Drug Treatment Systems in an International Perspective: Drugs, Demons, and Delinquents

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Edited by: Harald Klingemann & Geoffrey Hunt

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  • Part 1: Drug Prohibition and the Abstinence Paradigm

    Part 2: The Experimental Countries

    Part 3: Social Change and Drug Treatment in Central Europe and Russia

    Part 4: From Moral Crusades to Cost-Efficient Pragmatism

    Part 5: The Latin American Connection

    Part 6: Wine and Illicit Drugs

    Part 7: Economic Revolution and Cultural Transformation in the Far East

    Part 8: Gender, Finance, and System Integration: Findings from 20 Countries

  • Dedication

    The editors dedicate this book to their fathers

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    Acknowledgments

    This publication is the outcome of the efforts of 47 authors from 20 countries. The Kettil Bruun Society for Social and Epidemiological Research on Alcohol provided the intellectual context, the professional stimulus, and an international network for the effort. Also, it conferred upon the project the society's official status, even though the book is about illicit drugs—not a prominent topic in the Society's mandate.

    To coordinate a project of this type with so many different authors is an immense and complicated undertaking; it would not have been possible without the support of several research institutions and funding agencies, as well as the assistance of many people.

    Financial support was provided by the Swiss Federal Office for Education and Science (Grant no. 8471106) and the Swiss Federal Office of Public Health (Grant no. 8048). We thank officials at both of these agencies for this testimony to their belief in the project.

    Two research institutes—the Swiss Institute for the Prevention of Alcohol and Drug Problems, Lausanne, a World Health Organization Collaborating Centre for Substance Abuse Research, Prevention and Documentation, and the Institute for Scientific Analysis, Alameda, California—also contributed financially and hosted several editorial meetings.

    Jim Nageotte, our editor at Sage Publications, Inc., has from the beginning demonstrated his belief in the project and encouraged us through its various stages. His occasional use of German in his regular e-mail communications was something our German-born editor in Switzerland found particularly appealing.

    Many of our friends and colleagues gave generously of their time to review drafts of the thematic and country chapters. They include Nuño Felix da Costa, Director, Programa Nacional de Prevenção das Toxicodependencias, Lisbon; Harold Holder, Director, Prevention Research Center, Berkeley, California; Jørgen Jepsen, Director, Alcohol and Drug Research Center, University of Aarhus, Denmark; Ludek Kubicka, Research Scientist, Prague Psychiatric Center, Prague; Klaus Mäkelä, Secretary and Research Director, Finnish Foundation for Alcohol Research, Helsinki; Ron Roizen, independent researcher, Berkeley, California; and Laura Schmidt, Research Scientist, Alcohol Research Group, Berkeley, California. We wish to thank Andrea Mitchell, director of the library at the Alcohol Research Group, Berkeley, California, for keeping the editors apprised of the latest literature on drug treatment, and all the available on-line data sets.

    We are particularly grateful to James Gallagher for undertaking the linguistic editing of the book and improving the quality of the English. He has given much time to revising the manuscripts, consulting with the Swiss editor, and communicating with authors to ensure the preservation of their intent.

    Renée Girardet of the Swiss Institute for the Prevention of Alcohol and Drug Problems ensured the smooth and timely progress of the project, constantly applying an organizational rigor that, too often, the editors lacked. Like Dr. Gallagher, she is a veteran from the alcoholism treatment book Cure, Care, or Control, and perhaps unwisely, but enthusiastically, undertook the task again. She was assisted by Edith Bacher and Heidi Vaucher, whose cooperation is also highly appreciated.

    Introduction

    Drugs, Demons, and Delinquents: The Result of a Cross-Cultural Research Project

    As the rhetoric of the drug war developed, and with it, a growing concern about illicit drugs and the spread of HIV/AIDS, the call for more drug treatment services could be heard. Many countries with previously few specific drug treatment services have seen a rapid expansion in the past 10 years. In this book, we examine the ways in which 20 countries from around the world have chosen to cope with the spread of illicit drugs.

    Although comparative cross-national studies on policy making and policy evaluation have a long tradition in addiction research, comparative analysis of the treatment response to drug problems in the wider sense has been neglected. At best, it has been dealt with in a technical and restricted way and lacks regional coverage. Information on the basic features of treatment systems presented, for example, in an overview of control policies and epidemiological data recently published by the Regional Office for Europe of the World Health Organization (Harkin, Anderson, & Goos, 1997), and the first annual report on the State of the Drugs Problem in the European Union, in 1996, from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA, 1996) is limited to European countries and does not deal with the functioning of treatment systems in general.

