is no such thing as a drug-free society.
Are drugs becoming the norm?
Faugeron and Michel Kokoreff
For many years, drug issues were shaped by prohibitionism and perceived
links between the fringe elements of society, heroin and exclusion, but now, at
the dawn of the 21st century, they seem to be part of a new landscape
both in France and in other major countries in Europe.
Of course, things did not change completely overnight.
However, we are seeing new problems and categories that are causing us to
question the ideal of a drug-free society.
Ultimately, that line of thinking leads to the notion of societies
with drugs. This change in norm is taking place against a backdrop of new
risk reduction policies and is reflected in a tangible way in two types of
phenomena: new forms of social use and self-regulation, and the activation of
existing prevention and support mechanisms and the introduction of new players
(self-help groups, “front-line” workers, mediators, etc.).
None the less, approaches to intervention are still difficult to
reconcile. Strong institutional
approaches (criminal law, health) stand in contrast to approaches that are far
less certain or that entail grey areas when it comes to establishing new
This is the context in which this paper was compiled. The aim is to get a better grasp of the array of forms of
drug use and at the same time clarify changes in and the impacts of public
Shift in drug policy in France
France’s drug policy has changed since the mid-1990s.
The changes resulted from greater awareness of public health problems
related to the use of illegal drugs, the realization that there was no way to
eradicate substance abuse and pressure from neighbouring countries.
France could no longer go it alone.
The change in public health began with the suspension of the 1972 order
making it mandatory to produce identification when purchasing a syringe at a
pharmacy. Needle exchange programs
and the sale of sterile kits developed in the early 1990s.
A milestone in the middle of the decade was the February 1995 release of
the Henrion Report,
which recommended quick development of a risk reduction policy.
The report won support from a number of
authorities: Comité Consultatif National d’Ethique (1994), Commission sociale
de l’Episcopat (1997), Ligue des Droits de l’Homme (1996). The
documents drew considerable media attention, sparking a public debate on risk
reduction. Methadone and
high-dosage buprenorphine (Subutex®) received marketing approval in 1995.
The use of Subutex®, which is distributed by general practitioners with
few administrative restrictions, for substitution treatment developed quickly,
too quickly in some cases (Lert et al. 1998), while the distribution of
methadone, which can be dispensed only by a specialized centre, is still not
really widespread (Morel, 2001). According to Lert (2000), some 3,500 patients
were being treated with methadone in July 1999, whereas an estimated 64,000 were
Finally, drug treatment professionals and workers stated in no uncertain
terms at the national meetings on drug abuse and addiction in 1997 that they
supported a risk reduction policy and even decriminalization of the use of
illegal drugs. Many called for the
1970 legislation to be repealed or at least amended. Health secretary Bernard Kouchner gave a measured response:
“I do not believe that a hasty debate will bring about the necessary changes
to the legislation. But it is
important to proceed with caution and convince all of the players. We can develop a new mindset nevertheless and take comfort in
the fact that the debate does not become a farce.”
(p. 141). Many players have
indeed changed their way of thinking. Specialized
workers are no longer hostile toward substitution as they were for many years
(Bergeron 1999). The courts are
increasingly reluctant to put people in jail for simply using drugs.
The ministry of the interior refuses to amend the legislation in any way,
but some police officers are hesitant to write tickets and report to the public
prosecutor’s office. More and
more, the public prosecutor opts for something other than an injunction ordering
treatment. The number of people
being questioned by police in connection with simple drug use may be up, but the
number of convictions is relatively unchanged; more importantly, the number of
people incarcerated for a primary offence of drug use has fallen sharply (from
1,213 in 1993 to 471 in 1999).
the outside in
This account glosses over the deeper reasons that led to changes in
French public policy on substance abuse. Perhaps
a good image would be movement from the outside in.
French Jacobean tradition, the evaluation practices established by the
government (which is more interested in effects than processes) and a focus on
public order issues make it difficult to see such movement.
This is not a matter of local opposition to a central view, but rather
observation of how very real problems that can arise in day-to-day living, such
as finding used needles in public places, the unpleasant sight of beggars and
small-time dealers, fear of AIDS spreading among populations not considered to
be high risk, and lack of control in local facilities serving very poor
populations, can mobilize local players and bring about an array of very
different solutions. Some solutions
will be exclusionary: a ban on begging or relocation of street kids. Others will try to
mobilize the resources available under city policies (Joubert, 1998; Kokoreff,
1997). Still others will endeavour
to rationalize by casting the problem as a public health issue.
The public health argument is certainly one of the strongest available to
those seeking a risk reduction policy. As
Fassin (1998) pointed out, in matters of public action, health has a legitimacy
all its own, and in the area of drug abuse, close scrutiny of local situations
shows the extent to which the actions of some professionals, associations and
elected representatives have a truly innovative effect on public health (p.
In many cases, the process begins with tinkering that is often difficult
and may or may not be successful. But
that tinkering can lead to the creation of doctrine and the transfer of
expertise. The transition is also
helped by the fact that political figures in France are often involved in
municipal life and local communities. Mayors,
deputies and senators, particularly (but not only) those from the left, bring to
the debate the experience gained in their municipalities.
Progress toward national public action is not immediate and requires a
great deal of work to build doctrine and prepare joint representations; France
still has a long way to go. In his
article, Ogien highlights the difficulty in trying to transform into a public
health policy a public order policy that was dominant until the 1990s.
