drug Abuse

COMPULSIVE DRUG USERS IN THE NETHERLANDS AND GERMANY: THE OPEN DRUG SCENES IN AMSTERDAM AND FRANKFURT AM MAIN

Uwe E. Kemmesies, Wiesbaden, Germany

A cross-national study is presented which probes a wide range of drug research. Systematic comparisons of (actual) users of illegal drugs in different societies are rare. This is surprising because a comparison of drug users in countries with different political drug use strategies offers the possibility of a deeper insight into the connection between social conditions (drug-care system, police, justice, etc.) and drug-use patterns, and respectively the social and individual consequences of drug use. A Dutch-German comparison seemed suitable: we hear constantly that there are great differences in drug control systems between Germany and The Netherlands. Imagining this to be true, does this lead to different drug use patterns, risks and harm associated with drug usage ? The comparison focused on the open drug scenes of Amsterdam and Frankfurt am Main. This paper summarises the numerous observations and offers explanations for the astonishing main result: the phenomenon 'use of illicit drugs' seems not to differ considerably in the empirical field of this study although the drug policies in The Netherlands and Germany differ noticeably.

INTRODUCTION

This systematic, cross-national study, on the basis of a uniform methodological - empirical and analytical - framework, focuses on compulsive users of hard drugs (heroin and/or cocaine) in Amsterdam and Frankfurt's open drug scenes. The research process was guided by the question of whether a different political handling of the phenomenon'use of illicit drugs' generates different forms and intensities of drug use and social and health problems associated with drug usage. Undertaking a Dutch-German comparison seemed appropriate in so far as the relevant social, political and juridical conditions of the neighbouring countries (are said to) differ immensely from one another.

Without going into details (see overview literature: Leuw and Marshall, 1994; AKZEPT e.V, 1995) the political strategies could be characterised as liberal (Netherlands) versus repress ive/proh ib i tive (Germany), although this opposition stresses only the main political motives. From recent developments it seems that there has been some convergence between the two countries, because we were able to make out some Dutch tendencies in the drug pol ~cy of Germany - a kind of'Netherlandisation'of Germany's drug policy'- and some German tendencies in the drug policy of The Netherlands - a kind of 'Germanisation'of drug policy in The Netherlands.'

Drug policy of The Netherlands and Germany

Before describing the concrete research process, we outline the central motives and strategies of the drug policy in the neighbouring countries in the form of a short profile. Let us first take a closer look at the drug policy of The Netherlands, in respect of Amsterdam.

The local political strategy of Amsterdam reflects especially the political ideals of The Netherlands regarding the phenomenon'use of illicit drugs'. The political approach of Amsterdam serves as a kind of model for the national drug policy so to speak. Political guidance is led by the conviction tha~ a purely prohibitive policy would do more harm rather than contribute to a reduction of problems associated with drug usage (Roerink, 1995). With the intention of 'normalisation' and 'risk management'the political strategies are set up to minimise the potential risks for the drug consumer and the social environment, i.e. society, which may go together with drug use.

It is not the objective 'to remove the phenomenon altogether'; the aim is'to reduce the most important, unwholesome, and social effects, of drug addiction'(Leuw 1993a, p. 75). This results in a policy which emphasises the sociomedical and depreciates legal control - this is at the least the official representation of the Dutch drug policy and the dominant international image of the Dutch approach.

These political ideals as outlined inspired the concept of 'harm reduction'; they found real isation in the form of low-threshold methadone programmes and in an altogether differential drug help system, from a range of needleexchange programmes to long,term therapeutic treatment. In the sphere of legal control these political guiding motives led to a differentiation between so-called I soft'and'hard'drugs which resulted in a defacto leg, islation of hemp products (Fromberg, 1992) ofwhich the coffee,shop system stands out as the most conspicuous expression (Jansen, 1994). Despite that, these political motives led to a decriminalisation of consumption (in respect of hard drugs as well):'Legal control is expressed in intensified criminalization of drug trade (supply) paralleled by a decriminalization of drug users (demand)'(Korf, 1995, p. 6).

