Börje Olsson

Cocaine Use in Europe – A Multi-Centre Study: Patterns of Use in Different Groups

Aim: The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities. Design, Setting, Participants: Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment. Measurements: Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. Findings: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days. Conclusions: The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.

Cocaine Use in Europe – A Multi-Centre Study

An increase in the use of cocaine and crack in several parts of Europe has raised the question whether this trend is similar to that of the USA in the 1980s. However, research in the field of cocaine use in Europe has been only sporadic. Therefore, a European multi-centre and multi-modal project was designed to study specific aspects of cocaine and crack use in Europe, in order to develop guidelines for public health strategies. Data on prevalence rates were analysed for the general population and for specific subgroups. Despite large differences between countries in the prevalence of cocaine use in the general population, most countries show an increase in the last few years. The highest rate with a lifetime prevalence of 5.2% was found for the United Kingdom, although with a plateau effect around the year 2000. With regard to specific subgroups, three groups seem to show a higher prevalence than the general population: (1) youth, especially in the party scene; (2) socially marginalized groups, such as homeless and prostitutes or those found in open drug scenes; (3) opiate-dependent patients in maintenance treatment who additionally use cocaine. Specific strategies need to be developed to address problematic cocaine use in these subgroups.

Contextual Determinants of Alcohol Consumption Changes and Preventive Alcohol Policies: A 12-Country European Study in Progress

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

Sweden: Zero Tolerance Wins the Argument?

The theme of this paper is a modelling of Sweden’s drug policy and its relationship to drug problems. Both the drug problem and the drug policy of a country have to be put into their broader contexts. Although claims have been made on behalf of the Swedish ‘hard line’ on drug users — successfully promulgated by the Conservative Party during their period in opposition — the basis of Sweden’s relatively small heroin problem is the country’s geographical position and its social and economic policies, not its drug-specific policies.

The Swedish drug problem: Conceptual understanding and problem handling, 1839–2011

Aim To analyse the Swedish drug question by examining dominant concepts used to portray the problem in the years 1839-2011. Theoretically, we understand these concepts as ideological tools that shape the political initiatives and administrative efforts to deal with the problem. The study is based on two kinds of source material: articles in medical journals from the years 1839-1964 and public reports on vagrancy, the alcohol problem, mental health and the drug problem from the years 1882-2011. Findings During the nineteenth century and the first part of the twentieth century the drug problem remained an individual problem handled by doctors. When the Swedish drug problem was established as a political question from the 1960s on, it also came to disengage itself from the medical frame of understanding. Medically oriented descriptions of “dependence” and “addiction” have appeared adequate or attractive when, for example, the socially motivated coercive treatment solution has been discredited (as in the 1970s), when there has been a desire to connect with an internationally accepted terminology (as in the 1990s) or when a new organisational model with a stronger professional support has been on the agenda (as in the 2010s). But otherwise the social problem description has called for concepts that have more or less explicitly dissociated themselves from speculations in physiological or psychological predispositions for substance abuse.

Drugs on Prescription – The Swedish Experiment of 1965–67 in Retrospect

The programme of prescribing amphetamines and opiates to drug users in Stockholm carried out from 1965 to 1967 has frequently been referred to in the European drug policy debate. In this article, originally presented at the Conference on Drug Use and Drug Policy in Amsterdam in September 1996, the programme is described with regard to design, setting and outcome. The relevance of the programme for the general policy debate is discussed and a comment is given on the programme’s impact on the Swedish drug epidemic and Swedish drug policy.

Addiction research centres and the nurturing of creativity : Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Sweden

The Centre for Social Research on Alcohol and Drugs (SoRAD) was established as a national research centre and department within the Faculty of Social Science at Stockholm University in 1997, following a Government Report and with the aim to strengthen social alcohol and drug research. Initially, core funding came from the Swedish Council for Working Life and Social Research and from the Ministry of Health and Social Affairs for several long-term projects. Today, SoRAD, with 25 senior and junior researchers, has core funding from the university but most of its funding comes from external national and international grants. Research is organized under three themes: consumption, problems and norms, alcohol and drug policy and societal reactions, treatment and recovery processes. SoRADs scientific approach, multi-disciplinarity, a mix of qualitative and quantitative methods and international comparisons was established by the centres first leader, Robin Room. Regular internal seminars are held and young researchers are encouraged to attend scientific meetings and take part in collaborative projects. SoRAD researchers produce government-funded monthly statistics on alcohol consumption and purchase, and take part in various national government committees, but SoRADs research has no clear political or bureaucratic constraints. One of the future challenges for SoRAD will be the proposed system for university grants allocation, where applied social science will have difficulties competing with basic biomedical research if decisions are based on publication and citation measures.

Alcohol Prevention in the Swedish Workplace-Who Cares?

In this article we discuss what interest, and whose interest, there is in working with alcohol and drug prevention in workplaces. As the Swedish alcohol policy has weakened, alternative ways for primary prevention are sought. Public reports have pointed out the workplace as one arena for prevention that could compensate for the governments diminishing alcohol control. Will this work? What conditions are necessary in order to work successfully with these issues in a corporate environment? Several studies have suggested that there is little interest in working with prevention in workplaces, and this study supports this finding. This study involved interviews at 16 companies in Sweden with personnel managers, employees (in focus groups), union representatives, and in some cases the companys health care department. In a preliminary stage the findings verified our hypothesis that the overall interest in primary prevention in reality is not that strong. The participants in the study believed that the responsibility lies in intervention when the alcohol or drug problem has arisen, and there is really not much the company can do to prevent people from using alcohol or drugs.

Drinking policy or a political drink? Illegal alcohol in the Swedish press

During the last 10 years the Swedish tradition of restrictive alcohol policy has been seriously threatened. One of the most important causes of change has been Swedens entry into the European Union. Entrance into the EU gave rise to arguments for consumers rights and free trade. Swedish alcohol policy was questioned both with ideological arguments and on practical grounds. The alcohol policy was expected to be weakened in several ways by harmonization of taxes, demonopolization, increased import quotas and also illegal imports due to reduced boarder controls between EU-countries. At the end of the 1990s, illegal alcohol (smuggled or illegally homeproduced alcohol) became an important factor in the alcohol policy field: in 1999 the Minister of Health and Social Affairs stated that the fight against illegal alcohol is the most important issue for Swedish alcohol policy. The aim of this study was to explore how illegal alcohol was described in 10 Swedish newspapers during 1990, 1994 and 1999. The number of articles increased dramatically during the 1990s. In the first year most articles were found in the local press, but at the end of the period most of the articles were published in the nationwide press, indicating the greater importance of the topic. In 1990 and 1994 illegal alcohol was presented as a future problem if Sweden adapted the wrong alcohol policy. In the later years it was presented as an existing fact to which Sweden has to adjust. It was used as an argument for a wide range of liberal proposals. There was also a change when it came to the actors in the debate as representatives of different sectors of the alcohol industry entered the field. One of the most interesting features is that the industry and the public authorities together started a media campaign against illegal alcohol with a focus on the connection between illegal alcohol and organized crime syndicates. This is also an example of how the perceived problems with illegal alcohol depend very much on the interests of the actors. We argue that the focus on illegal alcohol can be understood as an example of the use of a good enemy. Several actors, including the public authorities, have had an interest in the fact that illegal alcohol is viewed as a serious problem. For the alcohol industry it is a way to combat a competitor, and for public authorities it can be a way of legitimizing changes in alcohol policy which they had to make anyway. Factors like this seem to have been very important in the formulation of illegal alcohol as a problem.