In the French system, there are two constraints that shape public action:
do not impose measures that would be perceived as attacking individual freedoms;
and do not break the monopoly physicians hold on medical expertise and decision
making. To get around these constraints, the health ministry encourages
initiatives by user groups
in order to allow better use of resources and prevent risks related to
injection. But in today’s
political climate, the health ministry cannot easily afford to grant the
requests now being made by groups lobbying for the decriminalization of drug use
and the controlled distribution of heroin, just as the distribution of Subutex®
or clean needles can help improve the health of intravenous drug users.
This explains the tentative position taken by Bernard Kouchner in 1997 (supra) and
the position taken in the years following by Mildt president Nicole Maestracci.
The late 1990s also shed more light on users of illegal drugs.
Until then, the only source of knowledge was the occasional
epidemiological survey of small age cohorts and/or target populations, such as
high-school students, or studies that by and large applied only to specific
groups of users, most of them selected using the “snowball” method.
The lack of knowledge was lamented first by the Association Descartes
program (Penser la drogue, penser les drogues, 1991) and later by the
Padieu Report (1994). It bears
repeating that until the late 1980s, empirical studies of drug use and sale were
few and far between (Ehrenberg, 1992).
A number of studies conducted in the following decade helps offset this
“knowledge deficit” (Faugeron, 1999; Faugeron, Kokoreff, 1999).
A series of studies, most of them qualitative and ethnographic, looked at
the use and users of marijuana (Aquatias et al., 1997; Bouard, 1994;
Ingold and Toussirt, 1998), heroin (Bouhnik, 1994; Bouhnik and Touzé, 1996;
Toufik, 1997, etc.) and, to a lesser degree, synthetic drugs (Kokoreff, Mignon,
1994; Ingold, 1997; Inserm, 1998; Colombié, Lalam, Schiray, 2000; Médecins du
Monde, 2000). There were no studies, however, on crack and cocaine apart from
two ethnographic studies conducted in Paris (Ingold, 1992 and 1994). There were
also studies that focused not on a particular substance, but on a particular
type of territory (Joubert et al., 1995 and 1996; Duprez, Kokoreff, 2000)
or specific groups (Hédibel, 1997; Tarrius, 1997; Pryen, 1999); these studies
took a more horizontal approach to drug use and living conditions.
Ultimately, though – and we will come back to the subject of practices
– these studies only scratch the surface of drug use.
Moreover, reliable statistics separate from those produced by
institutions and studies of the general population have been scarce.
lack of this type of data was the driving force behind the creation of the
Observatoire français des drogues et des toxicomanies (OFDT). In the years since, the OFDT and outside partners have
conducted general population studies using more comprehensive methods.
Beck (2000) lists those studies and points out the methodological
There is no perfect study, regardless of the data collection or sampling
methods used. One of the most
complicated hurdles is the small number of users of some substances, which makes
it hard to extrapolate the data to the general population.
For that reason, the studies conducted in France apply at once to broad
populations (12-75 years), such as the “Baromètre santé”, to populations
students, and to young people (17-19 years) called to defence readiness days. This system is complemented by a system of observing recent
trends (TREND) that does not provide specific figures, but rather information on
patterns of use and emerging uses. TREND identifies two types of
use: urban use, which is characterized more by “hard” use, and recreational
use. Heroin use is declining in urban areas, although it is still the drug of
choice. Stimulants (ecstasy,
cocaine and speed) are the most popular recreational drugs.
Stimulant use has increased among both hard and recreational users, as
has the mixing of drugs, often to counterbalance the ill effects of coming down.
All these studies underscore the
prevalence of multiple drug use, in particular one or sometimes two illegal
substances (not necessarily at the same time) with misused medication and
alcohol and tobacco. The increase
in tobacco use among young people is at least as much a concern for public
authorities as the use of illegal drugs.
studies provide greater insight into changes in public opinion.
The 1999 study by the OFDT
showed that a large majority (80.8%) favoured using alternate substances and a
smaller majority (63.0%) agreed that needles should be sold without a
prescription. Even controlled
distribution of heroin is relatively acceptable (52.9%) (see Beck, Peretti-Watel
1999). The authors note that
comparison with previous studies indicates an upward trend in the acceptability
of alternate substances: “[translation]
Overall, public acceptance in France of initiatives related to the risk
reduction policy seems to have been increasing since the early 1990s” (p.
133). Opinion is divided as to
whether illegal substances should be banned: 52% of the people surveyed think
that a ban on marijuana would be ineffective; only 48% think the same for
heroin. On the whole, the people
surveyed do not like the idea of marijuana legislation.
However, controls on access to marijuana drew support from about 30% of
the respondents. The overwhelming
majority of respondents said care should be mandatory.
some extent, these results are in line with the increasingly prevalent media
portrayal of drugs as a public health problem.
That portrayal mitigates some of the adverse effects of the 1970
legislation with its two components aimed at eliminating use and placing users
under medical care.
Those two components are in constant conflict, which professionals deplore,
since police pressure counteracts efforts to establish risk prevention measures.
Although the absolute number has increased, injunctions ordering users
into treatment have not had the desired effect; the evaluation by Setbon (2000)
shows that enforcement varies dramatically from one jurisdiction to the next and
that it is almost impossible to gauge the results.
Some jurists see the evolution of the 1970 legislation as “normative
tinkering” and refer to the ineffectiveness, indeed the counterproductiveness,
of the current legal framework (Charvet 2000, pp. 80 and 81).
