New governance of addictive substances and behaviours

253 Pages·2017·2.92 MB·English

by  Peter Anderson

The New Governance
of Addictive Substances
and Behaviours
Governance of Addictive Substances and Behaviours Series
Series Editors: Peter Anderson and Antoni Gual
Titles in the series
Governance of Addictions: European Public Policies
Tamyko Ysa, Joan Colom, Adrià Albareda, Anna Ramon, Marina Carrión,
and Lidia Segura
The Impact of Addictive Substances and Behaviours on Individual
and Societal Well- being
Edited by Peter Anderson, Jürgen Rehm, and Robin Room
What Determines Harm from Addictive Substances and Behaviours?
Edited by Lucy Gell, Gerhard Bühringer, Anne Lingford- Hughes, Petra Meier,
John Holmes, Lucy Gell, Sarah Forberger, and Jane McLeod
Concepts of Addictive Substances and Behaviours across Time and Place
Edited by Matilda Hellman, Virginia Berridge, Karen Duke, and Alex Mold
Impact of Market Forces on Addictive Substances and Behaviours: The Web
of Influence of the Addictive Industries
David Miller, Claire Harkins, Matthias Schlögl, and Brendan Montague
The New
Governance
of Addictive
Substances
and Behaviours
Peter Anderson
Fleur Braddick
Patricia Conrod
Antoni Gual
Matilda Hellman
Silvia Matrai
David Miller
David Nutt
Jürgen Rehm
Jillian Reynolds
Tamyko Ysa
1
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Foreword
Consider the travel of ideas. This book, The New Governance of Addictive Substances
and Behaviours, is a collection of contributions to the body of knowledge on the
governance of addictions in Europe, based on interdisciplinary research from
the European Union (EU) project Addictions and Lifestyles in Contemporary
Europe— Reframing Addictions Project (ALICE RAP). With this project, the
European Commission’s Social Sciences and Humanities Division challenged aca-
demia to contribute to enhancing policies for addictive substances and addictive
behaviors. The ALICE RAP project serves as a vehicle for the travel of ideas in
transnational governance and as an actor in epistemic governance (Alasuutari and
Qadir, 2014).
In what Freeman and Sturdy (2015) see as a new phenomenology of knowledge,
are described embodied, inscribed, and enacted knowledge. Embodied knowledge
is experience based on and expressed in people’s activities; inscribed knowledge is
formalized and written down in artefacts such as documents; and enacted knowl-
edge is knowledge in action, which is also constantly monitored and regulated, and
is essential when it comes to the realization of new policies.
The scientific production and dissemination of knowledge, as well as the trans-
lation of knowledge into policy practices, are central processes in the travel of
ideas at the transnational level. Knowledge transfer comprises two processes: de-
contextualization (translation from practice in one context into abstract ideas) and
contextualization (translation from abstract ideas to practice in a new context).
Translation competence is a key requirement of making appropriate translations.
Røvik (2011) has criticized the ‘management fashion’ theory, a leading theory on
how management ideas, trends, and concepts travel from one sector to another, and
even on a global scale, from country to country. As an alternative, Røvik (2011) intro-
duced a virus- inspired theory that he claims offers more appropriate concepts and
models with which to understand the translation and diffusion of ideas such as gov-
ernance recipes.
In the broad output from the ALICE RAP project, there has been a particular focus
on the conceptual frameworks of well-b eing, health footprint, and margin of expo-
sure. By the finalization of the project, ALICE RAP aims to offer concepts that can
provide a basis for a comprehensive future policy for the area of addiction. To do
so, ALICE RAP needs to identify institutional preconditions and constraints to the
social innovations represented by these concepts. In the translation from science to
future governance and policies, we need to ask: how ‘translationable’ are these three
conceptual frameworks and the three types of knowledge in the transnational de-
contextualization and contextualization governance processes?
vi FoREwoRD
From ideas to action
Governance involves ‘processes and structures of public policy decision making and
management that engage people constructively across the boundaries of public agen-
cies, levels of government, and/ or the public, private and civic spheres’ (Emerson
et al., 2012: 2). In the addiction field, we can add the aim of decreasing the negative
individual, relational, and social (and cultural) consequences of addiction.
