3.2. Tensions between prohibition and harm-reduction policies upon drug education
As drug and alcohol education was a central way in which community members attempted to shape the drinking values and practices of young people in Sutton; the opening section of this chapter will begin with a brief account of the changes to drug and alcohol policies, research
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and approaches to education in the UK exploring developments from prohibition stances to harm-reduction to contextualise how such changes relate to the London Borough of Sutton.
3.2.1. Prohibition: a history of moralism, temperance and a ‘Drug-Free Society’
Although the twentieth century is considered as the ‘age of prohibition’, prohibition commenced with the modern growth of European colonialism and global capitalism in the sixteenth century (Blackman, 2004:8). Specifically, drug and alcohol prohibition movements date back to the Quakers in the 1650s and The American Temperance Society in the 1800s.
Plant and Plant (2006:13) also state that many temperance organisations were prevalent in the UK during the nineteenth century, arguing that The Temperance Movement and The United Kingdom Temperance Alliance were particularly influential; movements of which adopted abstinence views influenced by US approaches. These movements “brought about the criminalisation of drug use through their moral campaign to both change and protect society” (Blackman, 2004:27) Despite strong historical links of prohibition, abstinence and temperance, in relation to alcohol prohibition, Plant and Plant (2006) argue that The Temperance Movement has had little influence in the UK in the past fifty years. Furthermore, recent debates about alcohol and its associated problems have taken place in a society where drinking is widely accepted and normalised (Berridge, Thom and Herring, 2007) and discourse about alcohol are secular (Plant and Plant, 2006). However, views on illicit drugs are viewed differently, whereby prohibition stances have been more prevalent in contemporary society, where “…drugs as a danger to the individual and a threat to the community. Drugs are defined as ‘bad’ or ‘evil’, and therefore prohibition seeks the complete removal of illicit drugs from society” (Blackman, 2007:4). Thus, prohibition has been historically, and is currently about power, control and contradiction underpinned by moralism as opposed to rationality or science.
In a contemporary context, the United Nations (UN) and World Health Organisation (WHO) are the two major institutions responsible for international drug policy and together could be seen as affirming recent drug prohibition stances (Blackman, 2004). Such stances have been maintained through American drug hegemony of the post 1945 period whereby the UN and WHO did not deviate from American drug policy. Blackman (2004:49) goes on to argue that
“under the influence of American drug hegemony, the UN adopted anti-drug policies which failed to recognise cultural difference and diversity within major areas of the world”. Consequently, under the UN, prohibition policies including the ‘Drug-Free Society’ of the early 1990s became a global approach to drug prevention which has acted as a way to continue
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support for drug prohibition. However, with increasing reference of the ‘drug normalization’
thesis, drug prohibition policy including the morally idealistic ‘Drug-Free Society’ has come into question with government and policy-makers recognising that drug-use is a prevalent feature of everyday life in a number of societies. Such views have contributed to some movement away from moralistic prohibition policy, recognising the value of harm-reduction policy and approaches.
3.2.2. Drug normalization and movements towards harm-reduction
According to Blackman (2004:137), “the first modern sociological application of the term
‘normality’ applied to drug consumption was put forward by Alfred R. Lindesmith (1938:597), who argued that theories of drug use “tend to be moralistic rather than scientific”. Parker et al.
(1998) have since produced a theory of drug normalization underpinned by six dimensions:
access and availability, drug trying rates, rates of drug use, being drug-wise, future intentions and degree of cultural accommodation of illicit drug use. Their theory argues that drug use is not just associated with deviant individuals because there is an increasing acceptance of drug use. However, as noted by Blackman (2004:138), “normalization does not suggest that drug taking is a widespread activity; it seeks to understand drug use as an action of everyday life for certain sections of the population.” Subsequently, in relation to recreational drug use, the normalization thesis has the potential to remove moralistic and pathological understandings of drug consumption by exploring it within cultural norms and as a social practice.
