The politics of recovery

There is a widely-held view that drug policy in Britain (and elsewhere) is in the throes of a major transformation. Whereas for the last decade or longer, the policy obsession seemed to be with crime and criminal justice, over the last year or two, this focus has ebbed somewhat, as a new recovery agenda has emerged and rapidly come to the forefront.

One way to read this shift is in ‘epochal’ terms: a ‘governing-through-crime’ strategy giving way to a recovery-oriented one. And for many in the drug field, it certainly feels as if big change is in the air. A noisy grassroots recovery movement even talks of a paradigm shift.

But I am not convinced. In my view, at a strategic level, continuity is much more apparent than change. As I noted in my last post, the new direction in drug policy retains much in common with the previous crime-focused strategy (and, indeed, the earlier harm reduction approach): the same problematization (heroin/crack users as sources of risk to the community); the same conception of drug users (rational calculating choice-makers); and the same strategic response (encouraging/cajoling responsible choice-making to reduce risk).

What has changed is that the most significant type of risk posed by drug users is now seen as being a burden on the public purse by drawing benefits and failing to contribute as a tax-payer. What we are seeing then is not so much a new era of drug policy but rather a new politics of drug policy. In a time of economic recession and public sector cuts, there is a novel set of social and cultural preoccupations and anxieties (coded in the language of ‘cuts’, ‘austerity’ and ‘efficiency’) which is shaping how we frame drug policy – and the emerging recovery agenda fits perfectly with this reframing. But underneath all that, I would suggest that the fundamental strategic pattern in fact remains pretty much the same as it has done for the last 30 years. Plus ça change…

[This post is an adaptation of pages 166-7 in this book]

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Drug policy, prohibition and public health

Drug policy campaigners often call for policy to be re-oriented towards public health, as a more progressive and constructive approach than the criminalising strategy of prohibition. The broad thrust of this type of call is that we should be more concerned about helping sick people, preventing the spread of disease and enhancing well-being, rather than punishing individuals for supposed moral transgressions. On the face of it, who could argue against that? Indeed, last month, I even found myself enlisted as a signatory to a letter enjoining the Government to ‘put public health first’ in its drug policy. But when I look at the genealogy of drug control policy over the last 150 years, I start to feel a little queasy about this apparently ‘obvious’ proposal. Here, I point to three key moments in this history that prompt my uncertainty.

 

1. The very first regulatory controls on opium in Britain were contained in the Pharmacy Act of 1868. This was a landmark piece of legislation within the genealogy of prohibition as it arguably paved the way for the first modern drug laws in the early twentieth century. Yet one of the key drivers for the 1868 legislation was the emerging public health movement which had identified the problem of poisonings as a major concern. In this sense, the foundation for our contemporary approach to drug control itself has deep roots in public health.

 

2. One period that reformers often hark back to as a high-point of a progressive public health approach is the so-called ‘British System’ ushered in by the famous Rolleston Report of 1926, in which doctors were empowered to treat heroin addiction as a manifestation of a disease rather than as a vice, which could be managed by the prescribing of opiates to addicts. But again, as I have argued elsewhere, things are not quite what they seem here either. The ‘British System’ was built on the base of a strategic liaison between penal and welfarist approaches, rather than a medical approach triumphing over a criminalizing one.

 

3. The British response to the threat of HIV in the mid to late 1980s has been seen as an exemplary public health approach to the drug problem which successfully averted a potential HIV epidemic. And I don’t question that success at all. Critics of the more recent obsession in drug policy with crime and criminal justice typically call for a return to the public health emphasis of the HIV era. But I am not convinced that the two strategies are in fact so different. Both are based on a shared view of the problem (drug users as threats to the community), a shared understanding of drug users (rational risk-takers and choice-makers) and a shared strategic response (urging and enabling responsible choice-making to reduce risk). (Incidentally, I see the current vogue for ‘recovery’ as essentially a variation on this same theme).

 

The idea then of a public health approach as a progressive alternative to a criminalizing penal one is problematic, as the two strategies have been closely intertwined over the last 150 years. It is difficult to sustain the idea that they are polar opposites or stark policy alternatives. I don’t mean by this that it is impossible, or undesirable, to emphasise or prioritise health concerns within drug policy. My point is rather that simple calls for a ‘public health drug policy’ ignore and gloss over this ambiguous and mixed lineage.

 

But I would also go further than this. Even if policy reformers eventually win the day and the entire existing prohibition regime is swept away, it is not clear to me that public health would or should necessarily emerge as the primary animating principle of any new approach. Other principles might stake an equal or greater claim to primacy, such as social justice, human rights, well-being or human security. Public health advocates would need very sharp elbows to emerge triumphant from that competition. 