With regard to orders of care at the trial or parole stage, Simmat-Durand
(1998) showed that very few statistics were available: the number of treatment
orders issued by youth judges, trial judges and other authorities was
statistically negligible. According
to Simmat-Durand, this near-insignificant result showed that the mechanisms
established in the 1970 legislation have not worked. On the other hand, charges for use have increased
considerably, from 24,588 in 1993 to 73,661 in 2000 for marijuana. Charges for heroin use have fallen since 1995 (from 13,299 to
4,831 in 2000). The police are
essentially marijuana police. Other
undesirable effects include grappling between the police, the courts and public
health officials that facilitates the sale of adulterated substances, which
adversely effects users.
A less Manichean debate
three-year plan to combat drugs and prevent addiction (MILDT 1999) is part of a
grassroots movement and will use the public health argument. To its credit, the plan recognizes that there is no such
thing as a drug-free society, clarifies some concepts and affirms that addiction
prevention and control pertain to more than just illegal drugs.
It also clearly illustrates the difficulty of reconciling repression and
care and the failure by the courts to mobilize treatment mechanisms.
It points out that the existing system focuses too much on heroin users
and does not tackle problems related to problematic use of other substances,
whether legal or illegal.
first clarification consists in dispelling the notion of drug addiction by
recognizing the existence of risk-free use and focusing on problem use and
dependency. Challenging the very
notion speaks volumes about the observed change, as illustrated by Bergeron:
“[translation] Through most of
the 1970s, the health ministry and some centres were convinced that drug abuse
was a ‘solvable’ problem, a problem that affected only some young people who
would ultimately be saved.” (Bergeron,
1999, 198) The increase in use and
then the appearance of AIDS fuelled that belief.
Today, people still talk about drug addicts (both in the clinical sense
and as a generic category), and even multiple drug addicts, but the fact remains
that the notion of “drug user” has become commonplace in social discourse
(among politicians, institutional players, professionals, journalists, etc.).
The distinction between use, abuse and dependency introduces a new shade
of meaning: it not only indicates a shift from the substance to the behaviour,
but also means that not all drug users are drug addicts” (Parquet et
al., 1999). Granted, these
distinctions are simply a recapitulation of the distinction made by the WHO:
use, harmful use (abuse) and dependency; however, they still serve to focus
government policy on the prevention of drug use problems and the related risks.
But at the same time, the notion of prevention loses the narrow meaning
it had been given in the 1970s and 1980s, that is, prevention of drug use, and
now includes prevention of health and social damage for users and those around
them. This broadening of the
concept of prevention is reflected in the slogan “know more, risk less” that
appears on the small brochures published by the MILDT.
Extension of the
anti-drug policy to include legal substances, primarily tobacco and alcohol, and
the misuse of prescription drugs plays down dependency on illegal drugs in the
broader context of studies on addictive behaviour and is an attempt to
revitalize a sector of treatment that is in escheat, particularly with regard to
alcohol. The three-year plan also
includes measures to strengthen alcohol counselling and bring it more in line
with specialized care and to create a diploma program in addictology; that
program turned out its first graduates in June 2001.
of institutional thinking
It is certainly too
early to assess the impact on mechanisms and practices of this change in
discourse and the measures accompanying it.
The circular on court
responses to substance abuse (JUS 9900148 C, July 22, 1999) recommended that
judges would be better to use existing mechanisms, in particular quick social
surveys, analyses, reference to the law in the form of dismissal with a warning,
dismissal with a referral to a health, social or professional facility,
court-ordered socio-educational monitoring, suspended sentence with testing,
general work, parole, etc. Unlike
its predecessors, it made a clear distinction between casual use, abuse and
dependency. It urged the courts to
take into account users’ efforts to get involved in an integration process, to
ensure continuity of care and to incarcerate users only as a last resort.
It reiterated the view that court-ordered treatment should be used
wisely, only for heavy users of illegal substances. It reaffirmed the need for
courts to deal with users locally, in liaison with the competent authorities, in
particular the police and customs.
The most innovative
measure is the “incitement to undergo care” outside the framework of
court-ordered treatment. It is
reminiscent of the “praetorian probation”
used by Belgian judges and analysed in the paper by Christine Guillain and
Claire Scohier. What is different
is that it cannot lead to dismissal with no further action; it must help shed
light on the correctional court’s decision.
The thinking behind the
circular is clear: avoid making casual users subject to severe measures out of
scale with their offence and their social situation. On the other hand, it is difficult to see why there would be
a raft of measures that were largely unused in the past, as illustrated by
Simmat-Durant (1998). Further, users are still at risk of being charged with
possession of or trafficking in narcotics no matter how small a quantity they
have. In any event, we are
compelled to discuss the operational thinking of the criminal system, so aptly
described by Aubusson de Cavarlay (1997, 1999).
Based on an analysis of narcotics cases handled by the public prosecutor
in Brussels over a five-year period, Guillain and Scohier showed in their paper
that judges have not made extensive use of the new measures available to them.
They went on to say that the criminal system’s reaction is basically
driven by socio-individual criteria, including the existence of a “record”,
that is, a history of failed measures. It
should be added that socio-health and criminal mechanisms are not always
compatible. Urging judges to rely
on the expertise of social work and health care creates a grey area between the
two which the vague phrase “reference to the law” does not manage to
clarify. The youth justice system
has long had and still has to deal with this problem
The problem is
complicated by the recurrence of concerns about safety.
