Drug Abuse

Drug Research and Policy in Britain

A CONTEMPORARY HISTORY

Nicholas Dorne PhD and Nigel South PhD, Research and Development Unit, Institute for the Study of Drug Dependence, London.

Drug research, like all research, is a product of its time. Whereas the decade of the 1960s generated research reflecting the liberationist themes of those times and the disciplinary response they aroused, the 1970s generated pragmatic and primarily quantitative research aiming to identify, monitor, or re-integrate deviant groups; and the 1980s are generating research into the market and into infection. Some areas of research are identified for the immediate future.

This paper attempts to give a flavour of the main trends in British research into 'drug misuse' - a term which can be taken to cover the use of illegal drugs, solvent sniffin and some aspects of prescribing and use of medicines. We shall try to draw out those aspects that may be of policy interest to international colleagues.

Our sources and resources in writing the paper are as follows:

the published literature held in the reference library of the Institute for the Study of Drug Dependence.

additional information on ongoing research projects in Britain, collected for ISDD's annual register of research projects, Drug Ouestions.

an historical perspective upon the role of research in the production of knowledge in the area of social and economic policy about drugs.

We also ask readers to note; however, that we are not attempting an exhaustive, complete or fully referenced review of the literature.

The reference library at ISDD contains approximately 45,000 books and articles, the vast majority being in English, with a high proportion being North American studies. There is of course considerable repetition in the literature, due to the same or very similar reports being published in several places.

"Who breaks a butterfly on a whee1?" 1960s drug research in the context of a contest between a liberationist idealism and disciplinary empiricism.

During the 1960s, there was widespread acceptance of the idea that Western societies were becoming more 'liberal' or 'permissive'. Some social groups favoured such changes, others were firmly opposed, but all agreed that there was a drift to liberality. Debates about drugs and, to some extent, research on drug issues, were a part of this. The question above 'Who breaks a butterfly on a wheel?" - was The Times newspaper's headline to its editorial after Mick Jagger had been found guilty of possession of amphetamines, but had appealed, with the result that the original sentence, three months in prison, was reduced to a conditional discharge. Jagger was flown by helicopter to be interviewed on camera by that newspaper's editor and by The Archbishop of Canterbury and other representatives of 'The Establishment'. He explained that he did not want anything to do with responsibilities toward society; society had always been in need of restraint; education, money and freedom from war had made his generation different from others; he just wanted to have as good a time as possible.

Undoubtedly, such themes and opposition to them - can be found interwoven with the assumptions and ambitions of social research in the 1960s. For example, some social sciientists adopted a series of avowedly 'radical' epistemological positions, which either denied the existence of structures outside the desires of the individual and the negotiations of the small group (phenomenology, interactionism), or accepted that such structures existed but identified them as the causes of social problems (labelling theory, moral panics, theories of victimless crime, etc.) There was what has subsequently been identified as a celebration of deviancy; it was subjectivist in morality, idealist in its epistemology and naively impractical in its approach to questions of strategy and power in society and in public policy-making. One can still find echoes of this in some 1980s analyses of drug policies.

Quite different from, and generally opposed to the idealism of some 1960s social science research, was a strand of research in the life sciences. This was ostensibly materialistic in its assumptions (there is more to the world than ideas and subjectivity), and empiricist in its method (empirical tests quite independent of theoretical assumptions can prove or disprove hypotheses). In the drug field, this approach seemed to be generally motivated by an interest in the restoration or modernisation of the disciplinary processes of society.

It was around the question of cannabis in particular, that these two epistemologies the idealism of social science and the empiricism of natural science - clashed in the 1960s. The pro-legislation lobby achieved a victory when the Wootton Committee (chaired by a distinguished social scientist of that name) accepted that the problems associated with the current controls on cannabis and cannabis users were great enough to justify reducing those controls. In the end, however, the anti-legislation lobby won the day, in spite of the discrediting of research supposed to show that cannabis causes brain damage. Fears of exacerbation of patterns of indulgence in 'unearned' pleasure, and fears of escalation from cannabis to other drugs, helped to stem the 'permissive tide', in drug policy and in drug research.

Drug problems in the context of modernising, high technology, consensus seeking society: 1970s epidemiology, aetiology, and research for demand reduction and social integration.

During the 1970s a broadly social democratic coalition came to the fore in many capitalist countries, reflected in the field of social problems and deviancy by an emphasis upon the reintegration of social groups into a mainstream, underpinned by modernisation and updating of economic and social institutions. Key questions for social problems researchers at this time, including drug problem researchers, were:

1. How big are the 'problems' (prevalence),
2. What causes them (aetiology), and
3. What measures reduce them (service evaluation)?