    It is against this background that this book should be seen. Its publication provides for the first time information on the development of drug treatment from a global perspective. The 20 countries included are Austria, Canada, China, Colombia, England, Finland, France, Germany, Hungary, Italy, Japan, the Netherlands, Peru, Poland, Portugal, Spain, Sweden, Switzerland, Russia, and the United States. The need to produce a global view of drug treatment is obvious in view of such developments as the globalization of the drug industry, the international drug trade and drug consumption, and the import and export of treatment models. Regrettably, in spite of the editors’ attempts to provide such a global perspective and provide information from all of the major geographical regions, certain areas, notably Africa and South Asia, are missing. Nevertheless, the wide range of countries represented here provides the reader with an excellent overview of current developments in treatment in different parts of the world.

    Figure I.1 International Study of the Development of Drug Treatment Systems (ISDRUTS), Geographical Coverage

    The production of a book with information on so many countries went far beyond the normal task of individual scholars collecting and analyzing data and writing up their results. In 1993, when the initial group of researchers came together in

    Toronto to begin work on the book, none realized the extent to which its production would become a fascinating cross-cultural dialogue between colleagues from 20 countries. At four workshop meetings, in Canada, Poland, Portugal, and Scotland, the country authors described and explained the development of the drug treatment systems in their different countries not only to the two editors but also to other members of the working group. The material contained in the book has been produced by 47 authors, who come not only from 20 different countries but also from a variety of different disciplines—an unusually heterogeneous research team. The product—the book—represents only the end point of complex negotiations among the project participants. The interaction of the contributors, the scientific editors, the language editor, the commentators, and the publisher was itself influenced heavily by cultural values and codes of intercultural communication. These interactions can in turn be understood as a social system in the classic sense defined by Parsons (1951):

    A social system consists in a plurality of individual actors interacting with each other in a situation which has at least a physical or environmental aspect, actors who are motivated in terms of a tendency to optimization of gratification and whose relation to their situations, including each other, is defined and mediated in terms of a system of culturally structured and shared symbols. (pp. 5–6; italics added)

    We believe, therefore, that the information on our dealings with the project participants and the interpretations within a wider framework of cultural communication are vital for a full understanding of the book. For the reader, reference to this framework will help to avoid premature conclusions and illustrate the reality with which drug treatment has to contend in the context of various cultural value systems.

    Key Features of the Book

    The book is not intended as either an international handbook providing detailed descriptions of treatment modalities around the world or a manual to determine which methods work best. Pharmaceutical drugs and over-the-counter medications are not taken into consideration, even though the dividing line between illicit and licit drugs has become increasingly blurred, and tobacco, as a licit substance, at least in the United States, is fast becoming a socially unacceptable drug.

    Instead, this volume develops four central features initially covered in the first book project, on alcohol treatment systems (Klingemann, Takala, & Hunt, 1992). First, the editors and country authors have adopted a system approach that provides a comprehensive overview of the main features of the treatment system in its societal context. “The word ‘system’ refers to those social structures and processes that have the function of drug treatment and, in a narrower sense, to the interconnection of different treatment units or agencies, chains of treatment and referral channels” (Klingemann et al., 1992, p. 4). The analytical focus is less on the “client path”—for example, entry and retention in the system and help-seeking behavior—and more on the “community path”—for example, the coordination of services and system description (Rush, 1996). The definition of system proved to be more straightforward than that of treatment. Substitution therapy, heroin prescription programs, professional reintegration measures, and activities designed to promote recovery without paid help (self-organized natural recovery) all create difficulties in describing and analyzing the treatment response.

    Second, we used a protocol/shopping list to ensure that a minimum of comparable information was supplied, while at the same time allowing each contributor to capture the specific flavor and story of his or her country. The list ensured that information on the following points would be provided: an inventory of drug treatment activities in each country; a discussion of the sociopolitical structure; trends in drug-related problems; the division between political, judicial, health, and social authorities; treatment rationales and specific methods; institutional cooperation and financing structures; and the role of self-help groups and unconventional methods and programs.

    The use of an interdisciplinary approach is a third feature of the book, and the range of disciplines represented goes beyond addiction research. It includes, for example, political science, psychoanalysis, and criminology. (For details, see the list of biographical sketches). We tried also to encourage coauthorship, ideally between a public health policymaker, a drug treatment professional, and a social scientist, in order to broaden the database and stimulate an intracultural discussion on each country's story.