The message is aimed first and foremost at police departments – the
forces of public order – whose legitimacy is based on an obligation to produce
results in terms of public peace and order.
The police are the ones who question individuals and lay the groundwork
for the case in the form of a police report.
They provide the raw material that goes to the public prosecutor, whether
the offence is use, trafficking or social delinquency.
The increase in arrests of users, mainly marijuana users, may come as a
surprise. The police need those arrests to show that they are out there taking
care of small-time and big-time trafficking. Trying to do things after an arrest
to avoid too harsh a criminal penalty for “ordinary” users transforms judges
and other players into tools in an attempt to solve a problem whose roots lie
elsewhere. And of course, the cases
referred to public prosecutors and the courts contribute to overall clogging of
the system, make for longer proceedings and stand in the way of
phenomenon that is constantly resurfacing is the professionalization of
trafficking in illegal substances. A
recent survey based on a critical analysis of court cases in several
jurisdictions (Hauts-de-Seine, Seine-Saint-Denis, Nord) and background
interviews with people involved in trafficking brought to light various aspects
of the professional nature of trafficking: organized files, increased division
of work, mobilization of skills and expertise, traditional techniques of
organized crime (intimidation, “hit men”, etc.) and underground activity
(having some operations carried out by people who are above suspicion, with or
without their knowledge), and money laundering (Duprez, Kokoreff, Weinberger,
2001). This process of
professionalization attested to by the relatively small number of arrests for
“trafficking” is manifested in different ways depending on the type of
market concerned. In the case of
local trafficking, dealing in marijuana and especially heroin and cocaine has
become a separate job, particularly in poor neighbourhoods, that mobilizes
resources (relational) and skills (professional).
Entrepreneurship and the desire for social success outstrip – at least
for the cases reviewed and the people interviewed – the need to cover the cost
of personal use of drugs. With
regard to marijuana-importing rings, there are well-organized structures that
provide a better understanding how goods move (logistics, distribution by
semi-wholesalers, return of money) and peripheral activities (disguising of
cars, driving skills, lodging, laundering networks) that make it possible to
generate wealth. Colombié and
Lalam observed similar professionalization related to “synthetic” drugs like
ecstasy. They showed how criminal organizations recovered then organized
trafficking in these new substances. This
comes as no surprise. The demand
for illegal drugs can only lead to a market structure in which the strongest set
the rules, and in that area, mafia-type organizations are the professionals.
Different uses, integrated users
Having painted an
overall picture of these changes, we now go back to the different types of drug
use taken into account in new public policies.
Socially differentiated use, integrated users, self-managed use: these
are the phenomena we are starting to get a handle on today in almost every part
of Europe. One of our objectives in
this paper is to describe and understand these processes.
the marginality/heroin/exclusion model to the integrated user model
into account the wide array of uses and relationships with drugs is a
departure from that Decorte calls the “worst-case scenario”, that is, with
the marginality/heroin/exclusion model. That
model shaped public policy and professional thinking as well as social sciences
research. We may be fairly familiar
today with the role drugs (use and trafficking) play among the population,
particularly the most marginalized segments of society (excluded among the
excluded, drug addicts with AIDS, characterized by a tenuous connection with
social networks and health care structures), but we know very little about
segments that are well integrated socially and economically – what are called
in France the middle and upper classes and in Anglo-Saxon countries “hidden
Almost a decade ago, Ehrenberg (1991, 1992) suggests a number of ways of linking
drug use to social mindsets to encourage people to give up drugs for good.
Around the same time, a
series of studies of former drug addicts from different social backgrounds
conducted under the direction of Robert Castel identified several options for
analysing the social determinants of drug use and societal supports that can
help users stop (Castel, 1998, 230), because in spite of accepted ideas and
shared beliefs, people do stop. The
research identified two types of drug user: “upper-class users”, who are
socially, culturally and economically “endowed” and have “something to
lose”; and “lower-class users”, who ultimately have “very little or
nothing to lose”, since social failure is part of life. Analysis of the
socially different meanings ascribed to practices and trajectories can be
related to analysis of the different types of drug addiction, because those
outcomes take a variety of forms, even within the various segments of the
In France, at least,
these options ultimately went largely unexplored. Why was that? It
may be because of “social demand”, which we define as the common
semi-scholarly representations that typically link segments of the population
and marginal, peripheral and criminal elements, and proponents of research that
is legitimized by “fear of the working classes”.
In fact, social demand is stronger in the lower classes than in the
middle and upper classes, in “hot” neighbourhoods than in “trendy”
neighbourhoods. But this type of
argument may fall down when it delegitimizes any form of knowledge or
investigation of what would primarily be “social problems” rather than
sociological issues (according to the old saying from Durkheim: “social is not
sociological”). This shortcoming can also be explained in terms of
stigmatization and visibility: on the one hand, the stigma makes some segments
(workers), groups (second generations) and areas (the street) visible; on the
other, social groups that have the resources can manage their private use (in
the comfort of their middle-class homes or behind the heavy drapes of their
psychoanalyst’s office). But the
methodological problems that are inevitable in a study of integrated users are
not insurmountable, as illustrated by the studies carried out by Decorte, Caiata
and Leroux. Other factors may be
come into play, such as those related to traditional research methods.
