Expert Group on Drugs in Modern Society: Community reactions to drug use by young people
Report and commentary by the General Rapporteur Objectives
General remarks on the discussions
Conclusions of the Expert Group
Recommendations by the Expert Group
Pages: 1 to 7
Creation Date: 1974/01/01
The following are excerpts from the Report published by the Division of Social Affairs of the United Nations Office in Geneva *
The Expert Group on "Drugs in Modern Society: Community Reactions to Drug Use by Young People" was convened at the Palais des Nations, Geneva, from 4 to 9 December 1972. The meeting was organized within the framework of the European Social Development Programme of the United Nations, with financial support from the United Nations Fund for Drug Abuse Control.
The main purpose of the meeting was to bring together a number of European experts with different backgrounds and work experiences, in order to consider the increasingly complex problems of drug use and abuse among the younger generations in the highly developed countries. More specifically, the meeting Was intended to discuss the ways in which modern societies tend to react to the growing consumption of various forms of drugs among some population groups; the appropriateness of these reactions to the basic issues involved; the emerging counter-reactions of the young people more or less directly involved with drug-using milieus; and the possibilities of overcoming the threatening polarization between the generations, in which the issue of drug consumption plays a considerable part.
In order to ensure such a broad, interdisciplinary approach to the problems under consideration, a number of experts representing different professional categories were invited to attend the meeting: politicians, civil servants, law enforcement officials, medical doctors, sociologists and psychiatrists, journalists, and a number of young people having personal contacts with drug-using groups and experiences in direct work with drug addicts in advice and reception centres, self-help groups and the like. In view of the exploratory character of the meeting, it was decided to invite participants only from a limited number of European countries in which the problems of drug use and abuse have become the objects of particular interest by the authorities, the mass media, and public opinion; and where on-going scientific research is contributing to a clearer insight in the many problems involved.
The Expert Group was thus attended by 32 participants from Denmark, the Federal Republic of Germany, France, the Netherlands, Sweden and the United Kingdom; all invited in their private capacity by the Division of Social Affairs.
Doctor Olivier Jeanneret, Professor of Social and Preventive Medicine at the University of Geneva, had been designated as General Rapporteur of the meeting.
The meeting had before it a number of working papers, prepared by outside consultants and covering the four main themes of discussion proposed to the Expert Group **. The working papers were presented in plenary sessions, then considered at length in three smaller discussion groups, which eventually reported back to a plenary session and suggested points for the conclusions and recommendations.
The meeting of experts was held to enable a small group of persons to study the application of the present system of combating drug abuse and the way in which that system and its application are affected by changing social attitudes, and to present their views on how a new, socially acceptable approach should and could be developed and implemented.
At the present time, the use of drugs by young people in western Europe (as well as elsewhere, of course, and especially in the United States of America) is a favourite topic of discussion.
Politicians, the mass media, professional organizations, all and sundry, believe that they have a duty to speak on the subject and that they are qualified to do so. What is more, a number of intergovernmental organizations have taken steps, under international agreements, to unite in action against drug abuse.
A growing number of fathers, mothers and others are frightened for their family and their friends when confronted with terrifying realities, sometimes because they misunderstand the public statements they have heard or read, and sometimes because even when properly informed, they feel incapable of dealing with what to them seems to be a menace. The uncertainty and the lack of self-confidence which, in the last decade, has characterized the attitude of adults towards the younger generation, have been strengthened and aggravated with the increasing use of drugs by the young. It has even been said that this reaction by parents to drugs is part of the general reaction of fear and hostility of members of their generation to young people, and that it is more a symptom of the "generation gap" than an indication of an objective attitude towards the social scourge of drug abuse. In that perspective it is clear that the emergence of new ways of thinking and behaviour among certain categories of young people in the industrialized countries - constituting an increasingly specific "youth culture" - is often viewed by the public at large with anxiety, and even consternation.