    Finally, the editors have included a glossary, which explains key terms that may be unfamiliar to readers outside the particular country. It includes information on leading figures and institutions in the treatment fields in various countries, as well as key terms and concepts not necessarily mentioned or explained in detail in the text. An explanation of these concepts and terms deals not with standard, official, or true definitions in a scientific sense but with the treatment rationale or cultural definition of the term. For the same reason, such terms as use, abuse, and dependency may be used by country authors in different ways and consequently have not been unified or replaced in the editorial process. All glossary terms are designated by country of origin and can be read as background information by readers who have a specific interest in a given country. Readers can also find the titles of the works cited in both English and the original language, thereby easing access to information not available in English.

    In addition to these features, the editors have introduced certain organizational elements that, it is hoped, will enable the reader to use the book more effectively as a truly cross-cultural reference work on drug treatment systems. Instead of producing merely a collection of largely unconnected contributions held together only symbolically by an introduction or summary, the intention has been to supply the readers with a series of intermediate reviews and topical comparative discussions throughout the book. More specifically, to strengthen the analytical and comparative power of the collection, the 20 country reports have been grouped according to overarching themes such as “experimental countries,” “treatment in drug-producing countries,” “drug treatment in traditional wine countries,” or “treatment in countries with punitive policies.” Each group of country reports is followed by a commentator's critique on the shared leitmotif of the countries discussed. In most cases, these commentators were not members of the ISDRUTS project group or, in some cases, were not even involved in addiction studies. They came to their task with fresh ideas brought from such diverse disciplines as criminology, psychoanalysis, political science, and anthropology. Readers can use their overviews to conduct their own comparative analyses.

    The presentation of three thematic chapters in the last part of the book continues the comparative theme by reviewing each of the country chapters from the perspective of one particular issue. Before publication, the completed chapters were examined and approved by each author to avoid any questions of misinterpretation. All three topics, chosen from a longer list, concentrate on previously under-researched treatment system issues. The chapter on women and drug treatment examines a number of questions, such as the extent to which treatment services in different countries consider gender-specific differences, or the situation of women in mixed institutions and how access to treatment is guaranteed. The chapter on modes of financing treatment is an informative analysis of the material basis of the changing features of treatment systems, depicting the impact of funding schemes reaching out to the specificities of treatment modalities. The chapter on the relationship between the alcohol and drug treatment systems considers the extent to which the growth of a drug treatment system has blurred the dividing lines between alcohol and drug treatment. From a technical point of view, the three thematic chapters allowed the country authors to concentrate more on other issues, which in turn eased the tension between concentrating on rich regional coverage exemplified in a greater number of countries represented in the book and concentrating on the more in-depth information on the specific features of national treatment systems.

    Finally, the country background information table in the appendix to the book provides data on size of population, type of political economy, surface area, degree of urbanization, gross national product, and unemployment. Readers can thus make more systematic comparisons between countries, especially in regard to their size and wealth.

    Taken as a whole, the contributions contained in this volume provide access to information on drug treatment systems from a wide cross-section of 20 countries; they take into account the cultural and societal context of the organization of drug treatment. We are sure that it will enable researchers and students of addiction, health planners and administrators, and treatment professionals to place the development of their own countries’ treatment systems in a wider context and to examine the extent to which that development shares common structural features with that of other countries and other cultures.

    The Cultural Status of Information

    In the editors’ attempt to collect descriptive indicators of subdomains of treatment systems, they quickly realized that the cultural status of empirical data and their availability cannot be taken for granted. There is a danger in assuming beforehand that more familiar types of data—for example, official statistics/monitoring data and data obtained from special surveys—are superior to key informant opinions merely because the former lend themselves more easily to academic standards of referencing and reproducibility. This point is well illustrated by the reactions of the Colombian author to our request for additional material. To the request for more information about the available services, he replied:

    This is Colombia, a developing, crazy, and chaotic country, not Germany, France, or Switzerland. I cannot answer your questions. Nobody knows how many institutions there are here! In the same month, you can have 3 to 10 new ones opening and five others closing. Don't ask me to break down by type a ghostly (or amebic) body, there is no formal directory, and no official census.

    On client profiles, he responded: “Patient characteristics are shared at formal and informal meetings with other institutions.” Finally, on the use of treatment methods, he answered:

    No surveys are available. If you want, you can say that this is my personal opinion. My impression is that you think that we in this country have (as you probably have in Europe) an army of sociologists doing surveys on thousands of issues. This is very far from reality.

    The key informant, in his roles as clinic director, research director, and policymaker, occupies a central role in many informal work-related communication networks and can therefore provide information similar to that obtained by a Delphi-type process. This information may be an even more valid basis for a prognosis of the development of the drug treatment system than the use of the VESPA reporting system adopted from the United States.