The transition from government to governance, marked by the establishment of
more collaborative and knowledge- oriented modes of governance practices, repre-
sents an intensification of the interface activity between ideas and institutions. The
introduction of more collaborative strategies in governance is part of a transnational
trend. The interface between ideas and institutions becomes formative for the travel
of ideas in multilevel governance structures. Thus, globalization becomes a changing
and converging force, not just within the national state, but also taking place within
the national systems in thought and action (Kettunen and Petersen, 2011).
The well- being framework grew out of transnational cooperation in the late 1970s.
The framework added strength to the social and political dimensions of the work of
the World Health Organization, and later became a basis for collection of informa-
tion on the quality of life globally by the Organisation for Economic Co- operation
and Development and other organizations. The measurement of well- being has
been continuously discussed together with questions about where moral and politi-
cal thought fit into it (Griffin, 1986). Thus, the idea of social well-b eing as relevant
for research and policy- making has travelled in time and space. It is inscribed in
governance strategies at all governance levels from local to transnational. In ALICE
RAP, well- being has functioned as a source for the formulation of an ethical aim of
research. In the process of knowledge translation, it contributes to the inclusion of
embodied, inscribed, and enacted knowledge in ALICE RAP’s approach.
The concept of a health footprint has borrowed inspiration from the concept of the
carbon footprint (Rees and Wackernagel, 1996; Wackernagel and Rees, 1998). The
development of measurements of health footprints for addictive substances could
increase our capacity to make industry accountable for the health effects of the con-
sumption of their products. Above all, the carbon footprint has been shown to be
a forceful term in communication with civil society. It has become a basis for our
understanding of lifestyle choices, and has in this sense become embodied. The aim
of increasing industry accountability is more complicated to achieve, and we can
expect the same to be the case with the health footprint as with the carbon footprint.
Measurement of the margin of exposure (MOE) has travelled from the area of
toxicology to the addiction area. With its introduction, ALICE RAP has improved
the capacity to make objective rankings of risk related to lethal doses of different
substances. The model was first presented in ALICE RAP (Lachenmeier and Rehm,
2015; Lachenmeier et al., 2011) and the inscribed knowledge travelled into the sci-
entific community and social media. In social media, MOE, originally developed as
an instrument to depict risk level in drugs, has been inferred as a way to represent
the level of safety in cannabis use. Consequently, the MOE and its ranking of drugs
has been unintentionally reinterpreted as an argument for the liberalization of the
use of cannabis. Here, the actors have regulated the practice of the knowledge. It is
FoREwoRD vii
significant for the future governance of addictions to follow the different contextual-
ized forms that the knowledge of MOE may take.
Knowledge translation in the making
The contribution of the AR concepts to the knowledge base could also be considered
as steps in the travel of ideas. The concepts travel between thematic scientific areas
and policy fields. In efforts to make knowledge and concepts relevant for future gov-
ernance, we need to highlight the processes when measurements, models, or knowl-
edge contextualize into policy and governance. By understanding these processes,
we aim to promote co- production between science, policy, and civil society.
Therefore, we should pay special attention to the relationship between the scien-
tific community and civil society in the future. It is at this interface that we find
important sources for the validation of our concepts and further scientific work,
and for securing the relevance of the concepts. This is in line with the elabora-
tion by Alasuutari et al. (2015: 60) of the term epistemic governance to ‘… stress
that … in modern world society are all about participants attempting to influence
other actors’ understandings: not only what reality is but also what is desirable,
virtuous and acceptable and with whom people identify themselves’.
Hopefully, with MOE, the scientific community has developed objective criteria
relevant for knowledge- based decisions. However, knowledge perception and appli-
cation in governance practice are normally beyond the scope and responsibility of
the research community. We consider the barrier in knowledge translation to consti-
tute a gap between science and governance, which it is possible to reveal by analysing
conceptual frameworks from ALICE RAP in light of the forms of knowledge it takes
(Freeman and Sturdy, 2015).
The challenge for the research community is to bridge the gaps between civil society
and governance actors. It is important to try out scientific concepts on the ground in
deliberative processes with people affected by addiction problems, civil society groups,
organizations, and formal authorities at different governance levels. Enacted knowledge
is also knowledge on the move in processes of monitoring and redefinition of concepts.