Under the influence of the mass media, public opinion is tending to regard the use of drugs as a dominant and characteristic feature of the new youth culture. The frequently observed habit in some of the mass media of associating, without good reason, the words "youth" and "drugs". helps to shroud the fact that not all young people take drugs, and that many "users" are no longer young. This has resulted in a lot of confusion and a feeling of frustration as regards both many of the problems raised by the use of drugs and the relations between the generations. On the one hand, for lack of something better, law-enforcement measures continue to be taken whose efficacy is no longer unchallenged. On the other, such measures are sometimes applied indiscriminately to particular categories of young persons, whatever the type of drug being used, and without sufficient consideration of the medical and social effects of the drug, which may be very different depending on the type of drug and the way it is used
** (1) "The laws and regulations on drug use and abuse", by Mr. Maurice Viennois; (2) "Facts of drug use and abuse", by Mr. Michael R. Codel; (3) "Attitudes of young people towards drug use", by Dr. Martin Mitcheson and Mr. Richard Hartnoll see Vol. XXV No. 2 of the Bulletin on Narcotics: (4) "Public opinion and community reactions to the problems of drug use", by Mr. Ingmar Rexed.
From the point of view of the young themselves, whether or not they have had experience with drugs, this confused mixture of public attitudes, expert opinion and enforcement measures adopted by society in the form of legislative or other provisions can only create an increasingly strong feeling of distrust of society and the forces which govern it. Attempts to suggest a more balanced attitude towards the problem, for example by distinguishing between kinds of drugs more or less acceptable from the point of view of accepted social values (as in the case of alcohol) often encounter hostility or flat refusal.
Lastly, the experts themselves hold divergent and sometimes even contradictory opinions concerning the actual situation regarding the use of drugs, its effects and the relative risks that it entails, and also concerning the practical questions that would be raised both by a permissive attitude towards certain drugs and by methods of preventing a wider consumption of other drugs. Because certain categories of professional people - doctors for example - are reputed to be omniscient on the subject, the general public and sometimes the authorities, would like to obtain from them authoritative and even categorical opinions in order to see matters clearly and even to take definite decisions.
In view of the diversity of the participants, one might have expected many divergent views and irreconcilable positions. But, apart from the usual semantic difficulties of multidisciplinary and plurilingual meetings, the divergences were more often manifested at the level of the existential concepts of individuals than on the discussion's fundamental points, concerning which clear majority opinions emerged; as to firm positions, they did not prove (or scarcely proved) to be irreconcilable except with regard to the legal status of cannabis. Lastly, there were unexpected blasts of nationalism in the group which had chosen to open the discussion by making its members, each in turn, present an inventory of the legal and epidemiological situation in each country represented.
In general, the discussion in the groups showed that each expression had to be more precisely defined, whenever it was used, as it concerned the following questions:
- what drug?
- what young people?
- what reactions?
- and from what section of the community?
Hence the difficulty encountered in summarizing the ideas expressed, the positions taken and the proposals submitted by each group, because of not being able to give an exact definition or nuance of the choice made in relation to one or other or several of the above questions.
The terms "society" and "drug use", which appear in the title of the meeting were criticized by members of one discussion group: present-day society - more heterogeneous than homogeneous - could not be considered as having only one voice; terms such as "drug use", and, even more so, "drug abuse", were overloaded with connotations and could be replaced by "drug taking" which was descriptive and hence neutral.
The participants generally agreed on these four statements:
- countries do not agree on the right policy for the drug problem: some countries had a more repressive policy than others;
- the information given to the public, in its broadest sense, has therefore to be based on the recognition that there is no "absolute truth" in this area;
- the experts disagree on the right course to follow;
- however, the only possibility of effective action might result from measures jointly suggested by experts of the disciplines concerned.
A certain unanimity emerged that the psycho-social approach should be given priority rather than the legal or medical approach.
The psycho-social approach enables one to consider drug-taking (no matter what drug or medicament and no matter what the taker's age) as a symptom of conflict, whether personal or within society. Actually in many countries it appears that there is increasing recourse to drugs, (and medicaments) in order to alleviate the ills and troubles from which many people are suffering, rather than concentrating on their existential situation.
The basic idea which justifies this approach is that the use of drugs is influenced by various socio-cultural factors.
Obviously this approach does not exclude the need to employ legal and medical measures, for example for dealing with the production of, and traffic in, heroin, as also with dependence on it. But its advantage is that it clearly does away with the excessively stereotyped image of the drug user in the role of a criminal or sick person. Moreover, it might help to encourage legislators and doctors to plan legislation and medical treatment in terms more clearly reflecting the social genesis of the phenomenon.