    Moreover, interaction with the authors from Colombia, Peru, and Spain brought out a healthy resistance to our attempts to focus solely on treatment for the use of illicit drugs. The draft reports from the Latin American countries and Spain stressed the crucial public health importance of alcohol abuse in those countries. The Peruvian authors were equally concerned about the editors’ focus on treatment at the expense of prevention. They insisted that structural measures of prevention in the form of promotion of crop substitution programs were a vitally important element of their drug treatment system.

    Also, the general cultural setting influences the seemingly clear-cut division between scientific researcher and policymaker. These roles seemed to merge in the case of the Latin American countries. For example, our key informant from Peru is a scientific member of the Inter American Society of Psychology, and is, at the same time, a fieldwork coordinator for a jungle community action program in areas experiencing terrorist activities. At the Edinburgh workshop of the project group, the author presented the organizers with a vest woven in one of the jungle prevention cooperatives—a strong symbolic comment on our efforts to isolate and pin down the treatment system.

    The influence of culture on the combined roles of our contributors was an important issue also in the case of the People's Republic of China. Disentangling political statements from descriptive and policy information proved difficult, and some information seemed to be very restricted and based on unclear sources. This did not signify any lack of expertise on the part of our authors, however; rather, it was due to efforts to apply Western-style thinking and writing to non-Western conditions. The Chinese way of writing and thinking, based on an Eastern philosophical tradition, favors a more holistic way of reasoning than is characteristic of the Western style of research. Also, it would be naive to overlook the enormous difficulties that our Chinese colleagues have in not merely obtaining information but also obtaining approval to use it. Finally, we need to remember the political obligations of professional scientists who have to struggle for scarce government funding and recognition.

    National Treatment Systems as Global Actors

    Interaction with our authors also taught us something about the question of the boundaries of treatment systems. As mentioned earlier, in the context of the European Union, the level of analysis chosen here—national political states or, in some cases, regions—may actually prove inadequate for capturing trends toward a global treatment system with elements of diffusion, exchange, and import and export. For example, the acceptance and role of the harm reduction approach in various countries are influenced not solely by political forces or the extent of drug-related problems, but also by the experiences and “model behavior” of experimental countries such as England, the Netherlands, and Switzerland. The Liverpool experiments in England have served as an important reference point for trials of heroin prescription in Switzerland, which may, in turn, provide a model for other countries, such as Australia and Germany. Other examples include the diffusion of American monitoring systems and treatment models to Latin America, and the extension by the European Union of its influence through the funding of research into treatment and prevention in central European countries such as Poland.

    Our key informants were not always aware of these global exchange processes, or of the impact of the reputation of specific drug treatment experiments on other countries. For example, the senior editor in Switzerland was disappointed on discovering that an early draft of the English paper did not contain a detailed insider story of the Liverpool experiment. However, from discussions with the senior author, the editor realized that in England the experiment had only a marginal influence on the development of the treatment system. Consequently, despite its reputation abroad, it could not be made a focus of the chapter. In a different way, the Latin American authors were well aware of North American influences on their national treatment systems and even described the difficulties of applying foreign treatment modalities with cultural values in sharp opposition to those of Latin America.

    Venturing Into Unknown Territory

    The familiarity of the editors with the drug treatment systems in individual countries varied and depended on either the extent to which the country was represented in the scientific literature or whether they had personal contact with the addiction researchers in those countries. From this perspective, the Latin American countries and Japan and China were terra incognita. In these cases, the need to validate the country stories was obvious. One way of doing so was to encourage multiple authorship, thereby ensuring a broader basis of information. This was not altogether successful, however. Requests to country authors to invite the collaboration of co-researchers, from different institutes if possible, were not always welcome and in some cases even violated cultural codes of networking. For example, the editors’ efforts to bring together researchers from different institutes in Japan were unsuccessful. Similar difficulties arose when they tried to build a female/male American/Finnish team, match treatment and research colleagues in Portugal, and enlist monitoring and survey experts for the Latin American contributions. In the first two cases, different research perspectives and interests were contributory factors; in the third, the editors were not sufficiently sensitive to the precarious financial and other constraints that prevented the authors from investing more time in an international book project.

    Conclusion: Where are the Demons?

    The subtitle of this collection of chapters promises demons (in Greek, daimon = evil spirits), but readers may look for them in vain. Browsing the country reports, readers will realize that the image of drug dependency as a condition is hard to change; an individual once “possessed” either in the historical sense in the temperance period by “the devil rum” or today by the demon heroin or crack cocaine is considered hard to change. These perceptions in turn exert an important influence on what are considered appropriate treatment measures.

