Title: National variations in the use of alcohol and drug research: notes of an itinerant worker
1National variations in the use of alcohol and
drug research notes of an itinerant worker
- Robin Room
- School of Population Health, University of
Melbourne - AER Centre for Alcohol Policy Research,
- Turning Point Alcohol Drug Centre, Fitzroy,
Victoria, Australia - Centre for Social Research on Alcohol Drugs
(SoRAD), - Stockholm University, Stockholm, Sweden
- For presentation at a NAD workshop, Making use
of alcohol and drug research, Reykjavik,
Iceland, 13 October, 2007
2 an itinerant workerFirst the experience 1.
California
- Berkeley CA, USA Research assistant ? social
research centre director, 1963 1991 - Testified to government hearings once in
Sacramento, once in Washington in all that time - Media interested only in how many alcoholics
until late 1970s - Relatively little interest from nongovernmental
organizations (MADD, Trauma Fdn as exceptions) - Sporadic alcohol industry interest, but on its
terms - Some interest from late 1970s on from independent
book writers, social scientists, civil servants
3First the experience 2. Ontario
- Toronto, Canada Vice-President for research,
provincial agency with research, treatment,
training, community program functions 1991-1998 - Testified to government hearings in Ottawa,
Toronto, Vancouver maybe 5 times - Regular meetings and some collaboration with
retail monopoly - Media somewhat hostile at press conferences we
retreated to press releases - Strong institutional connections with
nongovernmental organizations (often
quasi-governmental), researchers often more
distant - Alcohol industry asked agencys opinions,
sporadic meetings - Good connections with social scientists, civil
servants
4First the experience 3. Sweden
- Stockholm, Sweden social research centre
director, 1999-2005 - Testified to Parliament (15 committee members) in
first week informal hearings/meetings thereafter - Regular formal invited responses to
investigations - Regular meetings and some collaboration with
retail monopoly - Media is well informed sustained media interest
in alcohol research monitoring results (not
drugs) - Nongovernmental organizations interested in
research, alcohol pressure groups usually saw
researchers as allies - Alcohol industry (fairly weak politically) mostly
kept itself at arms length - Good connections with social scientists, civil
servants
5First the experience 4. Australia
- Melbourne, Victoria director of small policy
research centre within multifunction agency,
2006 - Testified to state parliamentary committees 4
times before moving to Australia, not since - Informal meetings with legislative committee
staff - Appointed to state federal advisory committees
- State liquor licensing agency is wary
- Media is interested, fairly well informed
- Nongovernmental organizations (often
quasi-governmental) interested, looking for
partnerships - Alcohol industry sniffed around for co-optation,
then stayed at arms length - Good connections with social scientists, civil
servants
6 then the analysisEach polity has its own
style
- of relationship between social science and policy
- U.S. more hands off, through specific-topic
research funding agencies - research insulated from politics unless shocking
- small influence of social science research on
policy - Canada (when I was there) research continuing
from old momentum, new research as an optional
extra - overall policies rather little influenced by
research - Sweden social engineering ideals -- the social
scientists utopia? - alcohol social research as a conservative force
- drugs social researchers suspect and
marginalized - Australia alcohol drug research largely new in
last 20 years - researchers main influence through committee
networks - the political level has been unable to get the
answers it wants
7Each polity has its own style of defining and
handling alcohol and drug problems
- U.S. Addiction disease as framing, but not in
handling - Ever further biologization of framing and
research (not of practice) - Coercive social handling through criminal justice
system - Social criminal problems a policy focus, but
not a research one - Canada mixed framing
- Creeping biologization, influenced by the U.S.
- Relatively uncoercive social handling
- Spotty social criminological research
- Sweden welfare and workforce framing
- Social rejection of drugs still strong, but panic
has faded - Coercion, but not primarily through criminal
justice system - Strong social and criminological research
- Australia mixed framing
- Politicians drugs! researchers alcohol,
tobacco! - Drugs panic fading, attention shifting to alcohol
- Social and criminological research strengthening
8Research and policy with Normal science
- What the policy process might look for
- Monitoring and analysis of behavioural trends
- Identifying new and worrying trends
- Alcopops, dance drugs,
- Intelligence on hidden behaviours
- Scoping and monitoring size of problems
- Effectiveness cost effectiveness of
interventions, policies - Studies of social handling systems
- If the answers will not be what the policy
process wants - Canada, Australia, often in U.S. pay for the
research, but ignore the answers - Sweden (drugs lt2002) and U.S. sometimes dont
fund the research in the first place
9 - Research could be seen as a modern instrument of
debate on policy, primarily on the alternative
means derived from the same basic values, rather
than on alternative goals. - Social research produces arguments rather than
logical conclusions regarding policy and
action.... The big decisions will always be
taken on the basis of values the small, but
still important ones might, however, be improved
by social research. - Kettil Bruun, 1973
10Abnormal science inconvenient knowledge and
how to deal with it
- The choices
- Denial
- U.S. scientists in 1940s-1950s alcohol does not
cause cirrhosis (D. Herd, Ideology, history and
changing models of liver cirrhosis epidemiology.