Finally, it implies that prevention should avoid being exclusively linked to the single phenomenon of drugs, but, on the contrary, should adopt a multicausal point of view and involve multi-disciplinary action.
The theme chosen for the meeting led to more emphasis being put on "demand" than on "supply". However, in two groups stress was laid on:
- the primary role of availability of drugs, whether legal or illegal;
- the major drawbacks (which exist already, but which could become considerably worse) of the activities of the pharmaceutical industry, especially the spread of pervasive advertisement of an obviously commercial kind.
On the assumption that the idea of prevention should extend to action against supply as well as demand, one group felt that only the informational aspect (information and education) of prevention should be the main objective.
One group stated that the inconsistencies of society's attitudes even to particular forms of drug-taking had the effect of confusing public opinion, particularly among the young. On the other hand, any adoption of a firmer position might be taken as rigidity and lead to hardening reactions by opposing groups, in particular in the groups belonging to sub-cultures. In that connexion, mention must be made of disagreements between authorities and the experts they commission - cases in which the former decide not to accept the recommendations of the latter (recent examples being the reports of the Wootton and Schafer Commissions), which demonstrate problems of communication, even at that level.
One group drew attention to the dangers inherent in the polarization of attitudes which seems to be taking place in a number of countries. The most disquieting aspect mentioned in this respect is the credibility gap between different age groups. If this trend were to strengthen, those who have decided to adopt a moderate and constructive position might experience difficulties in maintaining it.
The legal status of cannabis and cannabis resin, although not mentioned specifically in the programme of the meeting, was discussed by the groups. Various views were expressed. Some suggestions were made for changing the classification of these drugs in the schedules of the relevant international convention. Some participants argued that the existing situation led to divergence between the letter of the law (which is harsh) and its application (which is more or less flexible in different countries), that some national expert commissions had reported in favour of a change, and that the question of how cannabis was treated by the authorities at all levels was of paramount importance in determining the social attitudes of many young people to it and thus in either enlarging or diminishing the "credibility gap". Other participants, however, expressed strong opposition to any idea of changing the international legislation. Still others said that although they favoured the change, they did not think it appropriate or useful for the present meeting to make a formal recommendation on the subject.
All legislation to a certain extent reflects public opinion, but clearly it can also have a by no means negligible effect on the moulding of opinion among the public. Hence the importance of making known the evolving trends of legislation which are often preceded by changes in the methods of applying the legislation. But it is necessary to distinguish between the national and international levels.
It should also be borne in mind that while legislation may be applied flexibly, such an approach - very desirable from the point of view of the humane considerations involved in many cases - may nevertheless give rise to arbitrary and even abusive practices. There is also the danger that legislation on drugs may be used for ulterior purposes, for example political repression. A further aspect is that some legislation calls for different judicial treatment of users and of traffickers, whereas it is known that very often these are the same people. It is clear, however, that nothing should be done to diminish the severity with which large-scale traffickers are dealt with.
Evident gaps and differences of opinion exist between majority public opinion, on the one hand, and major sectors of scientific research and clinical experience, on the other, concerning cannabis and opiates. These basic differences are not adequately reflected in the level of legal control applied to these drugs. It was considered that cannabis should be placed in a more appropriate position (especially with respect to opiates), which is desirable in classifications used as a basis for determining the level of legal control.
The members of one discussion group stressed the importance of the relationships between legally prescribed drugs and medicaments on the one hand, and illegally obtained drugs on the other. It was considered that the increasing use of the former (sedatives, hypnotics, tranquillizers and stimulants of the central nervous system) was approaching a level where it too represented a danger to public health, and where conflicts may emerge with the interests of the pharmaceuticals industry.
The collection and compilation of data could not be limited to a counting of "cases", however useful this might be in helping to reveal trends, especially within countries. "Facts" must be understood as comprising all information - clinical, psychological, sociological, in the field of social welfare planning, etc. - which might help on a continuing basis to explain the phenomena under consideration. But the rapid evolution of these phenomena required a constant review of the ideas suggested by the facts and of their interpretation. This fluid situation could only add to the difficulties of communication at all levels between the various categories of persons involved.