    In reviewing the country reports, the editors have done everything possible to eliminate alarmist or moralistic statements that could be taken as problem amplification with little or no empirical foundation. In other words, the editors have chased the demons out, or at least introduced them in a “safer” divine form (see Noschis in “Dionysus Is Back” on drug treatment in wine-producing countries). Where necessary, the editors have cleansed individual country stories to ensure that scientific standards are upheld and moralistic attitudes removed. Nevertheless, the reader, in examining the development of the treatment systems in these 20 countries, should still keep in mind that the demons can reappear, as is often the case when the emotional dimension comes to dominate the public debate on drug-related policy.

    References
    European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). (1996). Annual report on the state of the drug problem in the European Union. Lisbon: Author
    Harkin, A. M., Anderson, P., & Goos, C. (1997). Smoking, drinking and drug taking in the European region. Copenhagen: Alcohol, Drugs and Tobacco Programme, WHO Regional Office for Europe.
    Klingemann, H., Takala, J. P., & Hunt, G. (Eds.). (1992). Cure, care, or control. Albany: State University of New York Press.
    Parsons, T. (1951). The social system. New York: Free Press.
    Rush, B. (1996). Alcohol and other drug problems and treatment systems: A framework for research and development. Addiction, 91, 629–642. http://dx.doi.org/10.1046/j.1360-0443.1996.9156714.x
    HaraldKlingemann
    GeoffreyHuntLausanne and Berkeley, June 1998
  • Appendix: Summary Table

