Torsten Kolind

Form or content: The application of user perspectives in treatment research

As part of a general trend in modern society, the voice of the ‘consumers’ of the services of the welfare state has gained increased legitimacy. However, this is not the case when it comes to drug-treatment users. The continuing neglect of this groups experiences is also reflected in methadone maintenance treatment research. This article seeks to counter this imbalance by exploring users’ experiences with enhanced psychosocial methadone maintenance treatment. The findings rest on an evaluation of the Danish Methadone Project. As part of the evaluation 37 semi-structured qualitative interviews with users were made, and two months of participant observation were conducted in the clinics. An important finding is that the users highlighted the form of the treatment as much as the actual content. It was not primarily the content of the services, but how the services were carried out that mattered. Most crucially, the users highlighted the attitude of the counsellor, the accessibility of spontaneous counselling, and spaces that facilitated non-stigmatizing social encounters. While drug users do not provide the definitive statement about the value of drug service provision, listening to their voices is a necessary step in building an ethically sound approach to drug treatment, with a high degree of client support where the treatment provided meets the consumers needs.

Drug treatment or alleviating the negative consequences of imprisonment? A critical view of prison-based drug treatment in Denmark

BACKGROUNDnThe availability of prison-based drug treatment has increased markedly throughout Europe over the last 15 years in terms of both volume and programme diversity. However, prison drug treatment faces problems and challenges because of the tension between ideologies of rehabilitation and punishment.nnnMETHODSnThis article reports on a study of four cannabis treatment programmes and four psychosocial drug treatment programmes in four Danish prisons during 2007. The data include the transcripts of 22 semi-structured qualitative interviews with counsellors and prison employees, prison statistics, and information about Danish laws and regulations.nnnRESULTSnThese treatment programmes reflect the treatment guarantee in Danish prisons. However, they are simultaneously embedded in a new policy of zero tolerance and intensified disciplinary sanctions. This ambivalence is reflected in the experiences of treatment counsellors: reluctantly, they feel associated with the prison institution in the eyes of the prisoners; they experience severe opposition from prison officers; and the official goals of the programmes, such as making clients drug free and preparing them for a life without crime, are replaced by more pragmatic aims such as alleviating the pain of imprisonment felt by programme clients.nnnCONCLUSIONnThe article concludes that at a time when prison-based drug treatment is growing, it is crucial that we thoroughly research and critically discuss its content and the restrictions facing such treatment programmes. One way of doing this is through research with counsellors involved in delivering drug treatment services. By so doing, the programmes can become more pragmatic and focused, and alternatives to prison-based drug treatment can be seriously considered.

Prison-based drug treatment in Nordic political discourse : an elastic discursive construct

Prison-based drug treatment (PDT) has increased markedly in the Nordic countries over the last 15 years. Based on data from Denmark, Finland, Norway and Sweden, we outline the historical development of PDT and analyse the rationales employed in the political discourse in the Nordic countries legitimizing this development. These rationales relate to the reduction of criminality, zero tolerance, rights and the modern welfare state, and managerialism. Though these rationales may appear dissimilar, they have been combined with relative ease in the political discourse. Actually, this elasticity may partly explain the popularity of PDT. We discuss whether the increased use of PDT reflects a criminalization of social problems and signals a rebirth of the treatment ideology in Nordic prisons.

Young people, drinking and social class. Mainstream and counterculture in the everyday practice of Danish adolescents

Analytical concepts such as ‘bounded consumption’ or ‘controlled loss of control’ have been applied to characterise contemporary youth intoxication. This article argues that this kind of cultural diagnosis benefits from being related to a focus on differences in social class. It is shown that in order to fully understand differences in the drinking and partying practices of young people, such practices must be related to the youngsters’ general life and values, especially aspects such as rule-setting and school culture. Moreover, such practices including drinking attitudes are used by young people to construct social class-related identities: mainstream youngsters continually confirm their taken-for-granted normality, and mainstream breakers resist the mainstream hegemonic (school) culture which usually defies them. In conclusion, bounded consumption, corresponding with contemporary ideals of self-realisation, mostly seems to be a mainstream practice. For mainstream breakers unbounded intoxication practices can be observed and analysed as part of a counterculture. The study draws on five months of fieldwork and 24 qualitative focus-group interviews with pupils attending ninth grade (14–16 years of age) and their parents in a provincial Danish school.

Insufficient access to harm reduction measures in prisons in 5 countries (PRIDE Europe): a shared European public health concern

BackgroundPrisoners constitute a high-risk population, particularly for infectious diseases. The aim of this study was to estimate the level of infectious risk in the prisons of five different European countries by measuring to what extent the prison system adheres to WHO/UNODC recommendations.MethodsFollowing the methodology used in a previous French survey, a postal/electronic questionnaire was sent to all prisons in Austria, Belgium, Denmark and Italy to collect data on the availability of several recommended HIV-HCV prevention interventions and HBV vaccination for prisoners. A score was built to compare adherence to WHO/UNODC recommendations (considered a proxy of environmental infectious risk) in those 4 countries. It ranged from 0 (no adherence) to 12 (full adherence). A second score (0 to 9) was built to include data from a previous French survey, thereby creating a 5-country comparison.ResultsA majority of prisons answered in Austria (100xa0%), France (66xa0%) and Denmark (58xa0%), half in Belgium (50xa0%) and few in Italy (17xa0%), representing 100, 74, 89, 47 and 23xa0% coverage of the prison populations, respectively. Availability of prevention measures was low, with median adherence scores ranging from 3.5 to 4.5 at the national level. These results were confirmed when using the second score which included France in the inter-country comparison. Overall, the adherence score was inversely associated with prison overpopulation rates (pu2009=u20090.08).ConclusionsUsing a score of adherence to WHO/UNODC recommendations, the estimated environmental infectious risk remains extremely high in the prisons of the 5 European countries assessed. Public health strategies should be adjusted to comply with the principle of equivalence of care and prevention with the general community.