Regarding the political situation in respect of drugs in Frankfurt, Germany, we have a less homogenous picture than in The Netherlands. Due to the federal structure of Germany, differentiation has to be made between federal drug policy and the drug policy of the individual states (cf. Kernmesies, 1994, p. 64); the individual communities also deal with the drug policy in a different way, according to the principle of local autonomy in social issues. Whereas the federal drug policy is still committed to the abstinence paradigm (related to the vision of a drug-free society) (see 'Nationaler Rauschgiftbek5mpfungplan': Bundesminister des Innern/ Bundesminister fOr Gesundheit, 1992), we find - roughly sketched along a'north-south divide' in the northern states a more liberal drug policy, which is also marked by a trend towards experiments and innovations, but the southern states are very orientated to the federal drug policy (for an extreme case compare the Free State of Bavaria and the City State of Hamburg).' Considering the strong national political differentiation and the enormous changeability of drug help as the problem of HIV emerged in the early to mid- 1 9~80s, a description of German drug policy can only be made according to the daily political agenda. Taking the drug help system, the city of Frankfurt represents the tendencies in Germany towards a differentiated and organised drug help system concerned with harm reduction. It seems as if the ideological basis o~Germany's drug policy - the abstinence paradigm - has been changed. Frankfurt can be characterised in terms of having a broad drug help system, which offers a wide range of options (e.g. needle exchange programmes, contact centres, methadone programme [based on medical care but in larger scope not until 19921). But the drug help system - especially concerning methadone substitution - has not yet reached the stage found in The Netherlands or Amsterdam. The main difference between the Dute h and German drug policies is the fact that in Germany criminal prosecution is still given priority. The drug law is totally adjusted to the (federal) drug policy's principle of'abstmence'; be it either to maintain this state or to regain it therapeutically by the intermediate step of legally provoked motivation ('therapy paragraphs'; slogan: 'therapy instead of penalty'). The chief witness principle and the employment of undercover investigators also correspond to this maxim. Even if in recent years it has~een obvious that the opportunity principle at the public prosecutor's level has been used more and more in legal practice - motivated by a decision of the Federal Constitutional Court on 9 March 1994 - and above all at the level of the majority of the federal states there have been steps towards a liberalisation of the consumption of cannabis and of the consumption-orientated retail trade (Quensel et al., 1995), the emphasis is still on a penal/criminal rejection of the phenomenon of drug usage. In contrast, the attitude towards drug policy in The Netherlands is mainly characterised by at least tolerance or acceptance of the consumption of drugs as part of a self-chosen lifestyle.

THEORETICAL BASIS/RESEARCH INTENTION

Starting from the stated theoretical basis of the 'setting's structure of drug use' (see Kernmesies, 1 995a, p. 61 ff), which developed from the linking of the ideas of Zinberg (1984) and Bronfenbrenner (1978, 1979) the setting and the particular social and environmental conditions, and not the pharmaceutical dynamics of the substances consumed, are seen as the main influences on drug usage. Seen from this theoretical perspective, the way, and the manner, of drug use seem to be culturally based, i.e. the decision 'which substances are used when, by whom, the method of use, how often and in what dose, where, with whom, and why and also which attitudes are connected with this, and which experience has been made',' (Bldtter 1995, p. 279) is influenced primarily by the cultural environment and by the particular social conditions. From this only roughly described theoretical perspective results the hypothesis of an intercultural variability of drug use on which this research is based: According to the different political approaches of the neighbouring countries on the exo-system level (mainly different drug help systems) and on the macro-system level (mainly different legal positions), different patterns of drug use can be observed.

The hypothesis of a intercultural variability of drug use is taken as a general one, as a 'working hypothesis', because the research intention was first of all of an exploratory nature. Thus there were no special, directed hypotheses constructed according to expected differences based on the international image of the drug policies in The Netherlands and Germany, the theoretical foundation of the harmreduction approach or the stereotypes regarding the so-called drug problem. This non-directed 'working hypothesis' was 'tested' in an exploratory mannerby comparing drug users in the two countries.

RESEARCH FIELD

If this is to be a comparison of the open drug scenes of Amsterdam and Frankfurt, then the term (or construct) 'drug scene' needs first to be explained: Is 'drug use' a sufficient criterion for the definition of the drug scene? In the present research situation this has to be rejected. The drug scene has to be seen as a complex construction which falls into distinguishable scenes on a closer look. Are we speaking of the socially integrated cannabis user, the cocaine-consurning manager, the rave-orientated ecstasy user or the socially marginalised street junkie? Are we speaking of the urban open drug scene or the provincial private cannabis scene? According to the research on controlled, socially integrated drug usage (e.g. Harding et al., 1980; Zinberg, 1984; Cohen, 1990; Waldorf et al., 199 1 ),those scenes associated with illegal drugs encompass the whole social profile - at least, the phenomenon'use of illicit drugs' is not equated with the segment of the open street scene, with the idea of the'impoverished street junkie'. This leads to the question of why this Dutch-German comparison took place in the research field of the'open drug scene'.'

First it has to be admitted that the empirical focus of this study is quite narrow. In order to describe the usage of illicit drugs in respect of the different facets and the social groupings a national comparison with nationally representative samples would have been adequate, but considering the special nature of this research field ('hidden population'; see Hartnoll, 1992, p. 10ff) this seems not to be feasible. Nevertheless, the results of this study are not transferable to the national situation concerning illicit drugs. T~e comparison is of tentative character, focusing on a small but highly relevant in terms of drug politics-subset of the phenomenon'use of illicit drugs'. The study represents a representative comparison through a focus on the open drug scene in Amsterdam and Frankfurt.'

Economic considerations were not the only reason for a comparison using the narrow focus 'open drug scene', but also the fact that urban, open, drug scenes in particular (not least as the outcome of mass media reports) are the focus of attention of (drug) political activities. Because the social reactions concentrate on the 'extreme population' of'open drug scenes'- which is regarded as the essence of the'drug problem'- it is to be expected that in both structures and forms the national approaches concerning the phenomenon'illicit drug use'can be observed.