In Britain this era saw the development of 'indicators' research, expansion of quantitative research looking for 'factors' connected with drug use by individuals, and some evaluation research on programme outcome in treatment and education. A summary of the correlates of this research may be made in the following terms:

a) It was not possible to be exact about the prevalence of various forms of drug misuse, but indicators throughout the 1970s were of a general spreading and increase (accelerating sharply at the end of the decade).

b) No single cause or constant pattern of causes was identified, other than the tendency for males to be more involved than women and for levels of drug use to be higher in areas of greater availability; heavier involvement seemed to be associated also with some other forms of deviancy (Plant 1981) but causative processes were unclear (Fazey, 1977).

c) No known forms of treatment, welfare intervention or education appeared to induce an overall reduction in drug use, though the pattern of service delivery or educational programme might help to reshape the profile of drug use or of associated behaviours or consequences (see for example Hartnoll et al, 1980; Blum, 1976).

In relation to drug education, the most one could say, taking British alongside Dutch and North American research (De Haes and Schurrman, 1975, Dorn and Thompson, 1976, Dorn, 1983, Schaps et al, 1981), was that whilst simple 'fear appeal' approaches might stimulate some experimentation, more even-handed factual approaches, or affective ('person-focused') approaches or 'mixed' approaches seemed to make no overall behavioural difference (though it was possible to shift knowledge or attitudes). Research carried out by Blum (1976) in the United States at this time deserves a second look, since he found that education might stimulate experimentation slightly, yet delay heavier involvement (a pattern that might also have occurred in other research, but be obscured by the tendency to aggregate the results). This is of potential interest in the context of 1980s drug problems, AIDS and harm minimisation goals.

The 1970s value-neutral, technical pattern of research - epidemiology, aetiology, evaluation - provides a broad contrast to the more 'critical' and qualitative research agenda of the 1960s. Neither tendency can be said to have had an enduring impact upon public policy, although 1970s research was more integrated into the policy process and became better placed to provide a basis for research in the 1980s. Both research traditions, and public policy itself, received something of an 'external shock' at the end of the 1970s, as a sharp increase of heroin imports into Britain (and subsequent increases in availability and consumption) called into question notions that 'society is overreacting' (as much social research of the 1960s would have it) or that the problem was userdemand-led (as 1970s research generally implicitly assumed).

Tackling drug misuse: research into service provision, - drug distribution and harm minimisation, in the 1980's political climate of value-for money and personal responsibility.

We can identify five main strands to British public policy on drugs in the 1980s.

i) 'Stopping the problem at source'. Government contributions to international attempts to reduce production of plant drugs, particularly in Pakistan; more recently, the EEC has taken a role in that area.

ii) 'We shall get you'. Increased emphasis upon law enforcement- international co-operation, customs interdiction and policing - with increasing resources, greater sophistication of technique and higher penalties.

iii) Counselling the user. Central government tending to stimulate the development of medical, advice, counselling and other services for drug users across the country (in contrast to the previous focus upon London).

iv) Localisation of responsibility. Efforts to transfer responsibility for the organisation and costs of service provision away from central government, to health regions, local authorities, charitable bodies, industry and local communities and families

v) 'If you must inject...' highlighting of problems around HIV, with a mass media 'awareness' campaign, but uncertainty over harm minimisation as a practically viable and politically acceptable strategy.

In respect of research, coverage has been very uneven across these policy areas. As far as Britain in the 1980s is concerned, cocaine imports have been of little significance in volume terms when compared with heroin, so we will confine ourselves to the latter. There is no really adequate evaluation publicly available of crop substitution programmes financed by UNFDAC (United Nations Fund for Drug Abuse Control), USAID, or INM (International Narcotics Matters, US State Department) in countries such as Pakistan. Nor is suffficient evidence available in relation to South American programmes. What we do have is a formidable list of questions about the viability of such programmes (see for example Stimson 1987) and about the relationship of such programmes to their geopolitical context (Dorn and South, 1987a).

Anti-trafficking measures have been a growth area in the 1980s, and the term 'trafficker' (which previously meant importer) has broadened to include drug suppliers within the country. The Drug Trafficking Offences Act (1986) obliges any court that finds a person guilty of supply of drugs to confiscate all the assets of that person except those which can be shown to have been acquired legitimately. This law, following the precedents set in a series of United States statutes, indicates not simply an escalation of penalty (on top of life sentences) but also a shift in enforcement strategy - from a focus upon drugs per se, to a focus upon the criminal organisation and flow of money. It therefore has to be appraised in this light (see Grieve, 1988, Dorn and South, 1987b and forthcoming). Research into drug markets and law enforcement is potentially the most controversial area of drug research in Britain.