Deliberative processes and co-p roduction in governance contribute to the validation
of concepts and improve the knowledge base, thereby also securing accountability and
safeguarding democracy. Arguably, future governance will profit from collaborative
knowledge development on an equal footing in its processes of de-c ontextualization
and contextualization. This book is a major starting point of such a process.
Hildegunn Sagvaag
Associate Professor, Dr. PH, University of Stavanger, Norway
Svanaug Fjær
Dr. polit, Head of Department, Bergen University College, Norway
Associate Professor (political science) University of Stavanger, Norway
Jan Erik Karlsen
Professor Emeritus, Dr. Oecon
University of Stavanger, Norway
viii FoREwoRD
References
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independent children’s rights institutions. Int J Polit Cult Soc 29: 57– 71.
Alasuutari P and Qadir A (2014) Epistemic governance: an approach to the politics of
policy- making. Eur J Cult Polit Sociol 1: 67– 84.
Emerson K, Nabatchi T, and Balogh S (2012) An integrative framework for collaborative
governance. J Public Adm Res Theory 22: 1– 29.
Freeman R and Sturdy S (2015) Introduction: knowledge in policy— embodied, inscribed,
enacted. In: Freeman R and Sturdy S (eds) Knowledge in Policy: Embodied, Inscribed,
Enacted. Bristol: Policy Press, pp. 1– 17.
Griffin J (1986) Well- being: Its Meaning, Measurement, and Moral Importance.
Oxford: Oxford University Press.
Kettunen P and Petersen K (2011) Beyond Welfare State Models. Cheltenham: Edward Elgar.
Lachenmeier DW and Rehm J (2015) Comparative risk assessment of alcohol, tobacco,
cannabis and other illicit drugs using the margin of exposure approach. Sci Rep 5: 8126.
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the benchmark dose/ margin of exposure approach: the example of ethanol and liver
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Preface
Study of evolutionary biology finds that humans have evolved to seek out and extract,
among other drugs, cholinergic agents from plants in order, among other things, to
combat invertebrate parasites such as helminths (Sullivan and Hagen, 2015). Present-
day examples of pharmacophagy are seen with Congo basin hunter– gatherers,
among whom the quantity of cannabis (Roulette et al., 2016) and nicotine (Roulette
et al., 2014) consumed is titrated against intestinal worm burden—t he higher the
intake, the lower the worm burden. Moreover, when treated with the anti- worm
drug abendazole the number of nicotine- containing cigarettes smoked is reduced
(Roulette et al., 2014). This does not imply that humans evolved to consume specifi-
cally, for example. cannabis or tobacco, or that cannabis or tobacco use is beneficial
in the modern world. What is novel in the modern world is the level of availability
and format of consumption. With alcohol, the evolutionary evidence implies that the
genomes of modern humans began adapting at least ten million years ago to dietary
ethanol present in fermenting fruit— a source of ethanol that is remarkably similar
in concentration and form (i.e. with food) to the low levels of ethanol consumption
that might reduce the risk of ischaemic events (Dudley, 2014). Again, what is different
in the modern world is novel availability through fermentative technology enabling
humans to consume beverages (devoid of food bulk) with higher ethanol content
than fruit fermenting in the wild.
The findings of evolutionary biology imply, on the one hand, that it is no surprise
that prohibition is unlikely to work, and that with prohibition of drug use, wide-
spread adverse side effects occur. Does it make sense to lock people up (or worse, kill
them) for selling, let alone taking drugs, that, worldwide, are used by over five per
cent of those aged 15– 64 years in any one year (UNODC, 2015)? In the UK, lifetime
use of an illicit drug reaches as high as 36 per cent (UK Focal Point on Drugs, 2014).
Does it make sense to design a system of governance in which murder is so rife— do
alcohol company producers and sellers murder each other with such regularity?
On the other hand, however, the findings of evolutionary biology imply that if
drugs are too readily available in terms of access and price, no wonder that so many
people use them heavily and thus run into problems. In this book, an outcome of the
Addictions and Lifestyles in Contemporary Europe— Reframing Addictions Project
(ALICE RAP) project (www.alicerap.eu), better regulation of drugs is the watch-
phrase. This means better regulation of the legal market through stricter regulation,
and better regulation of the illegal market through legalization, and subsequent
strict regulation.
Better regulation implies better management and a management system that
transfers across all drugs. This book proposes three new management tools. These
management tools can help with better regulation of nicotine and alcohol. And, they