Nordic Studies on Alcohol and Drugs

In this paper the notions of risk, pleasure and information are discussed with reference both to their utilization within the prevention discourse and to their relation to a process of de-traditionalization. It is suggested that the current lack of options for moral discourse directed towards the individual's freedom of choice, restricts the vocabulary of prevention to deal only with the harm produced by alcohol consumption. Prevention discourses can-not address the motivational structure connected to the individual's pursuit for pleasure and self-fulfilling experiences.

This constraint can be seen as a contributing factor to the centrality of risk in alcohol prevention discourses. Although risk-information is produced within the scientific community by a logic of its own, it is also related to the individuals expanding menu of choices that follows with subject-centered individualism with little or no room for moral discourse concerning the individual's construction of lifestyle and identity. When morality is no longer present, only risk can fill its traditional role, that of being a reason for renouncing. It is not by chance that the most important actors on the alcohol policy scene in traditional temperance societies now are professionals and bureaucrats and not voluntary temperance organizations and that the latter have increasingly adopted their arguments from the former.

In Finland, the role of the state in reorganising alcohol policy has become that of an information guide, and the responsibility for practical arrangements has been increasingly delegated to municipalities. With the dismantling of the state-run centralised alcohol policy system, the focus has been shifted to the prevention of substance abuse at the local level. The reorganisations have intensified the pressure to find adequate methods for preventing substance abuse at the local level.

In this article, we will discuss the pressures created by the dismantling of the state-run alcohol policy and the decentralisation of responsibility in the context of three cities. Our data consists of interviews with authorities from Helsinki, Tampere, and Lappeenranta who have actively participated in local co-operation projects in the substance abuse field.

The data was analysed from two different perspectives. First, we studied the data from the information perspective by examining how familiar our interviewees were with the recent history of alcohol policy and the changes in the alcohol policy system. We were also interested in their views on the reorganisations in the prevention of substance abuse and the reallocation of resources. Then, we analysed our data with the tools provided by the positioning theory and semiotic sociology.

A common feature for all three cities was that the prevention of substance abuse was perceived as the correct method for preventing and treating substance abuse problems. The role of the third sector in the prevention of substance abuse grew in the 1990s, which was also deemed important.

Differences emerged between cities, for example, in the identification of substance abuse problems. In Helsinki and Tampere, mixed substance abuse was categorised as the most serious substance abuse problem, whereas in Lappeenranta alcohol abuse was regarded as such.

Differences were also apparent in the ways in which authorities positioned themselves in the welfare tradition of restrictive alcohol policy. Interviewees from Helsinki and Tampere saw the reorganisations in alcohol policy as a change of direction within the old tradition. The prevailing opinion in Lappeenranta was that the prevention of substance abuse has created space for the revival of collective responsibility in the spirit of old village communities.

Helsinki was clearly lagging behind in the development of networks within the substance abuse field. Authorities from Helsinki admitted that the co-operation network between authorities was still in its infancy, whereas authorities from Tampere and Lappeenranta maintained that a sustainable co-operation scheme had been in progress for a long time.

Evidence-based medicine rests on the assumption of a hierarchy of evidence. The highest level of evidence is assumed to come from meta-analyses of randomised clinical trials.

Five illustrative recent meta-analyses of psycho-social treatment for substance dependence are discussed (Prendergast et al. 2002; Irvin et al. 1999; SBU 2001; Griffith et al. 2000; Pearson & Lipton 1999). In all cases the methodological strengths and weaknesses of the study are discussed, as well as the clinical and theoretical implications of the analysis. Studies that attempt to address very broad questions such as “does treatment work” produce conclusions that appear inconsistent and may be flawed, and the clinical and theoretical implications of the findings of such meta-analyses are unclear. In contrast, analyses of specific treatments produce findings that are clinically and theoretically meaningful. In cases where the populations or settings studied are diverse, but the type of treatment is similar, well-conducted meta-analyses may produce significant data on the degree to which the apparent effectiveness of a specific treatment can be generalised to new populations or settings.

It is concluded that the efficacy of specific classes of interventions for drug or alcohol use disorders may be a relevant target for meta-analyses, whereas meta-analyses that attempt to do too much by asking very global questions are unproductive, and that although meta-analyses are generally effective at addressing the question of whether a given treatment has support in the existing research, they are not able to answer questions about what should be the means and ends of drug policy and drug treatment at a more general level.

Between the 1850's and the 1920's the propaganda against alcohol changed in Sweden. At first the state was passive, but as time passed by the state took a great responsibility. In the 1920's almost all information about alcohol was sanctioned by the state. At the same time the strong temperance movement was involved in the propaganda. The message therefore was not only temperance but total sobriety. This connection to the temperance argument was however not debated.

The school was early recognised as an ideal place to inform the young citizens about a good behaviour. The pupils should not only learn not to drink alcohol, they should also learn that abstention was the behaviour of a good citizen. In the school it was also easy to reach the children of the working classes. The working class was often regarded as the main problem. They drank more and the problem with a heavy drinking was greater among them.

The gradually more intense information and propaganda can be connected to Nikolas Roses ideas about the advanced liberal state, where greater freedom is connected to more restrictions. In order to deserve democratic and liberal rights the citizens must know how to behave, which they learned in the temperence-education.