Since the late 1960s, a whole series of studies have been devoted to
marginal segments of the population. The
increasing prominence of the social and economic side of drugs and the decline
of the ideological side and the role of drugs in counterculture have in a way
extended that tradition.
We know that drugs are
not limited to the fringes of society. Aside
from marijuana use, which is a widespread phenomenon that we will come back to
later, there are heroin addicts who maintain social ties and use heroin to
fulfil social requirements (is this not Caita? ref.). The studies by
Cohen (1996) in the Netherlands and Diaz (1996) in Spain showed a wide range of
profiles among cocaine users. Cocaine
is not just a luxury drug popular in show business, high fashion and advertising
and among stock market traders and financiers.
Studies conducted in North America have shown that cocaine use now cuts
across all social classes (Fagan, 1994). This
pattern of use through all social strata is equally valid in France, as cocaine
has also become more commonplace among the lower classes.
These practices are not
very visible socially and have not been studied a great deal in France.
For example, very revealing studies on students (Moser, Ratiu, 1998;
Galland et al., 1995; Felonneau, 1994) did not examine deviance or
delinquency (Ballion, 1999). But this is also true in nearby countries like
Belgium and Germany (Groenemeyer, 1996).
of age and sex
The introduction of a
permanent mechanism for observing drug use referred to earlier sheds greater
light on the use of legal and illegal drugs.
These studies update the impact of age, generation and sex on drug use.
The study by Choquet and Ledoux (1999) showed that experimentation with
marijuana increases sharply with age and is more common among boys in all age
groups. At age 17, 49.9% of the
girls and 50.1% of the boys interviewed said they had tried marijuana; the
proportion increased to 60.3% of boys at age 19, for a total of 12,113
individuals. Twice as many boys as
girls use marijuana repeatedly (at least 10 times a year) (23.8%, compared with
12.6%), and the proportion rises to 32.7% among boys 19 years of age (OFDT,
2000). Between the ages of 14 and 18, repeated use of marijuana increases from
2% to 9% among boys; 15% of the 18-year-old boys interviewed used marijuana more
than 10 times in the previous 30 days. The
impact of cohort is also significant. One
study of students (n=500) carried out in 1978 and repeated in 1998 showed that
lifetime use more than doubled over the period, from 25% to 53%. Among the
different profiles, experimentation was steady (13%), occasional use increased
from 11% to 29%, and regular use increased from 2% to 11%.
While marijuana use
appears to be higher among males, use of psychotropic drugs seems to be higher
among females (29% of the girls had used psychotropic drugs, compared with 10.6%
of the boys). However,
experimentation with tobacco and alcohol is comparable between girls and boys
and increases with age.
Experience with alcohol, meanwhile, varies considerably by age and sex:
at 14, 26% of boys and 20% of girls have already been intoxicated from drinking
alcohol; at 18, the proportions rise to 71% of boys and 55% of girls.
data have obvious limitations. As a
result, there is little information about the social distribution of substance
use. The study by Baillon (1999) on
the behaviour of high-school students not only sought to identify the effect of
school type on deviant behaviour, but also put forward some interesting options.
The author divided the sample of more than 10,000 students into three
sub-populations: students in a priority education zone (ZEP), students attending
schools covered by mechanisms set out in the municipal policy (DSQ, DSU, city
contracts) and a group from non-ZEP and non-DSQ high schools.
The ZEP schools had the largest proportions of students from
working-class families (more sons of workers and employees, fewer children of
executives and middle managers).
The study showed that
just over 33% of the students interviewed had used an illegal substance during
the year (a marijuana derivative in almost 30% of cases).
However, against all expectations, the use of marijuana derivatives was
lower among the ZEP students (23%) than the DSQ students (33%) and the other
students (35%), particularly for frequent use (8.7%, compared with 13.2% and
The survey also confirmed the differences between boys and girls: 41% of
the boys had used a drug during the year, compared with 27% of the girls.
Still, while the girls from the “other” schools were more concerned
about drug use than the girls in the ZEP schools, in vocational ZEP schools, the
proportion of girls using drugs was similar to the proportion in “other”
schools”. It also appears that
the trickle-down effect is not a major factor in other schools, but is in ZEP
schools, where the students in vocational programs are far more concerned about
the use of hashish than their counterparts in general academic programs.
Finally, the study
showed that there is no contextual effect on drug use.
Baillon noted, however, that ZEP schools could be considered a social
environment more conducive to deviance because the proportion of students who
had most recently used marijuana was higher than in the other two categories of
schools: 19% of ZEP students who reported using drugs, compared with 6 % of DSQ
students and 9% of students in other schools (Baillon, 1999, p. 45).
How, then, do we
undertake a sociological interpretation of the data we have today?
How do we interpret the social legitimacy that marijuana now seems to
enjoy? Is marijuana use an integral part of a lifestyle (for young people)?
Are drugs so popular because they are a device for constructing the
individual (Ehrenberg, 1992, p. 55)? How do we interpret the sexual dimorphism
reaffirmed by all the studies? We
could say that these practices are part of a “youth culture” or that the
differences between girls and boys stem from socialization processes and
sexually differentiated normative models (OFDT, 1999). Again, we need studies
that analyse the tangible mechanisms.
One thing is certain:
it is no longer enough to associate drugs with marginality, exclusion or
disaffiliation. The proportion of
“invisible” users is driving the development of new hypotheses.