The final important area of research and policy in the 1980s has been harm minimisation and, within that, anti-AIDS policies. Pre-AIDS reports of the Advisory Council on Misuse of Drugs defined drug-related problems as being not only medical but also psychological, emotional and social, and the ACMD also defined 'prevention' as having the aim of reduction of drug related harm, as well as reduction of drug use per se (ACMD, 1982 and 1984). It has however taken the recognition of the AIDS problem, linked to drug use through sharing of injection equipment, to bring harm minimisation to the forefront of the policy and research agendas (ACMD, 1988 and 1989). The initial operation of the schemes has been monitored by Gerry Stimson and his colleagues. Their findings indicate that people who come to needle exchange schemes report a reduction in sharing, but other reports suggest that, amongst the injecting population in general, a high degree of sharing continues (Stimson et al, 1988 and 1989).

Certain forms of drug research - for example local indicator studies, profiling of local helping agencies, monitoring of needle exchange schemes and studies of drug users in respect of their injection practices and sexual habits- are already established in Britain. In this short concluding section, we shall restrict ourselves to the areas where research is as yet absent or undeveloped, but would have decisive policy implications. To construct these areas for research, we have drown upon the inheritance of the three decades- 1960s, 1970s, and 1980s - and have generated one key policy and research question from each paradigm.

Construction Of The Policy Agenda

Taking first the 'critical' mood of some social science research of the 1960s, and applying it to the conditions that we face today, we can ask, in 'social construction' fashion:

How do today's policy and research agendas become dominant? What possibilities are being excluded or obstructed by tacit agreements between the 'war on drugs' movement and the decriminalisers? How are alliances struck up, and how does the power to define issues do its work?

There would be a number of theoretical and methodological issues to be worked through in any such deconstruction of the policy agenda, but the aim would be clear enough: to see how certain 'issues' became recognised as such, and others excluded.

HIV In Prisons

Turning now to the 'pragmatic' mood of policy research, as came to the fore in the 1970s, we can adopt a quantitative, epidemiological approach and ask:

What is the likely spread of AIDS into the general population, if current preventioq policies are continued and if (as it seems reasonable to assume) they are only partly successful? For example, in the context of the British government's decision not to make condoms and clean syringes available in prisons, what is the likely spread of HIV through the prison population - a significant proportion of which are petty offenders, such as fine defaulters, or are prisoners on remand (Home Office, 1986) - and from there into the general population (via drug use and sexual intercourse outside prison?)

There may be stark choices ahead for penal policy, if HIV does spread as it may.

Drug Distribution

Taking our last area for policy research from social science paradigms of the 1980s, we turn to the market.

What is the best way of understanding markets in drugs, their structures, elements, dynamics and their relation to broader economic and cultural conditions, and to law enforcement?

One approach is that of conventional economics, which defines markets in terms of supply and demand (eg. Maynard and Wagstaff, 1987). Alongside this formal model, indeed preceeding it historically, is a broader 'business model' developed by social scientists and criminologists from Europe and North America; this focusses upon drug distribution as an intermediate set of systems, between production and consumption, with a complex and shifting structure, and including a variety of quite distinct types of enterprise (Preble and Casey, 1969, McBride, 1984, Dorn and South, 1987b). It is interesting to see these two quite different approaches to understanding drug distribution, alongside each other. It begs a big question - what sort of world do we live in? A world peopled by individual actors, prototypically masculine in the contemporary sense of equating rationality with cost-benefit calculation, each acting as homo economicus? Or a more complex social world, in which different groups, institutions, cultures, alliances, conflicts and contradictions, and forms of power and knowledge play a part? Evidently, our view of the world shapes our research, as much as (or more than) our research shapes our world view.

In conclusion, we can observe that, when viewed in historical perspective, drug related research in Britain exhibits some fairly clear trends but also some unevenness and a lack of overall coherence (Berridge, 1987); the same may be said of Europe (Berridge, 1989). From the point of view of an interest in co-ordination of research, this may seem regrettable. But from a point of view that would be concerned about the dangers of an undue narrowing of research and policy agendas that might follow from tight co-ordination, perhaps we should be grateful. Bearing in mind the plurity of our societies, the need to adjust to new circumstances as these arise, and the advantages of a rich heritage of many research paradigms upon which we may call, let us accept the un-coordinated nature of the research arena, and hope that it can develop to become more diverse and creative.

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