10. 1 The institutional tracks in the policy domains
As Bosso (1994) has pointed out, actors in the problem definition
process do not operate in a vacuum but in a contextual frame that
delimits their range of action. One institutional factor in that context is
the policy domain. Different opportunity structures to influence the
problem definitions and subsequently the action programmes can bring
about different actors in the policy domain.
The Dutch tradition of consultation between the central state and the
provinces centred around powerful cities, and later between the central
state and the pillars proved to be the most efficient manner of living
together (samenleven). The familiarity with different (sub)cultures can
explain why it is possible that `junkiebonds' could become part of the
policy network at the local level. The emergence of subcultures was not
a priori a negative or threatening phenomenon. The fact that illegal drug
use was not perceived as a threat to the nation can be explained by the
fact that the denotation of "nation" has never been very strong in the
Netherlands. Instead, provinces, cities, and later pillars were important
points of reference to the population.
When Sweden determined its policy, drugs were depicted as an
external threat to the nation and their very existence as the root of the
problem. The image of all good forces joining in the struggle against
the bad forces (whatever those may be) was made a project for all
citizens. Society (samhället) had to be kept together against the
intruder. The raison d'être for this project can be derived from the
history of Sweden as a homogenous society with a strong national
identity. Subcultures in Sweden are also welcome to participate in
policy networks, but not in all issues. The drug problem is a telling
example of a field in which the target group for governmental actions is
excluded from the policy domain.
These institutional factors can also explain that during the course of
development of the problem, the definitions and action programmes
remained largely unaffected by changes of government, regardless of
their party colour.
Besides these institutional factors, the way in which the drug
problem reached the political agenda as a social problem is also of
importance to comprehend the policy domain. Here a difference may be
noticed between the establishment of the drug problem compared to the
alcohol problem. Unlike the alcohol problem, attention to the modern
drug problem was not drawn by issue pressure groups like the
temperance movements. Instead, attention to the problem was signalled
by agencies that traditionally executed formal social control, e.g. the
judicial system, the medial professions and treatment of abusers. Other
actors entered the drug policy domain in reaction to measures against
illegal drug use that had been implemented in the infancy of the modern
drug problem. These early actions were too soft in the opinion of some
and too harsh or totally misplaced to others. Due to the novelty of the
phenomenon, and in particular its alleged massiveness, experts were
called in to fill the gap of knowledge on drugs and drug users. These
experts were recruited from the professional fields of formal social
control and from sciences like law and medicine.
Institutional actors in Sweden
A profound feature of the Swedish's tradition of governance and the
policymaking process is the central position of state authorities. During
the first definition process, the National Police Board was one of the
driving forces behind the perception of the drug problem as a calamity.
Besides its role in maintaining law and order, the Board had assigned
itself an important role as an opinion leader in public discussions on
drug policy issues. During the period studied, the national police
commissioner appeared on television and in newspapers as an expert
and in this way influenced public opinion. The Board also produced
annual reports on arrests, seizures, and other reports from the field,
showing that the situation was deteriorating (crisis). Together with
similar reports from Customs, this kind of information was an important
indicator that reflected the state of the drug problem and the outcome of
the drug policy.
Secondly, after the governmental ten-point programme, a prominent
actor in the process leading to first problem definition, namely the
medical profession almost disappeared from the drug policy domain.
Physicians would never again possess the dominant position they held
in the Narkomanvård Committee. By describing the dissemination of
drug abuse as analogous to an epidemic, they placed themselves offside.
The standard response to epidemics: warning, inspection, isolation, and
immunisation could not be executed by psychiatry. Warning was a
matter for the National Board of Health and Welfare, the National
Board of Police, the National Board of Education, the media, and
popular movements. Inspection was a matter for the police, social
services, and social sciences. Isolation could be a matter for psychiatry
but only for short periods. Other sites for isolation were treatment
homes, prisons, and institutions for compulsory care. Immunisation by
information and education was not a task for the medical professions
either. The drug problem had become a social problem that couldn't be
solved by medicine. Instead, the social services were assigned a central
position in the prevention of drug problems and treatment of drug abuse
at the local level. With the new Social Services Act in 1981, the local
authorities received overall responsibility for assistance to drug users. A
characteristic of the Swedish social services is that the provision of
social security and social work are executed by the same organisation.
Furthermore, the local social services became responsible for
investigating, initiating, and executing compulsory care according to
the Child Welfare Act and the Law on Care of Adult Abusers.101
However, social workers, employed by local social services, were not
trained for treatment of drug abusers and depend highly on treatment
entrepreneurs on the drug treatment market. Non-governmental
assistance organisations, which traditionally played a profound role in
intramural treatment of alcoholics, became increasingly prominent also
in the field of treatment homes for drug abusers.102
Together with social
services and psychiatry, they constituted the treatment sector of drug
abusers. To the Swedish professor of social work, Bergmark (1998: 38),
the Swedish drug treatment market is unusual. While care and treatment
is a social right according to the Social Services Act, the addict is not
the purchaser of treatment. Instead, the social services pay for the
treatment and buy treatment on behalf of the addict. Withdrawal of
economic benefits or the perspective of compulsory care can be used to
persuade the addict to enter the treatment proposed by the social
services. The obligation to pay for and provide care and treatment puts
the social services in a central position in the chain of care.