In other words, self-control techniques must not hide the existence of
other methods of controlling drug use: societal control personified by families,
neighbours, peer groups, user self-control (Castel, Coppel, 1991).
What is most
interesting about Decorte’s study of cocaine and crack users in Antwerp is the
choice of criteria: the subjects never sought or underwent treatment.
He showed that it is possible to find a group of “invisible” users,
shattering the stereotypes of lacking, illness and criminality.
However, external and formal controls do have an impact on the practices
of this group: they discredit individual efforts to achieve self-control or
attempts by friends and family to intervene.
The theory is this: the social environment, by developing rules and
rituals (that is, informal controls) is what gets illegal drug use under
control. The role of friends,
acquaintances, partners, parents and others, counsel and discussion, etc. are
elements that help make the social dimension a positive one.
These rules and rituals are part of a learning process that fosters
Illegal drug use is
still considered a taboo by society at large, families and co-workers.
To avoid being socially outcast, the individuals interviewed said they do
not disclose their illegal drug habit. The
moment official warnings are perceived as exaggerated or wrong, the gap widens
between non-users and users, between formal standards and informal rules.
Hence this contradiction that is all too evident regarding the limits of
transmission from generation to generation: every generation of users has
trouble passing on to the next the lessons it has learned.
When the process of transferring knowledge is undermined in this way,
tragedies tend to recur.
Caiata investigated the
strategies used by “integrated” heroin and cocaine users and the resulting
lifestyle through a number of qualitative studies in Switzerland.
An integrated user is a user who, in contrast to a known user, balances
drug use with other aspects of his or her personal life (work, family,
recreation) (Ogien, 1996). How can a person accommodate behaviour that is in
direct conflict with the dominant culture?
The sociologist began by identifying four broad categories of strategies
for dealing with the risks a person takes: limit the physical consequences of
drug use; manage the large expenditures drugs entail; switch between deviance
and compliance, being careful to avoid stigmatization; adjust to jeopardy and
stress. These personal strategies
are made possible by learning that produces the skills needed to manage drug
use. If, as Caiata points out, the
user tends to become a sort of “professional” user, he or she remains at
risk of failing. The paper goes on
to develop two case studies of users balancing their personal lives in a world
that considers cocaine and heroin use to be unacceptable.
Drug use is a way of assuming social constraints and the roles that being
a part of society entails. Drugs
shape the lifestyle. But the
relationship with the substance can also be more peaceful because of all the
symbolic work that goes into drug use to normalize the meaning and neutralize
the conflict with norms. This
results in two profiles of an integrated user.
Between alienation and approval, there are two sides to modern
individuals on whom there is pressure to be themselves.
That is why it cannot be fully understood other than in the macro social
context characterized by individual action.
Recent studies on this
issue examined substance abuse in sport. It
is a known fact today that participation in high-level sport offers no
protection against the use of psychotropic substances, as witnessed by the
results of qualitative and quantitative studies. The studies by Beck, Legleye and Peretti-Watel open the door
to comprehensive analysis of the links between sport and drug use.
While there is no obvious link between level of involvement in sport and
level of drug use, the authors point out that there is a U curve: for both
sexes, use is generally highest at the two extremes of participation in sport
(no physical activity and more than 8 hours a week).
A typology of psychoactive substance use based on discipline would show the
differentiation between those relationships.
shows that drug use and therefore the associated risks are guided by their own
set of rules (passion for the sport, limited involvement in other areas of
social life, such as family, school and friends, etc.). However, it also shows that the path is based on resources
that are unevenly distributed. The
article compares the high-level sports careers of athletes from working-classes
and affluent classes and highlights the difference in family support and the
emphasis placed on competitive sports, the impact of social belonging on the way
athletes begin and stop using drugs, and specific methods of managing the stigma
of getting “on” and “off”. During
or after participation in sports, the scope of this leeway depends in large part
on the social setting. And if
failure to integrate drug use is evaluated on the basis of social dissociation
indicators, former athletes from modest backgrounds fare worse than their more
In this context of new
discourse and changes in user practices, the institutional system has been
doubly tested. During the 1990s, a
whole set of mechanisms emerged amid the successes and failings of the system,
marking the development of prevention and support: Boutiques, Bus d’échange
de seringues, Sleep-in, Points-Ecoute, etc. Those mechanisms cleared the way for
new forms of social intervention promoted through city policies.
They are part of a much broader process of building new reference
Mediation is foremost among these
mechanisms. Development of the
concept of mediation not only conveys the public’s desire for productivity and
stronger ties between institutions and certain target groups; it also entails
the emerge of new occupations that draw their validity from being close at hand
(territorial anchoring, ethnic affiliation).
The experiment carried out by the RATP with “big brothers” to deal
with “incivilities” was used as a model.
This type of mechanism has since been extended to client service
personnel on public transit and in shopping centres, street mediators and other
night workers in “sensitive” areas. There
is a new analogy in substance abuse with “front-line mechanisms.
Outreach work and
How do the member
countries of the European community view “front-line work”?
That is the question examined in a joint study the key elements of which
Mougin reports here. This first field survey inevitably raises the question of
whether the new data are comparable, yet the real question is how much the forms
of intervention developed in those countries to assist drug users help create a
new paradigm. The question is not
self-evident for two reasons. First,
we are dealing with an area in which the objectives and forms of activities can
vary dramatically. The debate over
the terminology used in different countries is a good example: do we have to
consider that what is called “travail de proximité” in France (outreach
work in English) is meant to compensate for the failings of the traditional
system, that is, to cover “hidden” or marginalized populations in
particular, or is the aim instead to take broader preventive initiatives for a
public that is socially better integrated and far more heterogeneous?