    Glossary

    • Alcohol tithe/Alkoholzehntel(Switzerland): The Swiss Constitution (art. 32, paragraph 9) provides for the net income of the Alcohol Administration to be set aside for social purposes, a provision unique in the world. The income is divided equally between the federal government, for the Old Age and Widows and Orphans Pension Scheme and the Invalid Insurance, and the cantons, according to their populations. The cantons receive 10% of it (US$8.2 million for the budget year 1996–1997) earmarked to combat the causes and effects of alcoholism, drug dependency, and the abuse of generic drugs.
    • Approved institutions/Anerkannte Einrichtungen (Austria): A category of inpatient and outpatient facilities introduced by the amendment of the narcotic law in 1980. Since then, the Ministry of Health has to “approve” institutions, which then become the designated institutions for the treatment of those who are on probation under the narcotic law.
    • Autonomous commumties/Comunidades Autónomas (Spain): The autonomous communities are the 19 political and administrative divisions that make up the Spanish State. They enjoy various degrees of political and fiscal autonomy. Most have set up their own (regional) plans on drugs.
    • Basuco (coca paste) (Colombia): A compound obtained from mixing coca leaf with benzoic acid, methanol, kerosene or leaded gasoline, cocaine sulfate, sulfuric acid, and other alkaloids. The mixture yields coca paste, also known as basuco in Colombia. When smoked, its combustion is rich in fumes of freebase cocaine.
    • Canada Health Act (Canada): A federal law that guarantees federal health funding to provinces that support universally accessible health services.
    • Chacchar/Chacchado (Peru): A Quechuan word for the traditional use of coca leaves by Andean people; it represents the act of chewing the leaves and swallowing the juices produced.
    • Coffee shop (Netherlands): The most prominent feature of the “separation-of-markets policy” in the Netherlands and a mainstay of Dutch drug policy. It represents a distinction in the marketing of illicit drugs between hard drugs (heroin, cocaine, amphetamines)—which are treated as black-market commodities and in which trafficking incurs severe penalties—and soft drugs (cannabis), which may be marketed in the open in a system of so-called coffee shops (“hash cafes”). The logic of this distinction is that drugs of unacceptable risk (hard drugs) are to be marketed differently from drugs of acceptable risk (cannabis) and that the markets should be separated so as to prevent soft drug users from being exposed to hard drugs.
    • Community drug team (CDT) (England): A community-based team comprising community psychiatric nurses and social workers that provides training and support functions for generic health services and acts as a link between generalist and specialist services; its members also carry a client caseload.
    • Consultation Center for Alcohol and Drugs/Consultatiebureau voor Alcohol en Drugs—CAD; Categorical care (Netherlands): This is the main service center within the “categorical care system” for addicts: a nationwide network of institutions for outpatient treatment, care, and advice for addicts (alcohol, drugs, prescribed medicines, gambling). The system is called categorical because it serves addicts only, not nonaddicted psychiatric patients. Therefore, to be eligible for CAD services, individuals must be addicted to, or at least manifest problem behavior related to abuse of, psychotropic substances or gambling. CADs are members of the Dutch Association of Addiction Treatment and Care Centres.
    • D'66 (Netherlands): A left-wing political party (Democratic Liberal) founded in 1966, with its intellectual core mainly in Amsterdam. In 1984, the Amsterdam department of D'66 proposed legalizing “all substances that could be used for pleasure,” including such hard drugs as heroin and cocaine. In 1997, D'66 is the country's fourth-largest political party and part of the ruling coalition, together with social democrats and right-wing liberals.
    • Drug dependence unit (England): A facility staffed by a specialist multidisciplinary team clinically directed by a consultant psychiatrist and offering assessment and treatment of drug misusers. The team is designed to deal with complex and difficult cases.
    • Deutsche Hauptstelle gegen die Suchtgefahren (DHS)/(German Council on Addiction Problems) (Germany): An umbrella organization of all nonprofit organizations concerned with addiction to alcohol or drugs. It includes government agencies and temperance groups. It organizes an annual congress and publishes a journal.
    • Drug and Drug-Addiction European Observatory/Observatório Euripeu das Drogas e Toxicodependência (OEDT) (Portugal): A European Union agency, decentralized to Lisbon, whose task is to collect, analyze, and disseminate data on the search for drugs, strategic and national policies, international cooperation, and other aspects of drug traffic throughout the 15 member states of the Union.
    • The National Coca Enterprise (Empresa Nacional de la Coca; ENACO) (Peru): A government enterprise permitted to buy and trade in coca leaf and its derivatives for multiple uses (medicinal, infusions, cosmetic, etc.). It keeps a record of farmers legally permitted to grow coca.
    • Firma (Peru): A cartel or local mafia in coca-growing zones that controls the production and commercialization of basic paste of cocaine (PBC), an intermediate substance in the production of cocaine chlorhydrate.
    • Harm reduction approach (Netherlands, England, Switzerland): Harm reduction was appropriated from the safety and insurance industries. These industries try to minimize the consequences and probabilities of accidents and costly illnesses by providing incentives for behavior such as wearing safety belts, not smoking, and avoiding high-risk sports. This business philosophy has been transferred to drug-related public policy and basically aims at the minimization of adverse effects of both drug use and drug prohibition. Specific policy measures include the promotion of sterile syringes for injection drug users, methadone and other opioids for opiate-dependent people, adequate treatment for individuals suffering from chronic pain, noncoercive drug treatment programs for substance abusers, and medical marijuana for seriously ill people whom it might benefit. Harm reduction programs as prominent alternatives to use-reduction have been developed in many countries, such as Australia, Switzerland, and the Netherlands, as a very successful response to the threat of AIDS. However, the definition of types of harm reduction remains difficult when referring to the reduction of net total harm (i.e., total harm minus benefits of use to users), the reduction of total harm, or the reduction of harm to nonusers without considering the harm to users (e.g., see Caulkins, J. P., & Reuter, P. (1997). Setting goals for drug policy: Harm reduction or use reduction? Addiction, 92, 1143–1150).
      • The harm reduction approach is not limited to the case of illicit drugs only. The term also refers to those policies and programs that attempt to reduce the harm associated with alcohol consumption without the drinker necessarily giving up his or her drinking at the present time. Examples of such measures include server intervention programs, creating safer bars, standard unit labeling of alcohol containers and warning labels, as well as local regulations and enforcement strategies for licensed premises (e.g., see Plant, M., Single, E., & Stockwell, T. (1997). Alcohol: Minimising the harmWhat works? London, New York: Free Association Books).
    • Health maintenance organization (HMO)(USA): HMOs are health insurance systems developed as a response to rising health care costs in the United States. They are health insurance organizations that admit those insured to medical care only within a designated provider group. In some states, such as California and Oregon, they account for a large market share of the health care system.