As a result of emerging views about normalisation, more representative understandings about recreational drug use has allowed for new developments in drug policy to occur because, “the recent emergence of the normalization idea is one means put forward to advance the understanding of drug use in society to overcome the moralizing judgement of describing drug users as ‘other’” (Blackman, 2004:147). It is here that such views have allowed for the development of harm-reduction policy, which moves away from past moralistic stances, because as stated by Russell Newcombe (1992:1), “harm reduction is becoming the major alternative drug policy to abstentionism, which prioritizes the aim of decreasing the prevalence or incidence of drug use.” However, in agreement with Blackman (2004:184), drug prohibition remains the consistent position; nonetheless, in the twenty-first century, “international obligations within drug conventions have begun to show degrees of movement.” This is because policy is less focussed on attempting to promote an unrealistic idealism which seeks to completely eliminate drugs from society.
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Coomber et al. (2013) suggest that it is hard to locate the establishment of contemporary harm reduction; however, Brownstein (2013:40) states that understandings of harm reduction in UK drug policy dates back to 1926 with the release of the ‘Departmental Committee on Morphine and Heroin’ report by the Ministry of Health. It was here that harm reduction became established and gained support across Europe by the end of the twentieth century. When the Mersey Harm Reduction Model (MHRM) was developed in Liverpool in the mid-1980s, this became a pivotal point in the movement and development of harm reduction (Coomber et al., 2013; O’Hare, 1992). This highlights that in relation to both alcohol and drugs, harm reduction has been controversial since its original initiation (Blackman, 2004; Stockwell, 2006).
According to Newcombe (1992:1) “Harm reduction–also called damage limitation, risk reduction, and harm minimisation–is a social policy which prioritises the aim of decreasing the negative effects of drug use.” Harm reduction policy differs from criminal justice approaches by aiming to tackle and manage personal and social harms associated with drug use, and is defined as, “a public-health approach to dealing with drug-related issues that places first priority on reducing the negative consequences of drug use rather than on eliminating drug use or ensuring abstinence” (Riley et al., 1999:10). Brownstein (2013:44) suggests that harm reduction policy takes a different philosophical approach to other drug policies because it moves away from moral and/or disease models by focussing less on drug use itself and towards the consequences of addictive behaviour upon the individual or wider society.
Coomber et al. (2013:130) have criticised harm reduction policy for having a “muted and theoretically underdeveloped stance on morals, rights and values”. This is supported by Stockwell (2006:270), “while an evidence base is an important consideration for any strategy, one problem here is that allows the inclusion of abstinence approaches, which also inevitably reduce harm. As such, the term is emptied of any distinctive meaning in relation to other strategies.” However, Newcombe (1992) has produced a rigorous conceptual framework for harm reduction which counteracts Coomber et al. (2013) and Stockwell’s (2006) suggestion that harm reduction is theoretically underdeveloped. In his model, Newcombe (1992) acknowledges that harm reduction approaches are difficult to evaluate, more so than abstinence models. This is because harm reduction attempts to measure the health, social and economic risks, as well as harm to individual drug users, the community and society.
Therefore, he argues that with multiple risks operating at different levels, it is important for harm reduction evaluators to focus on specific risks to measure. Despite having such robust conceptual models for harm reduction in place, it seems that they occasionally fail because although drug policy approaches often have goals of harm reduction, they often fall back to abstinence approaches (McInnes and Barrett, 2007).
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Despite harm reduction policy becoming more prevalent in contemporary society, it appears that prohibition and abstinence stances often slip back into policy and strategies, creating tension and contradictory messages. Newcombe (1992) argues that is particularly true of drug and alcohol education. This can be evidenced in contemporary policy documents such as the Drug Strategy (HM Government, 2010c:10), which argues that the Government aims to reduce drug demand by stating that “all young people need high quality drug and alcohol education so they have a thorough knowledge of their effects and harms and have the skills and confidence to choose not to use18drugs and alcohol.” Thus, messages are still underpinned by prevention and abstinence approaches, rather than genuine harm reduction which feeds into contemporary drug and alcohol education.