While that question was asked in connection with AIDS, it goes back to a
time long before its application to drug users.
Mougin showed that since the end of the last century and especially after
the Second World War, outreach work has been associated with a series of players
(the poor, youth, new youth cultures, “hidden” drug users, users of
synthetic drugs) based on political traditions relating to drugs and the
priorities of the day, not to mention changes in context and any other changes
that may have occurred.
This means that in countries that take a pragmatic approach to drugs, like
Denmark and the Netherlands, the area has developed more quickly than in
countries like France that take a more political and medical approach.
While it appears that
outreach work has developed in most countries, the main target being traditional
drug users, political recognition of outreach seems stronger in northern
European than in the south. Another
discrepancy lies in the institutionalized or experimental framework in which the
work is done: in some cases, outreach may be done by health care agencies; in
others it is left to various groups (self-help, risk reduction associations,
etc.). The differences in current
practices show that there is a limit to this type of comparison and indicate the
problems encountered in evaluating something that is always changing.
Perhaps what is needed a challenge that can be taken up to bring about
On a very territorial
scale, the article by E. Jacob, M. Joubert and S. Touzé analyses the Points
Ecoute initiative and the underlying objectives and issues.
Established following the 1997 circular, this mechanism appears to be a
product derived from careful consideration that began in the early 1990s and led
to specialized care being separated from prevention.
Various factors contributed to its emergence: creating a “preventive
stronghold” by taking into account chinks in the social fabric, mental health
and the field of substance abuse and high-risk behaviour; developing preventive
measures by working on lifestyles and high-risk behaviour among youth and
establishing primary and specialized measures; fostering access for populations
that stay away from conventional means of intervention; and narrowing the gap
between institutions. In the latter
case, the authors clearly show that Points Ecoute are part of an outreach
approach in social work and substance abuse treatment.
Ensuring accessibility is a major issue that transcends the diversity of
direction that affects the location of Points-Ecoute outlets (in
“sensitive” areas or downtown). The
ability to adapt to local contexts must not mask the absence of a model and
clearly defined referents in the area of dug abuse prevention.
experience and abilities of users
A good illustration of
the changes in control methods and practices and in the resistance and power
issues control raises is the attempt at mobilization or recognition made by drug
users themselves. This phenomenon
is not “new”, but the context is completely different from what it was in
the 1970s. It is no longer a simple
question of dealing with “former drug addicts” who have expertise and
relational and therapeutic skills based on experience, working within a centre,
but people who are becoming professionals and challenging institutions in the
name of their expertise in a context of change.
study of self-help groups (Auto-Support des Usagers de Drogues), compared here
to other types of intervention (Narcotics Anonymous), clearly illustrates the
ambiguity of the actions that are taken. What
these groups have in common is a type of expertise rooted not in a diploma, but
in life experience. Through this
process, the emergence of a class of drug users as responsible, independent,
individual citizens is analysed. The
decline in the practice of sharing needles (from 48% in 1988 to 13% in 1996) is
a good indicator as well as an argument supporting this rise in accountability. More generally, lifestyle changes, centred less and less on
the quest for drugs, occur in a context marked by the development of
substitution programs and “front-line” mechanisms.
At the same time, the now-generic category of self-help groups covers
very different situations and skills. The
conditions in which the group develops, the role of former users, the range of
group actions, participation in the shaping of public policy, methods of funding
and opportunities for recruitment vary from group to group.
The ASUD is more focused, more mobilized and more vindictive than NA, but
not as radical as Act up; its members contribute to the development of new types
of professional approach to AIDS and substance abuse.
The notion of
“professionalization” emphasizes skills (not qualifications).
That is what makes ASUD a breeding ground for candidates for the
“low-threshold” mechanisms put in place since 1996. A dual process of socialization is toying with authors who
are non-users regarding drug-use practices and players who are former users
regarding institutional practices. But
professionalization also has its limits: recruitment problems, professional
relocation outside groups that are then deprived of their “best elements”,
precariousness, management of dual affiliation, lack of training and outlooks
for change, dependence on the institution that hires them, hence the dilemma of
It is still too soon
– as we saw earlier – to evaluate the impact of the change in the discourse
on drugs and the accompanying articles, practical measures and data.
We can probably view the change as a new direction that makes public
policy more pragmatic and more closely linked to issues of public health.
There are also signs already that representations and practices do not
change at the same pace, which is not surprising; moralizing messages about
drugs held sway for years and still do in some works and media; practices have
also been accompanied by a client-centred approach and the creation of lasting
networks; “strong” institutions like the police enjoy a level of credibility
in the fight against drugs and lack of public security that they do not want to
lose. Moreover, the criminal
justice system is easier to set in motion than social work and offers a number
of solutions, the most of immediate of which is confinement.
The time of institutions is not the time of statements of intent or
changes in thinking. Finally,
politicians have their sights set on the next election and refrain from publicly
supporting positions that could lose them votes, although some may support them
might even consider these new directions as a way of using other means to extend
individual discipline and control of the public. In any event, the question merits asking in a general way:
how might the new public health issues be considered the expression of an
insidious normalizing power? In a
more subtle way, Fassin wonders, urging the poor to take care of themselves so
that they can integrate and drug users to use substitution drugs so that they do
not contract AIDS, are we not seeing the creation in the most paradoxical way of
a policy rooted in physiology that would control individuals and at the same
time a policy rooted in biology that would protect the community?