METHODS

The previously mentioned high degree of differentiation of the construct 'drug scene' contains essential implications relative to the sampling procedure. It was necessary to get access to comparable samples and to a comparable empirical field, otherwise the research would run the risk of producing artificial differences, which would reflect rather more typical distinctions than those between countries (i.e. open versus private drug scene), which might also be seen in the particular countries. This idea was taken into account when considering the sampling procedure and the selection of the research field based on an outlined differentiation scheme fora more detailed description and classification of the particular drug scenes discussed (Kernmesies, 1995a, p. 82). The sampling was done according to the criteria 'sociolocal disparity', 'dominant grouping and organisational form'and'dominant drug use pattern'. The comparison took place among compulsive ('coercive' consumption, due to physical addiction) users of hard drugs (heroin and/or cocaine) of the open urban drug scenes of Amsterdam and Frankfurt, who have been living for at least four years in those cities and are either Dutch or German.

The interviewees were contacted and interviewed in the immediate environment of the open street scene. There were a total of 100 interviews performed (50 in Amsterdam and 50 in Frankfurt respectively) based on a standardised questionnaire with open and closed questions from April 1993 to December 1993. The average interview lasted 90 minutes, which surpassed the expected length of 45 minutes, and shows the great readiness of the interviewees to pass on information. The questionnaire covered many different aspects; besides the 'biographical standard data' (social origin, education., profession, marital status) the emphasis was put on the development of drug usage (drug sequence, r intensity etc.) and the routines of everyday life (financing, social contacts etc.). The questionnaire was compiled according to corresponding research projects (surveys of the 'open drug scene') in The Netherlands and Germany and covered the central i aspects which are -according to the present stance of research on drug use - seen as 'representative' of a drug user's lifestyle. The interviews were accompanied by an unstructured observation process which almost inevitably - complemented the fieldwork.

To sum up briefly, methods of data collection and analysis took the form of a'method triangulation'. On the empirical basis of the open drug scene in Amsterdam (AMS) and Frankfurt am Main (FaM) i investigation was carried out, according to the general rather than specific hypothesis, as to whether particular Dutch or German drug use patterns may be identified (i.e. whether a national, specific Dutch and German typology could be identified).

RESULTS

The following summary of the main report provides - considering the required brevity and the enormous body of data - only the central results in a shortened form. 1 will report mainly on those aspects of user careers' and 'drug use patterns'which in recent years have been of main interest on the drug policy and drug help system agendas.

Biographical Standard Data

The biographical standard data are quite similar. The  present age (about 30, see Figure 1), the social origin (the majority of the interviewees come from the middle classes), the overall low level of education (50% of the interviewees in Amsterdam and 58% of those in Frankfurt have not completed any vocational training), and the present marital status (72% of the interviewees in Amsterdam and Frankfurt are single) largely correspond. In comparison with the data of other  Amsterdam and Frankfurt research projects (Korf and Hoogenhout, 1990; Grapendall et al., 1991; Vogt, 1992; Ostheimer et al., 1993), the samples seem to have a high quality of 'exemplary representation' as egards the open drug scenes of the cities compared.

Drug careers'

Observing the drug careers from the perspective of age, differences can be seen only in details. The nfluence of the different drug political and drughelp conditions in the neighbouring countries on the development of drug use will be illustrated by some observations. Figure 1 shows how similar the temporal structure of the career patterns of the drug users in Amsterdam and Frankfurt are.

Drug Sequence

We will take a closer look at the drug sequence of the nterviewees according to the age of initiation into the use of various - licit and illicit - drugs.

NicotinelAlcohol

As seen in Figure 1, the average age at the initial use of licit drugs, nicotine and alcohol, is very similar in he compared samples.

Cannabis

It is striking that the Amsterdam interviewees began ouse cannabis at a far earlier age. This might be due to he more liberal handling of hemp products in The Netherlands, the latest example being the statutory fixing of the special Dutch hemp policy by means of he opium act revision in 1976. A further hypothetical xplanation may be founded on a possible interrelaion between geographical origin and onset of annabis use: on average the Amsterdam interviewees had lived in their respective cities since their late hildhood (age 10- 11 ) and the Frankfurt intervieweessince theirlate adolescence/early adulthood (age 718). Before moving to Amsterdam and Frankfurt he interviewed drug users lived in more rural regions.

Hard Drugs'

The age of initial use of hard drugs was determined by means of the earliest experiences, respectively eferring to the use of heroin, cocaine, speed or raw opium. The corresponding ages in the compared samples are similar. There might be - regardless of the overall more liberal 'drug political atmosphere' in The Netherlands - a'sociocultural inhibition threshold` (Reuband, 1992, p. 66) or (sub-)cultiiral control mechanisms, which are embodied to a certain extent in the stronger pharmaceutical dynamics and higher use risks of these substances. Above all, it is striking that the earlier start in the use of hemp products by the Amsterdam interviewees does not seem to imply an earlier initiation into the use ofhard drugs. Therefore, the thesis that early cannabis usage leads - as a kind of pacer - to early experimentation with hard drugs, i.e. drugs with stronger effects and higher risk factors, cannot be confirmed.

