Care

1. Care and politics Ideological visions embedded in the establishment and development of Swedish drug treatment 1965–2000 Care Johan Edman Centre for Social Research on Alcohol and Drugs, SoRAD Stockholm University johan.edman@sorad.su.se

2. The study examines... • ... the establishment and development of Swedish voluntary institutional drug care during the years 1965–2000. • ... the State’s management of this process. • ... the ideological visions embedded in this process.

3. The empirical investigations • Knowledge (official reports, bureaucratic investigations and instructions, etc.) • Government policy (government bills, committee reports, etc.) • Parliamentary debate (parliamentary resolutions and records) • Bureaucratic management of granted and rejected treatment programmes (authorization and supervision documents)

4. Government paradox • According to earlier research, the State has not been interested in or able to govern the actual treatment. • On the other hand, the State has occasionally been extremely active in supporting or counteracting certain treatment programmes.

5. Non-government thesis • Partly confirmed by the present study.

6. Discipline Transactional analysis House renovation Therapeutic community Concentrative movement therapy Role play Confidence exercises Creating drama Group discussions 12 step treatment Work therapy Contact training Psychotherapy Physical training Large forum Object relation therapy Medical rehabilitation Christianity

7. Non-government thesis • Partly confirmed by the present study. • At the same time, this treatment eclecticism is described – by both politicians and authorities – as experimental and therefore as an intentional outcome. • And also, some treatment programmes were highly counteracted, as, for instance...

8. Narconon (vs. the National Board of Health and Welfare) • Scientology is ”anti-medical, anti-political and anti-democratic”. • Scientology is ”based on pronounced economical interests”. • The treatment method is not based on ”science or well-tested experience”. • ”The church of scientology and Narconon originate from the USA”; the methods are “not desirable in the Swedish society”.

9. The political dimension 1965–1981 • Consensus: • support for work and housing measures; • medical discourse criticized. • Left-wing point of view: • class conflict; • commercialism; • modernity. • Right-wing point of view: • modernity; • social degeneration; • urbanism.

10. The communist party, 1979 “The children who were brought up in poverty and discrimination, all the workers that were excluded in the name of the holy competition and piecework, now they arrive – broken down, deprived of their dignity, distracted, addicted to drugs.”

11. The political dimension 1982–2000 • Consensus: • support for work, housing measures and welfare; • Left-wing point of view: • commercialism; • urbanism; • modernity. • Right-wing point of view: • familism; • subsidiarity; • reduced taxes.

12. The conservative party, 1984 “It is in the family that children get the confidence and norms that give them strength to resist when they are offered drugs. Still, if addiction to drugs arises, the family should be the foremost support for the child.”

13. A contradictory problem • National unity – strong support from every party that this is the most serious problem that should be solved with any means (doxa). • Political conflict – therefore also an eminent arena for playing out your own proposals as superior to your opponents’ disastrous politics. • Concrete suggestions on the drug problem hardly diversified, ideological standpoints more so.

14. The steering process • The drug problem primarily treated as an ideological catalyst calls for political steering. • Actual management of treatment programmes delegated to bureaucratic authorities. • Successful steering dependent on the political activity of the bureaucracy.

15. Bureaucracies as ideological gatekeepers? • The National Board of Health and Welfare 1968–1981: • management by variety; • focus on non-profit organizations; • distinct ideological line of policy (left-wing).

16. Bureaucracies as ideological gatekeepers? • The County Administrative Boards 1982–2000: • passive (non-ideological) management leading to a more narrow variety of treatment methods (12 step treatment increasingly dominant); • passive management transfers the initiative to treatment entrepreneurs and (ideologically driven) municipalities; • ideologically motivated shift from non-profit organizations to private entrepreneurs.

17. To sum up… • The problem as well as the proper method remained vague, therefore it stayed a highly politicized problem. • This shouldn’t surprise since all measures aiming to adjust the livelihood of citizens to the societal demands must remain ideological questions. • If managing and bureaucratic authorities do not have an ideological agenda of their own, they will certainly make decisions out of somebody else’s ideological agenda. • Ideology matters!

18. Care THE END Johan Edman Centre for Social Research on Alcohol and Drugs, SoRAD Stockholm University johan.edman@sorad.su.se