The author goes on to say that this interpretation is not borne out by
the facts. There is a definite gap
between discourse, which sets the standards, and practice, which reveals the
outcome. Instead of talking about
bio-power, which is often ridiculously ineffective, we should be talking about bio-legitimacy,
that is, social recognition of political management of the body. What is remarkable, in fact, is not the normalization of
behaviours and processes, as Foucaldian analysis would have it, but the way
social problems are not resolved by, but rather expressed in the most
authoritative way through the language of public health (Fassin 1998, pp. 38 et
This question in a way
takes the place of the questions about the extension of social control which
were asked in the 1970s (Lascoumes, 1977) and which the first players in the
specialized field of drug treatment thought could be resolved with anonymous
care (Bergeron, 1999). Time will
tell whether practices related to drugs will confirm the Foucaldian
interpretation or whether the language of public health has not only overlain
the language of criminal justice, without really replacing it, and just
successfully enough to solve the social problem.
We can be certain, however, that the issue of psychotropic substances,
legal or illegal, will long be a concern for public authorities.
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 See European legislation and drug policies (Italy, Switzerland, Netherlands, and some German cities, like Frankfurt), which tend toward the decriminalization of some drug use and the development of public health policy (Césoni, 2000). Even Sweden, which until now has been a diehard prohibitionist, is beginning to soften its attitude (Boekhout van Solinge 2001). See also the role played by the EMCDDA as an example of coordination.
 For needle exchange programs, see Emmanuelli 1997, 1999, 2000 and 2001; Lert 2000; and Emmanuelli, Lert, Valenciano, 1999.
 Commissioned by Simone Veil.
 Usage et trafic de stupéfiants. Statistiques 1999, OCRTIS, Ministère de l’Intérieur, 2000.
 Remember that the ministers responsible for public health and public order have locked horns several times, particularly over the Issue of prosecution of drug users. Even the 1970 legislation is an awkward compromise between the two ministries (Bernat de Célis, 1992).
 Not to mention the ban currently in force in Old Regime societies.
 For example, ASUD was supported by the health branch. See Voir Jauffret 2000, and elsewhere in this document.
 Two things emerge from this situation: the studies are predominantly British and American and there is a marked preference in the U.K. and the U.S. for lifestyle studies in a natural setting; and the results of the studies that have proliferated in France since the 1970s (Boullanger, Coppel, Weinberger, 1992) have been "disappointing" shedding only partial light on issues that are crucial (number of users, changes in user habits, tie-In with social or public health Issues, effectiveness of intervention).
 Decorte also illustrates the limits of drug epidemiology, which is often based on biased or incomplete data or data that focus on more familiar groups. There simply are not enough studies to provide us with facts about the lives drug users lead." See this document
 Tendances Récentes Et Nouvelles Drogues.
 Quota study of 2,000 people.
 Suffice to consider the problems encountered since the 1970 legislation on narcotics was passed and Belgian security contracts (van Campehoudt 2000, Devresse et Cauchie 2000).
 OCRTIS data provided by the OFDT.
 Belgian prosecutors can delay bringing a case to court indefinitely and can even drop a case if the person charged demonstrates that he or she is no longer using drugs.
 This term refers both to well-integrated populations largely unknown (if known at all) to anti-drug and health care agencies and to very marginalized populations that do not use help and support facilities for "drug addicts" and do not take advantage of other resources.
 "[translation] Drug use increasingly emerges as a functional nebula stretching between two poles: psychological comfort or well-being, and stimulation of individual performance after the doping model in sport, that is, use of substances that increase the person's psychological and physical ability to deal with heavy social constraints.” (Ehrenberg, 1992, 69)
in particular Duprez, Kokoreff, (2000, 168-192)
 In the 1990s, there were few mechanisms for measuring the social determinants of drug use, but in contrast, social factors in the use of psychotropic medication were studied in greater depth (Le Moigne, 1999).
 However, among the small minority who use other drugs (amphetamines, cocaine, heroin, etc.), tobacco and alcohol use is slightly higher than in the other two categories (6%, compared with 3%), especially concerning the most frequent use (3.8%, compared with 0.9% and 2.2%).
 The rates for 15 and under and 18-19 were 3% and 16% in ZEP schools, 12% and 13% in DSQ schools and 28% and 29% in other schools.
 This sexual differentiation is a recurring problem in criminology, from Lombroso (rev. 1991) to Cario (1992). The most convincing studies draw on the theory of differential socialization or differential associations and opportunities. The latter theory explains the growing number of women involved in drug trafficking. Some studies have identified a more aggressive delinquency related to lifestyle among boys and to runaway behaviour or prostitution more common among girls (Bertrand 1979). A recent wave of theory suggests that the sex gap in deviant behaviour will narrow because of growing similar in opportunities available to boys and girls. This is true for smoking, in any event, although smoking cannot really be considered deviant behaviour.
 However, age has a bearing on the curve: younger people are less active in sport and do not smoke, whereas more intensive athletes are generally older and part of the groups in which the incidence of smoking is highest.
 For example, "conventional" drug use giving way to the use of "new" drugs like ecstasy.