Cocaine/Speed

The initial use of cocaine and speed of the Amsterdam interviewees happens much earlier; this may indicate the earlier establishment, spread and - on the whole -a greater importance of stimulating drugs in open scenes in Amsterdam (1 will come back to this when referring to the present drug-use patterns).

Methadone

The most striking age difference can be seen regarding the use of methadone substitution. This can be interpreted in terms of the most important difference between the drug help systems of the neighbouring countries. Due to the fact that in The Netherlands methadone treatment has been a regular supply with almost no conditions for drug users addicted to opiates since the beginning of the 1980s, methadone treatment in Germany has only recently been integrated into the drug help system - mostly in urban areas, but it is still regulated and controlled` 'based on an individual and single-ease approach'   (Verthein et al., 1995, p. 99). Therefore it is not at all surprising that the interviewees in Amsterdam used this supply earlier and that there are more people with methadone experience (AMS: 94%, FaM: 68%; 2: 10.98, p<0.001, tlf 1).

LSD/Ecstasy/Crack

What these drugs have in common is that they do not seem to play -a role in the present drug-use patterns of the interviewees. LSD seems to have lost its usagemotivating subcultural context related to the hippie era (Leary's 'Turn on, Tune in, Drop out').'' With regard to the open drug scene, LSD and ecstasy show a kind of 'subcultural incompatibility' (on the [subcultural] context of ecstasy see: R5tsch, 1995, p. 3 15ffl. Ecstasy and LSD - or rather the youth culture connected to these drugs - seem to be highly incompatible with the lifestyle and the drug preferences of compulsive heroin users in open scenes. The analysis indicates that the relatively high average age of the interviewees is important because there seems to he no contact with the youth culture associated with ecstasy Ctechno-scene'). Whereas ecstasy seems to have a high lifetime prevalence in the samples (AMS: 48%, FaM: 32%) only one out of ten interviewees claims to have ever tried crack - this indicates that crack has not spread on the open drug scene (yet).` Of those with crack experience none reported present usage or a longer phase of usage, which is mainly put down to the adverse effects of crack. The thesis which describes an'enormous habit-forming potency'of crack (Sahihi, 1993, p. 39), which is similar to spontaneous constitution of an addiction status, has to be modified when taking into account those 11 persons who, despite crack experience, do not report long-term or present usage. `

Drug use related experiences

At first it is quite striking that we cannot make out any clear-cut, distinctive age differences concernirig the 'typical' development of a long-term drug user between the samples (see Figure 1). 1 would like to draw attention to some illustrative observations and differences, which are hidden behind the age benchmarking figures.

Experience with Police and Investigating Agencies

Surprisingly, the Amsterdam interviewees report more extensive imprisonment experience. It should be noted that in Frankfurt the interviewees report more treatment on account of court orders, adding to the number of imprisonments and court-ordered therapies. The result is a rather balanced relation of the samples regarding the legal status. On average the interviewees from Amsterdam and Frankfurt report three spells of imprisonment and/or courtordered therapies. On the whole the developments in drug use of the subjects questioned in Amsterdam and Frankfurt seem to be to the same extent subject to formal social, particularly legal, control.

Experience with withdrawal treatment and (tn-patierit) therapy

Taking a look at the therapy and withdrawal treatmerits as a whole conspicuous features arise which relate above all to the greater number of efforts in the Frankfurt sample. The interviewees in Frankfurt report double the number of withdrawal treatments (AMS: 4. 8, S D 3. 1, FaM: 11. 2, S D 4. 5; t4.3 5, p <0.001) and one and a half times the number of long term therapies (AMS: 1.7, SD 1.2, FaM: 2.7, S: 13; t 2.48, p <0.05), whereas almost all the interview partners had experience of withdrawal (AMS: 86%, FaNI: 94%) and every second interviewee had experience of therapies (AMS: 48%, FaM: 52%). The great difference is only partly explained in terms of the greater number ofextrinsic -by court order- motivated withdrawal and therapy treatments in the Frankfurt sample. Above all, the great number of intrinsically motivated withdrawal treatments in the Frankfurt group shows a stronger problem-based pressure, which was more often the motive for the specific steps to either change the drug usage behaviour or to stop using drugs for some time. That these turning-point experiences, induced by problem-based pressure, are not to be found to the same extent among the Amsterdam interviewees might be connected to the fact that those in such situations had access to a low-threshold methadone programme. It is clear from the analysis that there seems to be a connection which could be described as a 'catalytic effect' of substitution. With regard to first withdrawal, as well as to first therapy, it turned out that such experiences (primarily induced by problem-based pressure) in the course of drug-use development in the first group (at least temporarily) substituted (which consists mainly of subjects from Amsterdam, owing to the longer 'methadone tradition') arose much later. The time between initiationof heroin use and the particular experience is some years longer when compared with the group who were later or never substituted. Apparently the substitution had a stabilising effect and moderated the dynamics of negative development in respect of drug use.

