Book Review

This book is the first in a planned series of six arising out of ALICE-RAP (Addictions and Lifestyles in Contemporary Europe – Reframing Addictions Project) a five year, €10 million research programme financed by the Social Sciences and Humanities Division of the European Commission’s Framework 7 programme. Within ALICE-RAP, the term “addictions” is taken to mean the regular and sustained heavy use of drugs, such as alcohol, nicotine and cocaine; and regular and sustained heavy engagement in actions, such as gambling or internet gaming (p. v). In this book, drawing on Emerson, Nabatchi, and Balogh (2012), governance is understood as “the processes and structures of public policy decision-making and management that engage people constructively across the boundaries of public agencies, levels of government and/or the public, private and civic spheres in order to carry out a public purpose that could not otherwise be accomplished” (p. 7).

The book does not, however, do exactly what the title implies. It neither tells us much about governance nor does it focus on addictions as defined by ALICE-RAP. The data in this study refer specifically to cannabis, heroin, alcohol and tobacco. Many of the policies at country level are not solely concerned with heavy and regular use. The processes of governance have not been studied. What were looked at were the formal written strategies and the organisational structures of each country as they appeared from analysis of documents. Qualitative information was mainly derived from expert interviews. I very much doubt the value of relying on these: talking only to one or two experts in each country is bound to produce biases and some mistakes.

The real value of the book lies, as the sub-title indicates, in its innovative synthesis of European public policies on drugs, alcohol and tobacco, looking at policies on all three types of substances together – an approach which produces an interesting and rather different picture from that which conventionally arises where the three are looked at separately. The work provides a baseline (or as Peter Anderson, the ALICE-RAP International Coordinator, says in the Foreword – a starting point) for further studies in the governance of addictions. From their descriptions and analyses, the authors construct four models of policy, ranged along a continuum with a “safety and disease approach” at one end and a “relational management and well-being” approach at the other. Where this latter approach is found, there is some social acceptance of substances and addictions, the idea of individual freedom is valued and policies tend to focus on the social consequences of use. The shift is from a public security to a health-oriented approach. These four models are based on careful, systematic and objective observations of patterns and trends.

Countries in model 1 (which includes Portugal) are distinctive as “trendsetters in illicit substances”, especially by focusing their attention on encouraging harm reduction policies, and decriminalising use and possession of certain illicit substances, but showing less concern to strictly regulate alcohol and tobacco. Countries in model 2, “regulators of legal substances” (which includes Sweden), stand out as giving more policy attention to licit substances with stricter regulation of tobacco and alcohol and do not decriminalise illicit substances. Model 3 contains countries classed as “transitioning” (such as Slovenia but oddly also Austria and Denmark) and those in model 4 have a “traditional approach” (like Hungary). Model 3 is something of a residual group or ragbag: distinctive features include high levels of consumption of legal substances and having stated policies which are moving to adopt the concepts and approaches favoured by the European Union. Countries grouped in model 4 focus their attention on reducing the supply of illicit drugs and the Ministry of Interior rather than the Ministry of Health is the principal department in charge of policy.

These categorisations are plausible and ring true as a broad overview but it is likely that experts from any one country would challenge some of the statements made. For example, it is said that “the main body in the field of drugs in the UK is the Advisory Council on the Misuse of Drugs (ACMD) an advisory public body of the Home Office” (p. 83), a statement which would require much qualification regarding its influence in recent years. Model 2, in which the UK is placed, is said to “have prioritised policies aimed at tackling legal substances over policies towards illicit substances” (p. 86) in the years studied (2005–2011), which could legitimately be said about tobacco policy but is arguable regarding the relative attention to drugs and alcohol – highlighting also the problem of trying to capture a country profile, which may change over time and is not necessarily moving in one direction.

The construction of these four models carries with it an implicit theory of an evolutionary progressive development from a “traditional” to an “evidence-based” approach and an assumption of the desirability of a trend to convergence among European countries. There are a number of problems here. Firstly, the descriptions on which the categorisations are based are essentially top-down, relying on official documents and statements of strategy and structure. The authors accept that they have neither studied issues of implementation nor looked at differences at regional or local levels. The gap between rhetoric and reality is however an important feature of contemporary politics and policy in Europe. Similar terms may appear in policy documents (e.g. harm reduction) but whether or not there is a shared agreement on their meaning is open to question. The notion of “evidence-based policies” too is rather taken for granted, carrying the assumption that there is agreement about what constitutes evidence and what it implies for policy. The idea of ever greater union within Europe is now hotly contested in many policy areas and in many countries and addiction policies are unlikely to be immune to these trends. All this tends to gloss over the many differences between countries and cultures in Europe. It also seems to assume that all would agree that a comprehensive wellbeing and relational management approach to addictions is something to which we should all strive and that somehow the achievement of this is directly linked to ways of making decisions and organising politics and policies. The latter point while provocative is not proven nor is it clear why there should be a relationship between the two.

This formidable multidisciplinary team based at ESADE Business School and other institutions in Barcelona and Catalonia must be congratulated for the time and energy they have put into the project. They say “we devoted a huge effort towards obtaining comparable data in order to classify the different countries. It was a massive task to compile information on the 28 countries” (p. 127). They reviewed relevant literature and abstracted information from large data-sets including EUROSTAT, OECD Better Life Index, Sustainable Government Indicators, CIA World Factbook, World Values Survey, Transparency International, World Bank GINI Index, Global Health Observatory, Eurobarometer, EMCDDA, WHO and UNODC. They must have felt hugely disappointed that this activity in the end was unable to offer any explanation for the shape of the four models. However, the strength of their project lies in the very fact of having revealed negative findings. Many of us have long wondered if addiction policies could be explained using theories drawn from the wider social policy literature but no one has done the hard work of compiling data-bases and then analysing these to try to ascertain if there are any clusters of variables which link trends together. Are policy models explained by differences in values? By the type of political system? By level of economic development? By patterns of inequality? It seems not. Addiction policies do not fit with conventional social policy categories. This may indicate that there is something wrong with the general theories –the Esping–Anderson models in particular appear irrelevant and out of date (based as they are primarily on data on social security). Or it may be that use of psychoactive substances is a different type of issue. Whatever the reason, these authors, having expended much effort, have to conclude that there is no exact match between a range of economic and social indicators and the governance of addictions (p. 128). “The governance of addictions has its own levers coming from the contingent combination of context (state factors) and the logistics of policy (strategy and structure)” (p. 126). Good – this settles the matter. There is no need for anyone ever again to attempt to use this methodological approach to comparative policy as it has been proved wanting. This may not be so surprising as this conclusion has also emerged in other areas of social policy, even those where quantitative indicators are fairly reliable, such as social security and health expenditures: in general, correlations may be found when very broad comparisons are made across the globe and across time but they break down when more similar cases (such as European countries in one decade) are compared: for such comparisons a more detailed qualitative case study approach is required to illuminate understanding of influential forces.

This is then a very useful and generally sound compendium and commentary on European countries’ formal policies on drugs, alcohol and tobacco and is particularly valuable for having looked across substances. The four models highlight some interesting differences in the orientations of different countries: these may be most valuable as heuristic devices rather than as a formal typology. This work lays the ground for other ALICE-RAP research and publications which will investigate in more detail topics like the influence of key concepts, such as addiction, and the role of different policy players and stakeholders. Finally it may be possible to assess the impact of current policies on levels of harm and wellbeing across Europe. This thorough study is a good beginning and we await the later volumes in the series eagerly.

Declaration of interest

The author reports no conflicts of interest. The author alone is responsible for the content and writing of this article.