A basic concept is that of the harm caused by the use of drugs or by social reaction to such use. In the operational contexts it must be directly related to the diminution of the expectations which a particular individual in a particular existential situation may have, bearing in mind at the same time his particular vulnerability.
All aspects of information and education were examined, and several points, mostly well-known, were emphasized:
- information conveyed by the "mass media" was too often sensational, over-dramatized and under-documented;
- there was a natural tendency to want to establish a cause-and-effect relationship between a campaign and certain changes in the knowledge or the attitudes of those who were the target of the campaign;
- there were risks inherent in the flagrant contradictions between sources, between actual content and between underlying intentions;
- it was difficult to measure the effect of information in general on the mass public.
However, in general, a source of the most valuable lessons about community reactions was the "feed-back" inherent in all communication.
As a matter of highest priority, one group suggested that national and international authorities should consider the following working hypothesis: to what extent can certain forms of social control (legal action, education, pressure on public opinion) contribute in practice to the aggravation of the problems associated with drug-taking, and if they can, by what mechanism(s) do they do so?
Along a similar line, it was suggested that in any case legislation should be more capable of reflecting the contemporary prevailing mood and that it should be flexible enough to allow for changes both in society and in the existing pattern of drug use.
While the meeting was informed that the 1971 Convention on Psychotropic Substances would include prescribed psychotropic drugs in the list of substances to be controlled, the participants recommended that:
- the competent international bodies should do whatever is necessary to obtain better statistical data on the production and consumption of drugs of that type so as to be able to provide a clearer idea of the developments of this rapidly expanding market;
- governments should be invited to take the necessary steps to limit both the production and the consumption of such medicaments.
In order to facilitate the gathering of national and international data which could be relied upon as both representative and comparable (thus enabling the basing of information at all levels on honestly interpreted scientific knowledge) it was recommended either that central advisory groups should be established, or that existing facilities should be improved.
In view of the new trends towards a psycho-social approach to the problems of drug-taking, and of the increasing urgency of considering the drug problem as only one aspect of social development in complex societies, it was stressed that it was important to see this problem as affecting the whole of society and necessitating a multi-disciplinary approach. It was strongly felt that any attempt to isolate the problem by assigning the exclusive responsibility for it to law-enforcement officials, to the medical profession or to any other professional group, should be opposed. It was also recognized that the prevention of drug abuse required over-all social planning directed to the general problem of the socially deprived and the maladjusted, among whom drug abuse was only a symptom.
In view of the above consideration, and in order to prevent the harm resulting from traditional approaches to the drug problem, the meeting stressed the importance of integrated programmes of social action in preference to measures directed more specifically at the treatment of a single symptom (for example, special clinics for the treatment of heroin addicts). Partly with the same intention, it was suggested that governments should be encouraged to make available facilities for the analysis of blackmarket drugs, on an anonymous basis if necessary.
Among the recommendations concerning information and education, the meeting stressed the following:
- the need for governments and other appropriate entities to stimulate the creation or strengthening of bodies responsible for improving the quality and accuracy of information given to the mass media; and for the mass media to make an effort to improve their own standards of accuracy and quality in the way they report matter relating to drugs and the behaviour of drug users;
- for more specific information, the importance of establishing a group of experts with powers to view and/or evaluate the impact of available media, for example films;
- for education, the usefulness of awakening the social awareness of children at a very early age and, in the context of the school, the advisability of integrating the subject in many other disciplines;
- for schoolroom education itself, the necessity of linking it with efforts aimed simultaneously at parents, teachers and the community at large whose attitudes were still too often derived from fear or ignorance.
Starting from the idea that this kind of meeting of experts represented an innovation, it seems appropriate that it should be followed by other meetings on the same subject, which might profit from this first effort. Thus, it might be suggested:
- that the composition of the group should be similar;
- that additional data should be provided of the kind, for example, in working papers 3 and 4;
- that a more precise plan of work should be proposed, for example, in the form of description, of interpretation, of critical evaluation and possible practical applications of concrete cases selected as models;
- that the papers resulting from the meeting should be more numerous, more case-oriented and more personal than a single, final, consolidated report.