DRUG POLICY AS A MANAGEMENT STRATEGY
some experiences from the Netherlands
by Henk Jan van Vliet director METROPOLINK Amsterdam
The Netherlands occupies a special position among the nations of the world when it comes to dealing with drug problems. In the past few decades it has been one of the very few countries that have actually made in-depth analyses of the history and nature of its drug problems and drug users, and that have developed deliberate policies to manage these problems. Whereas most other Western countries, from the beginning, adopted the starting point of combating drug use by the criminal justice system (although often simultaneously calling it a public health problem) the Netherlands decided to address drug use as one of the expressions of a baby-boom generation that is growing up in an affluent, but increasingly paranoid, society. Although this approach required new ways of policy making, these did not, and still do not, include the legalization of any controlled substance.
This was the situation in the mid and late sixties, when the Netherlands was confronted, for the first time in their history, with extensive, illegal drug use within their own society . Although the drug situation and drug problems have changed markedly from hashish and marijuana use to the use of all kinds of drugs both dangerous and not so dangerous and from white middle-class youth to all classes, races and ages, drug policy in the Netherlands is generally decided on the basis of analyses of the actual situation, scientific research, treatment and prevention experiences and an open public debate.
For the purposes of this article, I will sketch some of the characteristics of the Netherlands and of Dutch society, and give a short summary of the cornerstones of the drug policy in my country Basically this is a policy aimed at demand-reduction through social integration of both drug users and people at risk of drug use.
"Because no other country has reached the compactness and the complexity of the Netherlands' society there art no well-tried recipes yet for the accomodation of various new kinds of business activity and society. They will have to be invented and tried-out in the Netherlands itself." (Coppes 1988)
This seemingly chauvinistic statement made by a Dutch business consultant about corporate activities in the late 1980's, holds for many more social activities in the Netherlands and among them for many activities associated with drugs, AIDS etc.. Although it may be an example of typical Dutch thinking, it can provide clues for addressing problems in other densely populated and highly developed areas of the world as well.
Being the delta of three big rivers (Rhine, Meuse and Scheldt), the Netherlands ha a density of population that is only exceeded by that of Bangladesh, the delta of the Ganges. Bangladesh, however, is an extremely poor and vulnerable country, whereas the Netherlands is among the 10 wealthiest industrial nations of the world, very highly organized and the home base of multinational corporations such as Philips, Shell and Unilever.
The Netherlands represents a type of society in which it has been proven possible to attain a very reasonable level of living for a nation of almost 15 million people, living very close together on a very small territory. Every citizen is surrounded by many neighbours and it is almost impossible, geographically speaking, to hide yourself from them or to escape from society; you are never alone and always within eye-sight of others. Many Dutch families stress this fact by keeping their curtains wide open all night.
Yet the Netherlands is not an Orwellian society; it is a very old and stable democracy with a strong tradition of resistance against totalitarian rule (Ruter 1988). Government bureaucracy, although a nuisance of course, plays a rather moderating role in society and is quite less a 'Big Brother' than the bureaucracies in many larger European countries.
As Dr. Peter Hartsock, of the National Institute on Drug Abuse, writes in a very focussed portrait of the Netherlands, "social responsibility" is a key-notion for understanding Dutch socie ty. "The widest possible benefits to all of society are produced not so much by imposition of law but by social expectations of all citizens". (Hartsock 1987)
The origins of this "social responsibility" can be found partly in the long Dutch history of the battie against the sea in which all residents, deviant or not, were needed badly. Building dikes, digging canals, stemming floods - have always required joint forces rather than individual acts, such as the famous Hans Brinkers puffing a finger in the dike. Hans Brinkers as the lone hero is an American invention and not a Dutch reality.
The characteristics mentioned here apply to the activities in the justice, health and drug fields as well. Drug users are, by both government policy and an impressive social consensus, considered and treated as a part of society, as deviant neighbours rather than as outsiders (even so, everybody complains about them, of course, but that is an other national trait). Unlike many other countries, however, drug users here are stimulated to participate in social activities and to make their contribution to social coherence.
