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National variations in the use of alcohol and drug research: notes of an itinerant worker

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Testified to government hearings once in Sacramento, once in Washington in all that time ... research insulated from politics unless shocking ... – PowerPoint PPT presentation

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Title: National variations in the use of alcohol and drug research: notes of an itinerant worker


1
National 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

3
First 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

4
First 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

5
First 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

7
Each 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

8
Research 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

10
Abnormal 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.

11
Research 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.

12
Research 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

13
Science 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

14
Some 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
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