Experiences with overdoses

The Frankfurt interviewees reported more extensive experiences with overdoses. The number of those with overdose experience is almost double that of Amsterdam (AMS: 40%, FaM: 72%; 2: 10.39, p <0.001, df 1). Additionally, those with overdose experience from Frankfurt report more overdoserelated emergency situations (4 to 3). The obviously higher overdose risk on the Frankfurt drug scene can also be seen respectively in the reports of personally known overdose victims and drug victims (on average the Frankfurt interviewees state that more than double the number of drug victims are known to them; AMS: 6, SD 5. 1, FaM: 13, SD 12.65; t 3.3, p <0.05). Understanding the concept'drug victims'in terms of 'too late or untreated emergencies" (Heckmann et al., 1993, p. 187) these figures have to be regarded as an indicator that the conditions of the Frankfurt drug scene seem to be connected to a higher overdose risk. This can also be seen in the national drug victim statistics, which show a higher death rate inGermany (see Korf, 1990, 1995, p. 225 ff) - but here the different registration criteria with regard to drug death in the two countries, and the problem of comparing them, has to be taken into account. With regard to this difference two risk factors emerged from the analysis, which seem to be characteristic of the Frankfurt drug scene and do, at least partly, explain the higher overdose prevalence among the Frankfurt interviewees. A special risk factor seems to be intravenous drug use, which is mainly- almost without exception - practised by the Frankfurt interviewees (AMS: 62% [primary orsecondary application], FaM: 98% [primary application]; 2: 20.25, p <0.00 1, elf 1). Of those who claim to administer heroin or other substances intravenously, 63% so far have had an overdose ex.perience, against 'only' 30% who do not practise intravenous application (2: 6.86, p <0.01, df 1). Also, the use of pharmaceuticals (in particular benzodiazepines), which is found to a larger extent among the Frankfurt interviewees, seems to be another risk factor. The more intensive use of pills, as well as the preference for intravenous application, among the Frankfurt drug users seems to be a consequence of poorer heroin quality on the one hand and higher pricing on the other.` In this situation the greater prosecution pressure on the level of the consumers, (when compared with that ofThe Netherlands) ma*y beresponsible which is, due to the'logic'of a black market, manifested in a very high end-user price but poorer drug quality. This causes the consumers to adopthigh-risk' drug-use patterns (mainly intravenous application and combined use of pills), which ensures relatively optimal efficiency (regarding heroin's/drug's effect) of the low-quality, inferior, black-market heroin. Therefore,'only'35% of those who claim not to have used pharmaceuticals (nonmedical) yet, or who have stopped after experimental use, report an overdose experience, whereas 61% (2: 4.47, p <0.05, df 1) of those who have used pharmaceuticals regularly report such an experience. Returning to the moderating effect of methadone substitution on the dynamics of developing high-risk drug-use patterns, it should be said that those who have already been substituted (at least temporarily) with methadone, before having had the first overdose experience, show a tendency to fewer experiences (3.5, [SD 4.61 to 5.5 [SD 7.51). This group consists only of Amsterdam interviewees. Therefore the lower density of overdose experiences among the Amsterdam interviewees seems to also be a sign of more extensive and longer substitution experience (cf. above) and is not explicable in terms of the particular Frankfurt risk factors only. The emphasis on the previously mentioned circumstances and risk factors, which Korf ( 1995, p. 223 ff.) also refers to with regard to secondary analysis of some Dutch research studies, does not disguise the fact that there are many causes for overdose victims and drug emergencies.

Summing up the observations on drug,use developments, it is widely agreed that it is true that the initial use of illicit drugs (here, cannabis) is earlier in the Amsterdam sample, but the key features of further drug-use development are almost identical. The first experience with the use ofhard drugs, the last abstinence phase and the present age, are also identical. Former drug-use development, since the beginning ofhard drug use, covered aperiod of 12 years, and in the samples there is a similarly high number of drug users who have already been using drugs for more than ten years (so-called 'long-term junkies': AMS: 56%, FaM: 58%). Let us conclude the presentation ofresults with a look at the present drug usage patterns and the present life situation of the interviewees.

Present patterns of drug use

The present drug-use patterns are quite similar with regard to outward appearances, in so far as we can speak without exception of polyvalent drug use behaviour with a similar high consumption level. The great importance of cocaine in current consumption was striking (almost three out of four had consumed cocaine in the past 24 hours) ; 16 in so far as the empirical basis of the present research-the open drug scene - is associated mainly with heroin (hitherto at least in Western Europe; see Bless et al., 1995, p. 136). The obviously great importance of cocaine in the two cities in the open drug scene can also be seen in the fact that the drug users - in Ams terdam as well as in Frankfurt - report a clear drop ii.-i the price of cocaine and heroin in the course of the last year.` From an economic perspective, this points to competition between the cocaine and heroin markets (which has been emphasised by some Amsterdam interviewees). It seems as if a situ ation arose on the black market for drugs in which, by means of a price war, market shares were either preserved (heroin) or added to (cocaine). Although the drug-use patterns of the interviewees point to slightly different national preferences for particular substances and application methods this does not suggest substantial, basic differences.