Thus for drug users, like for other groups at risk of dropping out of society, the Netherlands provide not only general social, health and judicial facilities, but also specific and specialized ones. Fundamentally, famous (or notorious) elements of Dutch drug policy such as the decriminalization of marijuana use and syringe-exchange programs for intravenous drug users, are just well considered tools meant to implement the Netherlands' general and specific social, health and judicial policies.
For more than 10 centuries the inhabitants of the Low Countries in North-Western Europe have been trading people, and today the Netherlands is still a leading commercial nation. Both Rotterdam (hosting the world's fourth biggest seaport) and Amsterdam (because of Schiphol, Europe's fourth biggest airport) are main gateways to Europe for travellers and merchandise alike. In combination with its excellent infrastructure, its high level of development and social organization and its relatively relaxed social climate, this makes the Netherlands a country fit for playing a leading role in drug trafficking.
According to enforcement authorities and others the Netherlands is such a country. It is said to be an important transit country for marijuana, hashish and heroin, and a main producer and shipper of amphetamines and hallucinogens. Yet the Netherlands have limited drug consumption problems compared with the other industrialized European countries and with the urbanized parts of the USA.
The use of marijuana and hashish has decreased slightly since the decriminalization in 1976, despite the low price and ample availability of both substances in youth centres and "coffee shops".
The use of amphetamines and hallucinogens is not viewed as a serious problem and the use of heroin has decreased among the stable and ageing group of 1920,000 Dutch opiate dependents, of which less than 40% take their drugs intravenously. Despite its availability and low price, high-risk cocaine use is mostly confined to this old addict group. The majority of non-deviant cocaine users apparently have not developed addiction problems or social problems - partly because of using marijuana type policies with respect to non-deviant cocaine use. Crack-cocaine as a ready-to use product was marketed in the Netherlands as early as 1973, but it did not catch on and is hardly seen on the streets since. The numbers of drug-related AIDS-cases and of HIV-infected drug users are among the lowest in Europe.
Before I elaborate on the drug policies that, in my opinion, are accountable for these fairly positive results, I want to make an important point about the nature of what is generally called THE drug problem.
In many countries the problems caused by the consumption and trafficking of illegal drugs are considered to be one and indivisible. No moral or legal differences are made between international traffickers, street dealers and sometimes even individual drug users - they are considered all of the same kind. No moral or legal distinctions are made between different types of drugs - they are all considered equally dangerous, which is a dangerous fallacy in itself. No distinction is made between use and abuse, between experimental, recreational and compulsive use - which poses a serious threat, especially to adolescents who are marginalized and criminalized for doing just what adolescents usually do - experiment with risks and boundaries in order to learn the necessary skills for coping with adult life.
By lumping all these different phenomena together, societies and governments help to create a drug problem which is unsolvable - that can become a "national problem number 1". The lesson that every country can learn from the Netherlands i6 that it pays to break down this seemingly inextricable drug problem into what I call 'manageable bits'. By doing so, one does not solve all the problems, bur one creates situations that car be analysed in their own context, that can be managed in a number of cases, and that can sometimes be solved.
Dutch drug policy can best be described as an 'integrated policy'. It is a typical example of the kind of innovative policy-making the Dutch were forced to develop because of the characteristics of their society. Without attempts to, at least, co-ordinate and integrate the various interests at stake in drug control - the criminal justice system, the medical and social helping system, and the communities - the tightly knit Dutch society would have been disrupted to a higher extent than it has been.
Actually, the Netherlands' government started a form of integrated policy-making in the late sixties, when the obvious and preconceived social reaction to drug use - law enforcement - ran out of control from the very moment it was placed in position against the early marijuana use of the urban middle-class youth. Dutch society could not (and cannot) afford to lose contact with its future executives and intellectuals. Marginalization and criminalization was, and still is, too high a price to pay when they are balanced with the damage caused by experimental and recreational marijuana use to both individual health and legal order.
To cut a long story short, the public debate about this issue led to the development of the first cornerstone of Dutch drug policy in 1976: the (legal) separation of (drug) markets, combined with an extensive and ongoing health and drug education strategy. Essentially, "separation of markets" means that the possession of up to 30 grams for personal use (and to a certain extent the retail trade of marijuana products) has been decriminalized in order to prevent young people experimenting with marijuana or becoming involved with more dangerous or addictive drugs. The retail trade in marijuana products is conditionally tolerated in youth centres and "coffee shops". The conditions for this trade are: no sale of any other drugs (apart from cafeine!), no advertising, no public nuisance and no sales to people under 16.