[This post is a reworked version of pages 134-5 of this book]

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The Contractual Governance of Drug Users in Treatment

Over the last year, I have been working with my colleague Matthew Bacon on an ESRC-funded project studying the growing use of contract-like agreements with drug users in treatment settings. It’s been one of the most fascinating studies I’ve ever been involved in, as it raises all kinds of theoretical, conceptual, empirical and ethical questions. There are intellectual puzzles and normative challenges all over the place!

We’re now starting to turn our attention to making sense of our data and publishing our findings. Our first scene-setting paper is currently in draft form and I thought I would share the draft introduction. Comments will be very welcome.

‘One of the abiding challenges for drug treatment services is how to engage drug users effectively: to identify and attract them, to keep them coming and to ensure they comply with what is required of them. Services which are unable to do this will obviously struggle to contribute to important drug policy objectives, such as, reducing mortality rates, curbing the spread of blood-borne viruses and supporting recovery. Effective engagement is the sine qua non of effective treatment.

 Over the years, many innovations have been introduced to deal with engagement and retention problems, including reducing access thresholds (Finch et al, 1995; Millson et al, 2006), establishing rapid prescribing services (Keene et al, 2007), rewarding attendance and compliance (Prendergast et al, 2006; Petry, 2012), developing outreach services (Needle et al, 2005) and making case management more ‘assertive’ (Vanderplasschen et al, 2007). In recent decades, for certain groups of drug users, there has been a particular emphasis on using the leverage of the criminal justice process to do this (Seddon, 2007; Seddon et al, 2012). Inevitably, there is a mixed picture of success from this diverse range of efforts and the challenge has far from disappeared. Indeed, to the contrary, in an ‘age of austerity’ with public spending budgets across Europe (and beyond) being squeezed tighter than for many decades, the problem has arguably become even more acute. The need for drug treatment to demonstrate that it can engage effectively with its target group is greater than ever.

 This paper examines one particular strategy or practice for enhancing engagement that appears to have spread quite rapidly in recent years: the use of contract-like written agreements between treatment service providers and users. Although, as we will see, these agreements can take on many different forms, typically they set out the responsibilities and requirements placed on users and, somewhat less frequently, what the service commits to providing for them. This novel practice of contractual governance of drug users in treatment may be viewed as having considerable potential, not only to address the engagement challenge we have described but also to underpin efforts to provide more personalised social and health care (HM Government, 2007). On the other hand, it may also be seen to raise serious ethical issues and concerns about human rights, as it appears based on a model of autonomy and responsibility that may seem at odds with conventional notions of addiction (West, 2006; cf Foddy and Savulescu, 2006).

 It is significant that if we look beyond the drug policy field, the emergence of contractual governance is clearly part of a wider set of developments in the realm of politics and government at the turn of the twenty-first century. As we will show, in recent years, the use of contractual or quasi-contractual mechanisms to regulate behaviour has arisen in diverse domains, from school education to public housing to youth justice (see Crawford, 2003). A key part of our purpose in this paper will be to locate the contractual governance of drug users in treatment in this wider context of new social control strategies and practices. In particular, we will draw theoretical, conceptual and empirical insights from the largely socio-legal literature which has begun to examine this phenomenon.

 The paper is organised as follows. In the first section, we introduce some of the key conceptual building blocks for our enquiry: contracts, contracting and contractual governance. We then turn, in the second part, to a consideration of some of the specific issues that may arise in relation to the contractual governance of drug users in treatment settings and include a review of the small body of literature in this area. In the third section, we present some preliminary findings from the first stage of an empirical study we are currently conducting. Finally, in conclusion, we map out a research agenda to advance our understanding of what we believe to be a significant development in the field.’

Let me know what you think!

 

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Visiting Oxford

Last month, I presented this paper at an All Souls Criminology Seminar in Oxford, at the kind invitation of Ian Loader. I promised those who were there that I’d blog about it and, although it’s taken a bit longer than I’d hoped, this is what I made of the experience.

The turnout was very good, with perhaps 40 or 50 people gathered in the rather austere Old Library. It’s always hard to tell but there looked to be lots of PhD and postgrad students there which was good to see. The paper seemed to go pretty well. As always with a first-time outing for new work, I discovered the usual things – some bits worked better than others, some of the sequencing of the argument was wrong etc. Most remarkably, I ran pretty much to time: Ian had asked for 45 minutes and I was wrapping up almost bang on that. This left a generous amount of time for questions, in fact, eventually running on for nearly 50 minutes.