Current lifestyle

Referring to the present daily routines we can make out structural correspondences as well. In the overall picture the interviewee's everyday life is primarily concerned with drug use" and takes place r'nainly in the social context of the open drug scene. ` The main motives for hanging around are to buy drugs, to meet people and to do'drug business' (e.g. dealing, receiving, procurement, drug-use related services`). Although the Amsterdam interviewees have more reference points outside the scene," they can still he characterised as socially marginalised. As a whole the dailyroutine seems tobe primarily concerned withthe cycle withdrawalmoney/drug procurement- drug use. In terms used by Grapendaal et al. (1992, p. 4), we can characterise the interviewed drug users in Amsterdam and Frankfurt as'full-time junkies', whose contacts with the'main culture'are mainly connected to the institutions of legal and sociomedical control.

Summing up the results, there seem to be no principal differences in terms of a'maximum contrast'in the empirical reference point (the open drug scene) in this study between the cities compared. This implies that there is no clear-cut Dutch or German type of drug development. There are some differences concerning druguse developments and the drug-use patterns which do point to divergent influences of the different structures at the macro- and the exo-system levels. But this is not substantial, as a comparison of the (rather liberal) Dutch and the (rather repressive) German drug political approach might suggest; as already mentioned a typology that explicitly shows national types of drug use or drug development cannot be proven.

DISCUSSION

In conclusion 1 would like to make some remarks reflecting on the results of the structures found, which are similar. Three questions follow which 1 would like the reader to keep in mind regarding the tentative, exemplary character of this international comparison, focusing on a section of the whole drug phenomenon:

1 . What explanations do we have for the similar s mwtures? Why is there no national drug-use typology, even though there are divergent drug political approaches in the neighbouring countries? There could be three 'levelling factors', which cause the structural similarities of the phenomenon in the neighbouring countries, but these are left for further research.

Hypothesis I

It can be assumed that there are only a few variants of relevant influence factors and contextual conditions because of the related culture of The Netherlands and Germany.

Hypothesis II

It can be assumed that there is a drug-use controlling dominance of the informal values and norm system of the (comparable in the neighbouring countries) subcultural sphere of the drug scene in contrast with the (partially diverging in the neighbouring countries) formal values and norm system of the main culture and that from this are derived attempts at political- institutional control.

In this manner, the expressions of the phenomenon can be explained rather by the informal rules and value system of the subculture and not from those of the formal control mechanism on the macroand exo-systern levels of the main culture (see Rcuband, 1995). To'dlustrate'this thesis, 1 would like to use the example of global youth and protest movemerits (e.g. the hippie movement), which expressed themselves quite similarly in various countries despite cultural differences in their'immaterial' (values) and 'material' appearance (language, clothing, grouping; also preferred drugs etc.).

Hypothesis III

At the core of the matter the drug political approaches of the neighbouring countries are on the macrosystem level, focusing on general drug prohibition, so that despite the drug political variations the problems are comparable.

Focusing on the formal control mechanism of the macro-system level and the norm structure (here, narcotic drug control acts), we are also - according to the international drug control agreemen tS222 _ dealing with general drug prohibition in The Netherlands. That the black market logically aims at maximising profits, including all negative implications for the entire society (e.g. crime, use of enormous institutional, i.e. financial, resources to push through norms and rules) as well as for the drugconsuming individual (e.g. social marginalisation, criminalisation, health risks), holds true for the drug political approach of The Netherlands as well.

2. What do these observations indicate?

Thesis: The 'Dutch model' neither meets the 'demonisations'of earlier times, nor does it meet the present 'idealisations'.

The results show that the basic problems of disintegration, psychosocial as well as physical impoverishment and criminalisation remain unsolved in The Netherlands as elsewhere. Even if the dimensions of these negative outcomes are slightly smaller, such expressions of drug use (as regards drug policy) are still seen to be at an unacceptable level; in The Netherlands too people die due to the criminal situation of the use of illicit drugs. Even the internationally praised Dutch drug political basic motive, to see drug use rather as a social, health and political issue rather than as a penal matter, is not reflected in the observations. The drug-use developments are in the same way subject to formal - primarily penal - control mechanisms, and the incrimination pressure does not differ. 2~ Summing up the results it can be said that the international demonisations dating from the commencement of a liberal Dutch drug policy as well as the present idealisations of it do not stand up to the observations.

Thesis: Approaches to the drug political phenomenon are at the very least based on a control illusion.