As I said before, the level of marijuana use has decreased since 1976, whereas the "classic" hard-drugs have lost much of their attraction for young people and the state of knowledge of Dutch youth about drugs in general has increased enormously.
In the mid-seventies, when the abuse of heroin spread among white lower-class youth and black and Mediterranean immigrants, and associated social problems began to take a threatening shape (especially in some inner cities) the concept of harm reduction was developed among the helping services.
This concept is essentially based on the conclusion that it is not enough to rely on primary prevention and drug free treatment alone, as there should also be a range of strategies to reduce the harms to those dependent drug users who are unable or, as yet, unwilling to achieve abstinence. By setting up 'user-friendly' and often outreach services that are non judgemental and not aimed at immediate abstinence, professionals see drug users who would otherwise stay beyond the reach of the helping system. Thus, they can monitor the health, social and legal status of the users and begin to achieve some success in reducing actual and potential harm to both the individual and society.
At the end of the seventies, the Netherlands' government adopted the harm reduction concept as a second cornerstone of their strategy and the offlcial starting point of Dutch (hard-) drug policy.
In the Netherlands an estimated 70 to 80% of the dependent drug users are known to caring agencies, compared with not more than 10 to 40% in most other countries. Needless to say, the present AlDS-crisis and the need for AlDS-prevention among intravenous drug users strongly underline the importance of the concept of harm-reduction.
In the early eighties a third cornerstone was developed as the result of a government-sponsored research project into the typology of drug users. This is the policy-concept of normalization of drug problems. (Janssen & Swierstra 1982)
Normalization of drug problems essentially means the admission that extensive drug use, both legal and illegal, has gained a firm foothold in society - as already is the case with alcohol and tobacco.
Worldwide it has proven to be an unrealistic option to try to eradicate illegal drugs and drug use completely, as it has with regard to alcohol and tobacco. It is far more realistic to aim at the reduction of drug use, at the containment of the damage caused, and at the management of the individual, social and legal problems. Basically, this is the same policy-concept the Dutch use with respect to alcohol and tobacco - and it works.
In effect, this means fighting organized crime, drug trafficking, obtrusive retail trade and other public manifestations of anti-social behaviour, and integrating - or encapsulating - the drug users in 'normal' society. It also means that society makes itself clear about what it can and cannot, will and will not tolerate, and about the rights and obligations of drug users as members of society, as fellow-citizens and as neighbours.
This is not a kind of 'soft' way of dealing with drug use and drug users. It is a pragmatic way of coping with a social and public health problem and it is the way we try to cope with our social and public health problems in general: by using social rather than legal coercion.
And then there was AIDS. When the AlDS-crisis broke out, it found the Netherlands prepared, so to speak, to cope with at least its initial effects.
The majority of Dutch intravenous drug users are in contact with an established helping agency, so many could be reached - although by far not enough - with AlDS-prevention activities through this system. Representatives from the helping system took part in the activities of the National AIDS Task Force long before the first IV-AIDS case was detected, and soon afterwards the organized drug users the Dutch Federation of Junky Unions - took part in the AIDS policy-structure as well. This is both an indication of the success of the normalization policy, and a badly needed extension of AIDS prevention activities to those pockets of society where only drug users themselves can go.
These ways of integration and co-operation, and the strategies developed and implemented, will inevitably change the face of Dutch drug policy again. The AIDS crisis has the power to reshape the whole paradigm of drug policy and drug control and it will inevitably do so. I think, however, that the starting position of the Netherlands for controlling both drug abuse and AIDS as social problems is far less uncomfortable than that of many other nations.
Coppes, M., July 20 1988, NRC-Handelsblad .
Hartsock, Dr. P., 1987, Trip Report: Europe, National Institute on Drug Abuse, Rockville, MD.
Janssen, 0. & Swierstra, K., 1982, Heroinegebruikers in Nederland, een typologie van levensstijlen. Groningen.
Ruter, Dr. F., 1988, The Pragmatic Dutch Approach to Drug Control, Does It Work? Drug Policy Foundation, Washington, DC