‘When you're boxing you don't think so much’: pugilism, transitional masculinities and criminal desistance among young Danish gang members

ABSTRACT This paper draws upon international research evidence that suggests a relationship between protest masculinity and the manifestation of violent crime among young males, and that criminal desistance may be linked to (inter-) subjective processes such as the reconstruction of masculine identity. The paper considers the potential that pugilism (the art and practice of boxing) may have on enabling young, disadvantaged minority male gang members to find avenues for alternative identity construction and to gain transitional experiences which trigger self-confessed desistance actions. Drawing upon an ethnographic study conducted in a boxing rehabilitation centre on the outskirts of Copenhagen, Denmark, the paper reports on data gleaned from participant observation and qualitative interviews with 22 ethnic minority young men. Findings suggest that the masculine context within the rehabilitation programme provided the young men with a safe space to perform broader versions of locally dominated views on masculinity and to reflect on their current situations and dilemmas. The young men were clearly in transition and their desistance journeys were characterized by hope and ambition but also disappointment and despair. In some cases it appeared that the young mens dogged attempts to desist from crime became a new way for them to ‘do masculinity’. The authors draw upon the findings to make recommendations for policy, practice and research.

Desistance and the micro-narrative construction of reformed masculinities in a Danish rehabilitation centre:

Juvenile justice systems and reformatory institutions hold the potential to help young offenders and drug abusers change their behaviours and life-courses. Driven by an ambition to pave new ways to examine the inner workings of reformatory institutions this study explores how young male offenders’ gendered identities are engaged in a Danish reformatory programme. In recent years existing research on the gendered aspects of reformatory interventions has highlighted how reformatory institutions at times work to promote desistance by problematizing offenders’ and drug-abusers’ performance of hyper-masculinity and by constructing therapeutic spaces where men can reformulate softer versions of masculinity. Contributing to this line of research, this study explores and discusses how reformatory programmes at times also utilize hyper-masculine symbolism and imaginaries to encourage young offenders and drug abusers to engage in narrative re-constructions of identities and to socialize these into new subject positions defined by agency, self-responsibility and behavioural changes.

‘Why Don’t They Just Do What We Tell Them?’ Different Alcohol Prevention Discourses in Denmark

In recent decades great focus has been placed on the excessive consumption of alcohol by young Danes. In this connection, Danish parents have been called upon by the national health authorities to function as prevention workers with a view to reducing their children’s alcohol intake. Parallel to these efforts, and also responding to the increase in drinking by young people, efforts to reduce the harm caused by the drinking practices of adolescents have grown bottom-up among parents. In this article we identify and compare these two seemingly contrasting discourses, both of which influence the prevention field: a public alcohol prevention discourse and an everyday discourse, respectively. The analysis is based on alcohol legislation, public health programmes and national alcohol recommendations, as well as on a qualitative study of a special Danish phenomenon: parties for young people organized by parents. In the two discourses alcohol consumption is presented differently. However, traditionally liberal Danish alcohol policy plays an important role in both: the central feature of this policy relies on individual control rather than on public regulation.

The importance of cannabis culture in young adult cannabis use

Abstract Background: Research into drug use initiation has focussed on drug use as risky behaviour. Qualitative research suggests that a culturally derived set of beliefs about the positive effects of cannabis play an important role in the production and maintenance of cannabis use. Methods: An online survey questionnaire was designed to measure both perceived positive and negative effects of cannabis. The questionnaire was submitted to a factor analysis, and two factors were extracted: a positive and a negative effect scale. Using regression analyses, associations with cannabis use, perception of general use and perception of general acceptance of use were assessed. Results: After removing respondents based on age and responses to questions, 1416 valid survey questionnaires were collected. In bivariate analyses, both positive effects and negative effects were associated with use (pu2009<u20090.001), perceived normative use (pu2009<u20090.001) and acceptance of use (pu2009<u20090.001). In multivariate analyses, only glorification remained consistently associated with perceived use, acceptance and all categories of use (pu2009<u20090.001). Conclusions: Positive beliefs about the effects of cannabis use are important and form part of a cannabis culture, which are essential for understanding initiation and maintenance of cannabis use. These findings have important ramifications for cannabis preventive work and also call on further investigation into the relation between cannabis culture and individual use.

Prison drug treatment in Denmark: A historical outline and an analysis of the political debate

Aims The article outlines the historical development of prison drug treatment (PDT) in Denmark in order to understand the present situation where PDT is viewed as a natural benign practice. We also identify the different rationales within the political debate on PDT since its rapid expansion in 2000. Data Historical and policy documents, grey literature, interviews with key informants in the field. Results Four historical periods are identified, from a period when drug treatment was unwelcome in prisons to a re-emergence of the rehabilitation ideal over the last 15 years, when PDT appears unquestioned and its popularity has exploded. Five dissimilar and at times conflicting rationales have been present in the political debate legitimising this policy shift. Conclusion Part of the popularity of PDT stems from the fact that it has been used in political debates in order to justify a range of different and even conflicting objectives. With changing penal discourse, PDT may again become unwanted in prison settings.