As shown, the drug political approaches in the neighbouring countries generate a'drug problem' with comparable shapes and expressions." A possible interpretation could be that approaches to the political phenomenon are based on a (not assessable) control illusion. This interpretation is at least consistent in so far as it stands up to previous experiences with national as well as international drug control policies: drug usage took place and takes place, despite general drug prohibition.

What political consequences can be deduced from observation of the similar structure of the phenomenon 'use of illegal drugs'?

It seems to be the case that a clear decrease in the discrepancy between the actual and the required situation of the so-called 'drug misery', as based on the Dutch drug policy motives oCrisk management'and a'normalisation policy' (see Leuw, 1993b) and on the recent German discussion of an'acceptance orientation'(Kemmesies, 1993 ) '25 needs to be put into clearer context. The question raised, and answered positively by Kaplan et al. ( 1994), as to whether the Dutch drug policy can serve as a model for the world, has to be seen from a new angle. Also, under the conditions of the Dutch approach to the phenomenon, negative outcomes of the use of illicit drugs, as well as the associated risks for the drug-consuming individual, the social environment and the society as a whole, do emerge to an unacceptable extent - and not only as 'the exception to the rule'. Therefore, regard it as doubtful that the Dutch drug policy can serve as an international - or even, as suggested by Kaplan et al., global - model. The risks of the use of illicit drugs still exist in The Netherlands under the policy of general drug prohibition (discussed earlier), but contrary to widespread speculation" this is not actually taken into consideration. Therefore the following conceptual idea of a'drug political strategy of integration'suggests itself, owing to the similar structure of the drug use phenomenon in the neighbouring countries, despite clear differences of the 'drug political phenotype':

The development of a risk-conscious (relieved) drug culture depends on the withdrawal of the social, formal - penal and sociomedical - control mechanism.

The shaping of drug policy should be undertaken in accordance with the following perspective, which negates the illusion of a drugfree society: A (political atmosphere of) social acceptance must be created, which accepts the use of non-encultured drugs as an expression of a self-chosen lifestyle. This requires the abolishment of all formal control approaches and institutions, which either imply or enact special treatment of drug users, as far as social marginalisation and stigmatisation effects are concerned. Then one would withdraw the breeding ground for social disintegration, impoverishment, crime, etc. of the drug political dilemma. Then there could develop a'drug use culture', where, relieved of stigmata and myths, a rational debate on drugs between equal partners would be possible. Such a practice would enable the development of a riskconscious (-relieved) drug culture, maximising subjective benefit and minimising outcomes harmful to the individual as well as to society. A path could then be cleared for a drug culture in which the present control mechanism concerning drug policy and drug help would be superfluous.

Uwe E. Kemmesies, PhD, Adolfsallee 28,65185 Wiesbaden, Germany.

Email: EwU3Kem@aol.(.om

' Mainly an increasing differentiation and acceptance of drug help, gradual decrease of the criminal control of the consumers (above all regarding cannabis products) - opportunity principle(§31 a BtMG).
2 Mainly a stronger control of the market for cannabis products, coffee,shop systems (reduction of the maximum sales amount and retail shops) and national cannabis production, emphasis on criminal prosecution - orientation towards the German'therapy instead of penalty' motive (see Drugsnota, 1995) 'Translated by the author. ' This judgement is supported by concrete statistics on prosecution (e.g. in a certificate on the cannabis situation in Germany which has been done by the Bremer Institut for Drolgenforschung for the University ofAmsterdam Quensel et al., f 1995, p. l6ff).
'The term'drug career' refers to the development of an individual's drug use' (Korf 1995, p. 189).

'Translated bv the author.

"'The German health insurance schemes pay for this treatment only if the methadone substitution serves as a possibility to cure severe diseases like hepatitis, AIDS and "similar severe diseases ... .... The NUB guidelines do not necessarily guarantee methadone therapy for each addict who fulfils the requirements. Differences in the number of physicians willing to use substitution therapy in the different states of Germany depend on ideology and the extent of the local drug problem' (Zenker, 1995, p. 139).

" Though it has to been added in this context that LSD seems to be experiencing a kind of renaissance corresponding to a reorientation to the 1970s in recent youth cultures (rave-, techno-scene).

12 Contrary to this, a recent Frankfurt study shows a significant increase in the importance of 'crack' on the open drug scene (Kemmesies, 1995b, 1996) and supports the thesis that a 'crack market' is being built up.

'' The observation of a compulsive use pattern obviously not automatically connected to the consumption of crack has also been made - with a larger empirical basis and a higher level of differentiation - in the course of a Canadian 'crack study' in and around Toronto (Cheung et al., 199 1 ).

` Korf et al. (1994, p. 20) assume an average amount of 30% of heroin hydrochloride in total according to their study on the Amsterdam drug market (street dealing). Contrary to that, the police figures in Frankfurt assume an amount of only 3% to 8% of the heroin purchased by the end user (see Poliziepr5sidium Frankfurt, 1993, p. 190).