The questions were the usual mixed bag (in terms of coverage, not quality!) and all of them were interesting or made me think. Two in particular stuck in my mind. One person asked the disarmingly direct question of whether I was optimistic about the prospects for radical drug policy change in the future. My answer was probably excessively equivocal and even-handed but I was still thinking the next day about what it really means to do critical social science. Before I entered academia, I spent 10 years in the voluntary sector doing research and policy work, so I’ve been grappling with this one for some time! The other question that I couldn’t stop thinking about afterwards was about how I saw my overall intellectual project in this area. I may write something about that in a future post but it was a great question to have provoked!

A very pleasant drink and dinner followed with Ian and some of his criminology colleagues, finished off by spending the night in a room in College. It’s a long time since I’ve stayed anywhere without its own toilet and on a mid-January night I found myself unexpectedly wishing I’d packed my slippers and dressing gown for that midnight walk down the corridor!

I’ll be giving the paper a second run-out in Sheffield at the end of the month. Watch this space to hear how that goes…

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ManReg: The Manchester Centre for Regulation, Governance & Security

Last Wednesday, I spent a very enjoyable afternoon here with a group of my colleagues from the Law School. Sat around the table were several lawyers with expertise in different fields, an economist, some criminologists and a handful of socio-legal scholars. We were gathered to talk about a new research initiative – ManReg: The Manchester Centre for Regulation, Governance & Security.

You might wonder what such a diverse bunch of people could possibly have in common. What, for instance, would an environmental lawyer, a policing scholar and an intellectual property lawyer have to talk about? The basic premise of ManReg is that in fact, despite our widely differing expertise, our group actually shares some important things in common:

  • a concern with how rules and standards are made and developed;
  • an interest in understanding why rules and standards are followed or breached by different individuals, groups or institutions;
  • a focus on how different approaches to enforcement and compliance can vary significantly in effectiveness.

This common ground – the making, breaking and enforcement of rules and standards – is core territory for regulation scholars and it is under the sign of regulation that we have come together to form ManReg. We believe that our multi-disciplinarity and diversity will be one of our key strengths.

We hope to have a ManReg website up and running in the next few weeks, where you’ll be able to find out more about who we are, what we do and what our plans for the future are. Watch this space for details! In the meantime, if you want to make contact, please leave a comment below or, alternatively, email one of ManReg’s Co-Directors, Andrew Griffiths or David Williamson.

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Inventing Drugs

Today’s my last day in work in 2011. This week, I’ve got immersed in writing a new paper (actually first started a while ago), provisionally titled ‘Inventing Drugs’. It’s essentially an extended and significantly developed version of this small piece published last year which, in turn, was based on a very short passage from the first few pages of my last book, A History of Drugs. Since then, with the help of my colleague Nishat Hyder, I’ve been trawling through parliamentary proceedings and other documents from the late nineteenth and early twentieth centuries, slowly piecing together what I hope is an interesting picture of the origins of the ‘drug’ concept.  But beyond historical interest, the paper will also argue that there are significant implications for contemporary drug policy and politics.

I’m going to road-test the paper at seminars at Oxford and Sheffield in early 2012 and then attempt to get it finalised for submission to a journal, maybe in the Spring. In the meantime, below is a special Christmas sneak preview of the latest version of the first few paragraphs.

‘There are no drugs “in nature”’, Jacques Derrida once declared[1], ‘the concept of drugs is not a scientific concept, but is rather instituted on the basis of moral or political evaluation’. In other words, to label a substance a ‘drug’ is an evaluative rather than descriptive act[2]. There exist simply chemical compounds – whether naturally-occurring, processed/refined or entirely synthetic – which have a variety of properties when ingested by humans (poison, stimulant, sedative, nourishment etc). The different labels we then attach to these compounds are human constructions, some of which are legal in character, some not. These labels are not settled or universal but rather are historically and culturally contingent, that is, they change over time and vary from place to place.

 

The English language is in fact unusual in attaching a double meaning to the term ‘drug’, referring both to a medicine and to an illicit psychoactive substance. Certainly in most of the main European languages, there are separate words for these two senses: in Spanish, for example, medicamentos and drogas, respectively[3]. My focus in this paper is on the second of these meanings, that is, the notion of a ‘drug’ as an illicit substance used for the purpose of altering one’s psychic state or consciousness. The puzzle I wish to explore is highlighted by this observation from the late historian, Roy Porter[4]:

 

“If you’d talked about the ‘drugs problem’ two hundred years ago, no one would have known what you meant. There was no notion then of ‘drugs’, in the sense of a small group of substances scientifically believed to be harmful because addictive or personality destroying, the availability of which is restricted by law. The term ‘drugs’ as a shorthand for a bunch of assorted narcotics is in fact a twentieth-century coinage: if you’d mentioned ‘drugs’ to anyone in George III’s time or in the Victorian era, they’d have thought you were referring to the remedies physicians prescribed and apothecaries made up.”