British Journal of Addiction 87179-192, 1992.) - Christopher Pyne, Australian federal minister it
is "naïve and dangerous" to suggest that alcohol
kills more people than illegal drugs (23 Feb.,
2007) (http//www.caan.adf.org.au/newsletter.asp?C
ontentIdt20070305) - Distracting attention
- Lois Ferguson, a Registered Dietitian, says
there is a lot of evidence to disprove the theory
that beer makes you put on the pounds. But the
good news doesn't stop there. Studies have
consistently shown that the moderate use of
alcoholic beverages is associated with a decrease
in the risk of coronary heart disease.
http//www.brewers.ca/EN/ontap/V17N1/vol17_issue1.
htm - Facing up to it
- The conclusion that treating alcoholics is not
sufficient response to the alcohol problem is
based on an empirical result namely, that the
problems associated with drinking are distributed
rather broadly through the population of
drinkers. - M. Moore D. Gerstein, eds. Alcohol Public
Policy Beyond the Shadow of Prohibition, US
National Research Council, 1980, p.47.
11Research and policy in paradigm shifts 1
- A research-led shift alcoholism ? alcohol
problems in the U.S. - Social researchers find alcohol problems widely
dispersed in general population, 1967 - Alcohol problems a report to the nation, 1967
- But press reports it as being about alcoholism
- Influence of Nordic thinking through Canada
Bruun et al., purple book, 1975 - Head of California state agency influenced by
1974 - New head of NIAAA influenced by purple book, 1978
- Alcohol and Public Policy, National Academy of
Science Report, 1981. - Industry fights back forces out 2 of 3 heads of
NIAAA by 1982 - On the one hand was the heightened sensitivity
of the industry, versus the maturing body of
research evidence as expressed by the Institute. - NIAAA pared back Keeping to its more narrow
issue of alcoholism thats enough for it. It
has the capacity to do basic research and thats
it. - (John DeLuca in R. Room, Former NIAAA directors
look back, Drinking Drug Practices Surveyor
1938-42, 1984) - But despite the pushback, the paradigm shift
endured.
12Research and policy in paradigm shifts 2
- An administrator-led shift harm reduction comes
to Sweden on little cat feet - Before Drugs as The suitable enemy (Christie
Bruun, 1985 1996) - Illicit drugs as a suitable enemy for the modern
Nordic state - Can be presented as dangerous
- Associated with powerless outgroups
- A distraction from intractable problems
- Alcohol, tobacco, medicaments as unsuitable
enemies - Drug control as a national project (Tham, 1995)
- Goal of drug-free society as an absolute moral
philosophy - Consensus of the people against something alien
from outside - General national project for the defense of
Sweden - Appointment of Drugs Coordinator Feb. 2002
- Politicians have been making decisions on the
basis of too little knowledge - Funding of a variety of small studies of what is
really going on - Needle exchanges (15-years in experimental
status) regularized - Buprenorphine made available through MDs, breaks
the logjam on methadone - Decline of the drug warriors
- Sweden becomes a normal European country in terms
of de-facto harm reduction - Drugs policy moves to the usual Swedish pattern
of pragmatic social engineering
13Science and the Nordic politics of substance use
- Relatively, a general pragmatism commitment to
knowledge-based social policies - But symbolism and values important in Swedish
policies - Means of sustaining both values
- Researchers encouraged to stay within fences
- When a critique comes from representatives of a
state-financed alcohol research centre it is
naturally yet more remarkable - Inconvenient research marginalized before 2002
in Sweden - Drug researchers and other drug policy experts
were ... placed in an intellectual quarantine - Research as a way to postpone the debate or
decision - e.g., controlled trial of Saturday opening
- But there is another side shifts in the
paradigm - Science often plays a subversive role,
undermining a current governing image - The strongest influence of science is thus often
outside the immediate political moment
14Some last words to researchers ...
- We work in a field laden with values and
symbolism - Our task, if publicly funded, is usually to find
solutions to what are seen as serious problems - Value-laden task, if only in the choice of focus
- To try to see and write beyond these
circumstances will both produce better research
and be more useful in the long run - Research findings become elements in value-based
as well as rational arguments - To restrict the focus to rational argument and
action is to miss crucial parts of the politics
of substance use - We need to develop research paradigms which bring
the assumptions and values into the object-field
of the research