" Whereas in the 'Frankfurt drug use pattern' heroin can be seen as a main drug, the 'Amsterdam drug use pattern' shows equal importance of cocaine and heroin. Therefore the question arises as to whether the actual situation of cocaine in AMS (the Netherlands) suggests future development in FaM (Germany) or rather points to a different subcultural drug use pattern in the two countries. In favour of the first suggestion is a current Frankfurt study, suggesting an increase of the importance of cocaine in respect of drug use on the open drug scene in the period 1992-95 (see Kernmesies, 1995b).

17 Concerning heroin, a drop of about 23% was reported (AMS: from G 93 to G 73, t 4.73, p <0.001 -, FaM: from 13M 127 to DM 97, t 4.97, p <0.001). Concerning cocaine an average drop of 12% in Amsterdam (from G 110 to G 97, t2.8, p <0.01) and in Frankfurt a drop of as much as 22% (from DM 168 to 13M 131,t 3, 93, p <0.01) was reported (prices per gram).

" Some 80% of the interviewed people said that their daily activities focused on drug usage (mainl drug purchasing and consumption). '24 hours hunting the poison' (Karl, 43 years old, FaM);'Just dope' (Peter, 25 years old, AMS). Only two of those interviewed said that they had a regular job, i.e. 98% are unemployed and are presently not involved in any kind of vocational training.

" In total the interview partners are spending an average of nine hours at the scene six times a week, but this contact seems to be more intense in Frankfurt (contacts per week: AMS: 4.9, SD 2.1, FaM: 6.5, SD 1.6, t4.11, p <0.001).

" For example provision of equipment for intravenous drug use in exchange for the used filters. This seems to typify the Frankfurt drug business. Drug users doing this business are called 'service men' (Kemmesies, 1995a, p. 224ff). This kind of service is placed on the lowest rung of the drug business hierarchy.

` The more intense social relations with non-drug users alluded to in the Amsterdam sample can be seen in the fact that only onethird of those interviewed in Amsterdam professed relations with non-drug users, whereas this was stated by every second interviewee in Frankfurt (AMS: 30%, FaM: 54%, 2: 5.9 1, p <0.05, df 1).

` 'Single Convention on Narcotic Drugs' (1961); 'Convention on Psychotropic Substances' (1971); 'United Nations Convention against Illicit Traffic in Narcotic Drugs' (1988): These conventions built up the basis for the predominantly repressive drug control policy internationally, 'whose foremost goal is the total elimination of the use of forbidden substances' Worf 1995, p. 1).

"General national figures support this observation; it also has to be taken into account that they are only comparable up to a certain point. For The Netherlands it is assumed that about every second prisoner has consumed hard drugs and shows an addiction problem (Lemmers, 1993, p. 8). For Germany it is assumed that this holds true for every third prisoner (but to a larger extent in urban prisons, see St5ver, J994, p. 15). In 1987 every fourth prisoner in The Netherlands was arrested for an offence leading to conviction related to an illegal drug, whereas in 1977 only every eighth prisoner was arrested due to a violation of the opium law (Verhagen, 1989, p. 16). It should be mentioned that this increase was not intended by the 'Opiumwet' of 1976. In Germany every eighth prisoner has been convicted due to a violation of the BtMG (see Statistisches Bundesamt, 1993, p. 20).

` This judgement is also suggested by Reuband's (1992) secondary analytical comparison of The Netherlands and Germany on the basis of representative, epidemiologic studies. Korf (1995), too, points in a study (also with secondary analyses) to the many similarities in the phenomenon 'use of illegal drugs' in the neighbouring countries.

25 'Acceptance -orientated drug work and drug policy means first of all the recognition of the reality that the goal of abstinence from drugs is not equally valid for all drug users, and not realistic for all at every juncture' (Stover & Schuller, 1992,p.193).

6' For the problem of defining'drug scene', see Kemmesies ( 1995a, p. 77ff). Stressing qualitative aspects Bless et al. (1995, p. 13) define 'open drug scene' as 'all situations, where citizens are publicly confronted with drug use and drug dealing'.

These cities were chosen because of their relative high degree of 'representativeness' of the drug political situations in The Netherlands and Germany and because of the fact that they are quite similar because of relevant social and economical structures. Both cities represent international financial centres, international traffic junctions and have almost a equal number of inhabitants (AMS: 690 000 (Bless et al., 1993,p. 52), FaM: 660 492 (Amt fur Statistilo, Wahlen und Einwohnerwesen, 1993, p. 7). Furthermore Amsterdam and Frankfurt could each be described as a 'drug metropolis' with a quite attractive drug market and almost the same number of regular hard drug users (AMS: 6000-7000 (Bless et al., 1993, p. 52; Zwart and Mensink, 1993, p. 58), FaM: 5000-8000 (Nimsch 1991, p. 24; Gemmer 1991, p. 41); due to the special nature of the research field these figures represent estimations, with a more or less empirical basis).

` In the government document mentioned earlier, a legalising of 'hard' as well as 'soft' drugs is rejected explicitly (Drugsnota, 1995, p. 16ff).

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