3.2.3. Contradictory drug policy and its impact on community education
Although it might be assumed that the three main players in the formation of drug policy, (politicians, police and the media) collectively take a primary prevention stance; they actually take opposing positions (Blackman, 1996a). Stockwell (2006) suggests that drug policy terminology is contested which impacts upon the communication and understanding of key mechanisms of policy approaches. Consequently, such contradictory policy and terminology feeds into drug and alcohol education delivered formally to young people. This is supported by Simpson, Shildrick and MacDonald (2007:9) who argue “there has been a long-standing tension between education strategies that aim to minimise the harm that might come to young people if they do use drugs and those that aim to educate young people to avoid drug use per say (i.e. prohibition).” Consequently, contradictions fail to meet the definition and expectations of drug education which is for young people to gain ‘the acquisition of knowledge, understanding and skills, and exploration and attitudes and values which facilitate young people to be able to make informed decisions about their own and other people’s use of drugs’
(Drugwise, 2016).
A key contributory factor reinforcing contradictions in drug policy is that drug policies often do not recognise, or fail to admit, that drugs are not always necessarily harmful and can play an important role in the lives of people within society; thus, they lack a neutral position (Blackman, 1996a; Brownstein, 2013). In line with drug policy, although drugs education should be about drugs this is often not the case because it against use (Blackman, 2004). This results in biased approaches that deny pleasurable associations of drug use and refutes that drug use is not
18 Underlining is my own edit to the quote.
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necessarily harmful in all contexts which is central to harm reduction policies (Newcombe, 1992). The impact of having drug and alcohol education that does not adopt a neutral position is that many education programmes in schools have little influence upon young people’s attitudes or behaviours towards drugs (Blackman, 1996a). However, the pleasures associated with alcohol and drug use should not be ignored or else education will be ineffective because it inevitably returns to prohibition, abstinence and prevention approaches of the past which are evidenced as being ineffective and counterproductive (Blackman, 2004).
Contradictions about alcohol policy specifically are evident in current government policy and strategy documents including, ‘The Government’s Alcohol Strategy’ (HM Government, 2012:5) which states, “Our ambition is clear – we will radically reshape the approach to alcohol and reduce the number of people drinking to excess” and subsequently lists a number of harm reduction strategies regarding alcohol consumption. Therefore, one could interpret the current Government’s alcohol policy and strategies as being geared towards harm reduction approaches. However, the report subsequently produces a discourse around prevention, particularly in relation to youth. The report (HM Government, 2012:22) makes few references to alcohol education strategies, but when it does, references are prevention based:
Good schools play a vital role as promoters of health and wellbeing in the local community. They understand the connections between pupils’ physical and mental health, their safety, and their educational achievement, and are well placed to provide good pastoral care and early intervention for problems which may arise from, or lead to alcohol misuse. The Government’s review of Personal, Social, Health and Economic (PSHE) education is focussed on improving the quality of PSHE in all schools and its core outcomes. This will include exploring how schools can better decide for themselves what pupils need to know, in consultation with parents and others locally.
Schools and out-of-school services will also be able to access information about effective alcohol prevention programmes19 through the Centre for the Analysis of Youth Transitions (CAYT). (HM Government, 2012:22)
Therefore, much like drug policy, alcohol policy attempts to present a tolerant approach through the notion of harm reduction; however, hidden within it are abstinence messages (Blackman, 2004). This reinforces contradictory messages, and as will be evidenced in the forthcoming sections of this chapter, such contradictions impact upon messages that young people receive about alcohol and drugs via education by local community educational professionals. Drawing upon fieldwork undertaken in community educational spaces, I argue
19 Underlining is my own edit to the quote.
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that these contradictory messages promote ephemerality in alcohol and drug education delivered to young people in this study.