Nordic Studies on Alcohol and Drugs

The aim of the article is to critically reflect on the harm reduction approach used in Danish substance abuse treatment.

The article is based on qualitative interviews with staff at treatment institutions in Copenhagen.

Three themes are addressed. First, our data indicate that low-threshold methadone treatment is difficult to combine with a long-term goal of abstinence. In fact, many harm reduction proponents among staff are directly opposed to treatment models in which abstinence is a goal. Second, we illustrate how the development of harm reduction measures is embedded in a socio-political trend focusing on a combined “autonomization/responsibilization” of social clients. This focus on clients as autonomous and responsible subjects clashes with another central conception among staff: the idea that heroin addicts are slaves to their substance use and hence cannot be treated as fully rational human beings. Third, the article analyses the relationship between harm reduction and social integration.

Although social integration of substance abusers is part of the rationale behind harm reduction measures, this goal is difficult to reach with a group of clients as marginalized as the ones in focus.

During the last 10 years researchers in the field of substance abuse treatment have found most of the treatment organisations quite research and innovation resistant according to adopting the concept of evidence-based practice. It is the aim of this paper to show that the treatment services are not resistant to research and innovation, but they are organized around some organizational principles that are hardly compatible to the principles embedded in evidence-based practice.

This study includes a mapping of the service structure and the treatment method's (evidence-based and not-evidence-based) in 21 outpatient treatment services for adolescent with substance abuse problems.

The treatment services showed not to be occupied by implementing evidence-based practice, but were at the same time open for adoption of innovations in treatment structure and method's, which indicates that they are not resistant to innovations.

In this paper the self-organization of the treatment centres is analysed through a new institutional theory approach, and it is described how the institutional orientation of the treatment centres exclude an adoption of the concept of evidence-based practice. It is suggested that the researchers should shift focus from the inability of the treatment organizations to develop evidence-based practice, and instead focus on how to build up an evidence-based infrastructure in which the producers of evidence-based knowledge and the treatment organizations can obtain knowledge of each others work.

To analyse two generations' associations to the words ‘alcohol’ and ‘illegal drugs’

Focus groups were conducted with seven groups of 18-year-olds and four groups of parents of teenagers. The groups of young people and the groups of parents were in several respects each other's opposites. The young people were selected for focus group interviews because they drink and like to party. The parents were selected because they represent parents who take an active interest and care in young people's alcohol and drug habits. The focus group sessions started with the participants writing down all their associations, first to ‘alcohol’ and then to ‘illegal drugs’, with two minutes for each topic. The processing was done by classifying all words under separate headings depending on the theme of the associations.

The most striking similarities between the young people of the study and the parents are that the two generations have similar notions of the benefits of alcohol. These regard having fun together with other people, creating a party atmosphere and feelings of togetherness, and also that alcohol offers relaxation. Notions about the short-term negative effects of alcohol are also similar. The most obvious difference between the generations is that young people lack any words connoting the long-term negative consequences from alcohol use.

When it comes to illegal drugs, disassociation from illegal drugs is the foremost similarity between the young people and the parents. The differences in the main are that the young people have more concrete associations as well as value-free descriptions of the effects of using drugs and the times for using drugs. The parents describe the phenomenon more from a distance. Their associative paths extend to things that probably do not exist within their own sphere of reference. Another difference is that the young people sometimes have positive associations to drugs, which are missing among the parents.

In several ways young people and parents share the same ideas about alcohol and illegal drugs. In regard to alcohol they share the idea of the immediate beneficial properties of alcohol as well as its immediate negative consequences, ideas that seem culturally deep-rooted. In regard to drugs the associative picture given by young people and parents to a large extent also seems mutual, with respect to the predominantly negative picture. To a certain extent, however, the young people show in their associations that illegal drugs are a normal phenomena, while simultaneously showing that drugs are abnormal, and that most disassociate from them. Even in young people with positive connotations to drugs there are expressions of cautiousness and risk consciousness.