      • Junkie organizations(Netherlands): In the Netherlands, there is an organization called the National Platform of Drug Users. The Netherlands’ health system has always provided for continuity of care between the official care and treatment system and the community, the informal sector. This general principle has been applied uniquely to heroin users. Over the years, the government has supported a number of “user organizations” that advocate policy changes and protect the human rights of patients in the official system. These organizations are akin to support groups with respect to other chronic disease categories of patients in the Dutch system. Today, the former Junkie Unions have been reorganized into a national platform organization for policy advocacy for drug users.
    • Kotanski, Marek(Poland): A psychologist concerned with drug treatment for more than 20 years. In the late 1970s, he introduced therapeutic communities into drug treatment. He is founder and charismatic leader of Monar, the first nongovernmental organization in the drug field in Poland. Monar runs a network of counseling and residential rehabilitation centers as well as preventive activities. Kotanski, as its leader, has undertaken many initiatives in such different fields as drug prevention, environmental issues, AIDS, homelessness, and prisons. He also competed in Poland's first presidential election.
    • LTP(Russia): The Russian prophylactic labor treatment center for alcohol and drug addicts with a stern regime (as in prison).
    • NDATUS (National Drug and Alcohol Treatment Utilization Survey)(USA): NDATUS is cosponsored by NIDA and NIAAA, and it represents the only national data system on public and private alcohol and drug programs in the United States. Point prevalence surveys have been conducted between 1979 and 1996. The data refer to agencies rather than clients.
    • NIDA (National Institute on Drug Abuse)(USA): Originally the Division of Narcotics Addiction and Drug Abuse within the Department of Health, Education and Welfare, NIDA was established in 1973 or 1974 (there appears to be some discrepancy as to when NIDA began). In addition to continuing the research programs, one of its major tasks is to oversee the national network of treatment programs.
    • NIAAA (National Institute on Alcohol Abuse and Alcoholism)(USA): The federal agency mandated by the U.S. Congress to fund alcohol research and provide policy direction.
    • Parents’ organizations against drugs (Finland): These are voluntary organizations that help and support young drug users and their parents and promote a search for effective means of combating the dangers of drugs in society. The first such organization in Finland, Vapaaksi Huumeista ry (Freed from drugs), was set up in 1983. Similar organizations had been created in Sweden and Norway at the end of the 1960s. One organization, Irti Huumeista ry (Free from drugs), has 18 sections throughout the country and 300 trained volunteers.
    • Progetto Uomo(Italy, Spain): An organization founded in Rome in 1979 by a militant Catholic group and “exported” to Spain and many other countries. Progetto Uomo adopted the American Daytop Village mixed model of therapeutic community, including professionals and former addicts on its training staff. Its therapy is socioeducational in nature and based on the principles of discipline and self-help, leading to behavior modification.
    • SAMHSA (Substance Abuse and Mental Health Services Administration)(USA): In 1992, a reorganization of the original Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) took place. NIDA, NIAAA, and NIMH (National Institute for Mental Health) were transferred to NIH (National Institutes of Health), and the remaining agencies—CSAP (Center for Substance Abuse Prevention), CSAT (Center for Substance Abuse Treatment), and the Center for Mental Health Services were left in the restructured organization, whose key mission was to improve service delivery nationwide.
      • Sectorisation (France): Organization of mental health services introduced in the 1960s. It allocates to every mental hospital unit the care of a defined geographical area. Its effect has been to develop outpatient care.
      • Service des Statistiques, des Etudes et des Systèmes d'Information (SESI)(France): A service of the French Ministry of Health and Social Affairs. It collects data on the whole social security system in a broad sense, and it studies and analyzes financial, demographic, and health information. It conducts an annual survey (enquête toxicomanies) of medical and social units that declare themselves as taking drug addicts in charge.
    • Traditional Chinese medicine(China): The study of the physiology and pathology of the human body and the diagnosis and control of diseases. It has a unique theory system and rich clinical experience. The theory system of traditional Chinese medicine was deeply influenced by ancient materialism and dialectic thought—the theory of yin and yang (the two opposing, yet uniting, forces in nature)—and the five elements—wood, fire, earth, metal, and water. Its medical theory system is characterized by taking the concept of the human body as a whole as the dominant idea; the physiology and pathology of the organs, bowels, channels, and collaterals as the basis; and the determination of treatment on the basis of the differentiation of symptoms and signs as the main method of diagnosis and treatment.
      • Traqueteros (Peru): Usually, young people involved with the firmas in zones where coca leaf is transformed into PBC; their task is to buy PBC in small amounts and send it in bulk to places where it will be further processed into cocaine chlorhydrate.
    • Treatment prison (Behandlungsvollzug)(Austria): A category of prisons introduced by the amendment of the penal code in 1975 and designed to both prevent prisoner addicts from taking drugs and treat their addiction. The treatment prison for alcohol and drug addicts in Vienna—the so-called penal institution for offenders in need of withdrawal—was the first such treatment prison.
    • Volunteer probation officer(Japan): Volunteer probation officers, commissioned by the Minister of Justice, are a unique feature of Japan's community-based treatment. Their most important tasks are to supervise and assist probationers and parolees in their efforts to rehabilitate themselves in the community.
    • War on Drugs(USA): President Reagan first used the term in 1982, but it was not until the emergence of crack cocaine in 1986 and the passing of the Anti-Drug Abuse Act that the term was taken up by the media and politicians in general. However, in the 1997 White House National Drug Control Strategy report, the War on Drugs metaphor was considered, for the first time, “misleading.” According to the White House report, “A more appropriate analogy for the drug problem is cancer.” Under this new rhetoric, the task is “to reduce the cancer of drugs in America.”
    • Wohlfahrtsverbände (Welfare organizations) (Germany): Six large, national, nonprofit welfare organizations dominate the nongovernmental social sector in Germany: Caritas, a Catholic organization; Diakonisches Werk (DW), run by the Protestant Church; Zentralwohlfahrtsstelle der Juden in Deutschland, which represents Jewish institutions in Germany; Arbeiter Wohlfahrt (AW), which has strong ties to the labor unions; Rotes Kreuz, the German Red Cross organization; and Deutscher Paritätischer Wohlfahrts-Verband (DPWV), a conglomerate of nonreligious groups. They differ in numbers of members, influence, focus, and realization of their goals. Up to 90% of their budgets come from the federal government, the states, and local communities.