A third important actor comprises the popular movements, both the
traditional ones and those that were established in the 1960s. The
struggle against drugs was not just a matter for authorities but also to a
large extent a cause for the whole population, whether or not organised
in popular movements. While not an important actor at the start of the
definition process, they were assigned a crucial role in the
implementation of the action program. Especially in the field of
information and in creating an anti-drug youth culture, the participation
of popular movements was singled out as essential.
Institutional actors in the Netherlands
In the Netherlands, the departments were important actors. The
Department of Justice was important on both the departmental level and
the local level. The guidelines from the Prosecutor-General in 1969, for
example, introduced a distinction between cannabis and other drugs and
between categories of incidental, integrated users, and addicts.
Furthermore, the department put pressure on the Department of Health
to produce evidence on the harm of cannabis that could justify the
execution of the current Opium Act.
The position of the Department of Health was initially weakened by
internal contradictions on the cannabis issue but would later become the
co-ordination point for the drug policy. A third important actor was the
Department of CRM, responsible for social work and youth policy. All
three departments were involved in the assistance system to drug users.
The interdepartmental steering group (ISD) held an important position
by preparing drug policy issues on the governmental level and advising
the government in subsidy matters.
Secondly, the four major cities played a profound role.103
They
experienced the consequences of problematic drug use and claimed
room to develop local drug policies, adjusted to their particular
problems. However, the government rejected municipal proposals for
both the prescription of heroin and compulsory care, which was a
matter for the central government. The national guidelines for
prosecution, on the other hand, were based on and confirmed local
practices. This pattern of local influence can be discerned in a number
of other features of the Dutch drug policy as well, for example, low-
threshold methadone programmes, the house dealer system, which all
emerged prior to a governmental standpoint and policy.
Thirdly, the organisations in the assistance system were important. In
the Netherlands, the provision of social security is a matter for
municipalities. Non-governmental organisations provide social work
and in the field of addiction especially the CADs with their share of
probation that entailed a special relation to the judicial system.
Measures to implement the drug policy were subject to negotiations
between departments and representatives of assistance organisations.
This dependency of the central government on the organisations for the
implementation of assistance created plenty of room for local influence
of the national drug policy. However, at the end of the 1970s it became
clear to the government that the assistance organisations had failed in
reaching the problematic users. Instead, earmarked funds to
municipalities were an incitement for starting projects that were
adjusted to the needs of this category of users. State subsidies were the
main instrument to influence local practices.
Furthermore, the traditionally small share of psychiatry in assistance
to drug users is also in contrast to Swedish conditions. Instead, clinics
for alcohol and drug addicts were established by both traditional and
alternative assistance agencies. However, with the introduction of
heroin, medical professions became an important actor and especially
general practitioners and municipal ambulatory health services.
A difference is also that all intramural treatment facilities,
acknowledged by the state, are financed by a law on extraordinary
expenses caused by illness (AWBZ). Ambulatory care is tax-financed
and is free of charge. This means that the client and the provider of
treatment discuss an admission without the need for consent of social
services.
Different arenas for policymaking
Another difference may be noticed regarding the level of policymaking.
In Sweden, the struggle against drugs was a national project under the
leadership of the central government. The implementation of the drug
policy was a matter for the central state and local authorities with
assistance of non-governmental organisations. In the Netherlands, the
government left the implementation of the drug policy to departments,
the cities, and non-governmental organisations. The different relations
between the central state and local governance are reflected in the
different possibilities for the local level to influence the national
policymaking on drugs. For example, the tripartite deliberation (Lord
Mayor, Head of Police and Public Prosecutor) in the Netherlands,
where the implementation of national guidelines is discussed in relation
to the local situation, has no equivalent in Sweden.
A similar difference can be noticed when we look at the issue
pressure groups. The issue pressure groups in Sweden were organised
as national associations and action alliances, and attempts to influence
the drug policy, by the media, demonstrations, and petitions, were
directed at the national policymaking arena. Organisations like the
RNS, FMN, and Hassela succeeded also in making allies among MPs
and thus made sure that the issue was kept on the political agenda.
In the Netherlands, issue pressure groups operated primarily at a
local level. It was there that they could influence drug policy matters.
`junkiebonds' protested against police actions just as angry local
residents protested against drug-related nuisance in their
neighbourhood. Parents of drug users demanded compulsory care; the
`junkiebonds' organised actions against that.
To understand these different arenas to influence the policymakers
we must not only include institutional factors but also developments
during the sixties, which is an example of a contingent factor. In the
Netherlands, the era of pillarisation had ended but the pillar structure
was still in place. In addition, instead of corporatism with a
representation of the people by the leaders of pillarised organisations,
the Netherlands turned into a kind of participatory democracy at the
local level. The pillarised organisations had turned into professional
organisations but in many fields of social life alternative movements
emerged. In Sweden, the policymaking process remained unchanged
after the sixties and the same actors as before continued to rule. Even
the protesting youth movement followed the traditional path of popular
movements operating in the centre for national policymaking,
Stockholm.
101 The execution of compulsory care was reallocated to the central state in
1994.
102 However, the share of state and local authorities in assistance to alcohol
and
drug abusers has never been as large as in the 1970s, when the assistance system
to
drug abusers was established.
103 For example, the City of Amsterdam discussed local drug policy plans with
the
government before presenting them to the city council. The reason was that
Amsterdam's policy could influence other cities' drug policy as well. The
Amsterdam problem with youth centres was also (confidentially) discussed with
departmental officials.