 

Porter reminds us here that the idea of ‘drugs’, as we understand it today, is a relatively recent invention, still only around 100 years old. But how has this ‘twentieth-century coinage’ accomplished this apparent self-evidence as a way of describing the world? After all, even the most trenchant and radical critics of drug policy rarely question the term ‘drug’ itself….


[1] J. Derrida, ‘The rhetoric of drugs: an interview’ (1993) 5(1) differences: A Journal of Feminist Cultural Studies at 2.

[2] V. Ruggiero, ‘Drugs as a password and the law as a drug’ (1999)…

[3] This is the same in French, German and Italian. I am grateful to my colleagues Juanjo Medina, Pierre Schammo and Simona Giordano for information on this.

[4] R. Porter, ‘The History of the “drugs problem”‘ (1996) 24 Criminal Justice  Matters 3-5 at 3.

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Tough Choices – drugs and criminal justice

Over the last 15 or so years, I have been involved in a series of research projects on drug interventions in the criminal justice system. I’m now at the point where I feel like I’ve said pretty much everything I ever want to about this topic! But my last word (or 80,000 words) on the subject, co-written with Lisa Williams and Rob Ralphs, will be published next year in book form by Oxford University Press in their Clarendon Studies in Criminology series. The book will be titled Tough Choices: Drug Policy and the Risk-Security Nexus, and below is a short extract from the concluding chapter which gives a flavour of what it’s about.

Our central task in this book has been to attempt to understand the emergence of the criminal justice turn within British drug policy. Why has the drug-crime link become in recent decades so central to how we view the drug question? And why has policy taken on the particular forms that it has, with the emphasis on using the criminal justice system to identify and target drug-using offenders in order to channel them into treatment? We briefly summarise here our main arguments.

In chapters two and three, we sought to answer these questions by setting the development of drug policy within the context of the ‘big picture’ of social change. We argued that the transition over the last 40 or so years from the welfare-liberalism of the middle twentieth century to an era of neo-liberalism at the turn of the twenty-first has changed the nature of the drug situation in Britain, greatly extending the reach and prevalence of ‘recreational’ drug use amongst young people and creating new pockets of severe neighbourhood drug problems (in which drugs, poverty, crime and worklessness coalesce). This transformation has generated new risks and insecurities which have, in turn, been understood and problematised in a distinctively neo-liberal way. These problematisations have posed new policy predicaments: drugs are everywhere (in the media, popular culture and society) and at the same time deeply problematic (linked to intractable problems of social exclusion and crime). The responses to these predicaments, of which the criminal justice turn is one part, have also, in turn, been shaped by the transition to neo-liberalism, becoming entwined with questions of risk and the governance of security. In chapter three, drawing on interviews with national policy actors, we sought to piece together in more fine-grained detail exactly how the policy was put together and developed at national level, focusing on the motives and intentions of these actors. Together, these two chapters set out an original account of how the evolution of the criminal justice turn in recent British drug policy can be understood as a (socially-structured and culturally-shaped) process of problem-solving action in the face of a new (socially-structured and politically-constructed) drug policy predicament. 

We then explored the implementation of the criminal justice turn by local partnerships in chapters four to six, drawing on data from three multi-method local case studies we conducted. We framed our analysis here by viewing the drug interventions delivered through the criminal justice process as a risk management system aligned to a security project. In chapter four, we focused on drug testing and assessment processes in the police station, understood as elements of a risk-filtering machine. In chapter five, we examined interventions at the court stage, conceptualised as parts of a system for the administration and management of risk. In chapter six, we explored the ways in which the role of criminal justice drug workers could be understood as brokers of risk knowledge within the system, rather than as therapeutic professionals conventionally defined.

In chapter seven, we addressed the thorny question of the impact of the criminal justice turn: has it worked? We argued that there is insufficient evidence currently to claim that it has been effective in reducing crime. We also suggested that there were some good reasons to believe that such an impact would in fact be unlikely anyway. We argued, too, that it is helpful to widen out what is meant by the idea of impact, to provide a more rounded and nuanced assessment. We turn now to consideration of the wider significance of our study.

If you like the sound of that, watch this space for publication details nearer the time!

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