    About the Editors

    Harald Klingemann, Switzerland, studied at Cologne University (Germany), where he received the degree of Doctor of Economics and Social Science. He has taught at the University of Bonn, where he was a senior researcher in criminology, and at the Fachhochschule of Cologne. Currently, he is director of research at the Swiss Institute for the Prevention of Alcohol and Drug Problems (Lausanne). His main research interests include the cross-cultural analysis of treatment systems, deviant careers, and the natural recovery process. He has coedited Cure, Care, or Control (State University of New York Press, 1992). Recent journal and book chapters include “Drug Treatment in Switzerland: Harm Reduction, Decentralization and Community Response” (Addiction, 1996); “Coping and Maintenance Strategies of Spontaneous Remitters From Problem Use of Alcohol and Heroin in Switzerland” (International Journal of the Addictions, 1992); and “Environmental Influences Which Support or Impede Change in Substance Behaviour” (Oxford University Press, 1994).

    Geoffrey Hunt, USA, PhD, is principal investigator of a research project on street groups, alcohol, and violence that is sponsored by the National Institute on Alcohol Abuse and Alcoholism at the Institute for Scientific Analysis, Alameda, California. His previous research, in the United States and England, has been on drinking practices and behavior, community substance abuse prevention programs, and the culture of drug and alcohol treatment systems. He has published on alcohol and drug use, alcohol and drug treatment systems, ethnographic evaluation, youth gangs, and international migration.

    About the Contributors

    José Manuel Gaspar de Almeida, Portugal, a medical graduate of Oporto University, trained in psychiatry and specialized in alcohol-related problems. He is a member of a multidisciplinary team engaged in prevention programs in alcohology and is in charge of inpatient treatment at the Oporto Regional Alcohology Centre for the prevention and treatment of alcohol-related problems in the north of Portugal. He is an associate member of the Portuguese Family Therapy Society, the Portuguese Behavioral Therapy Society, and the Kettil Bruun Society, and he has Direction Membership of the Portuguese Alcohology Society.

    Gabríele Bammer, USA, PhD, is a Fellow at the National Centre for Epidemiology and Population Health at the Australian National University. Her primary area of interest is multidisciplinary research into complex social problems. She has directed a 5-year feasibility study into an Australian trial of heroin prescription, the implementation of which is awaiting a political decision.

    Judith C. Barker, USA, PhD, is an associate professor in the Medical Anthropology Program, Department of Epidemiology & Biostatistics, University of California, San Francisco. Trained in medical sociology and medical anthropology in New Zealand, Great Britain, and the United States, she has done field research for over 10 years in Australasia, the Southwest Pacific, and the United States. This research, primarily qualitative, has examined the recognition, day-to-day management, and expression of a variety of health conditions (especially chronic illnesses) and health-related behavior, particularly with respect to the frail elderly in community living. She has a long-standing interest in gender and ethnic differences in the experience and expression of illness. She is widely published in gerontology and in anthropological sources.

    Anders Bergmark, Sweden, is a professor in the Department of Social Work at Stockholm University. He is director of the Addiction Research Group, which is engaged in several extensive research projects on alcohol and drug treatment in Sweden. His published work includes Drug Abuse and Treatment, The Concept of Control and Alcoholism, The Limits of Phenomenology and Objectivity, Long-Term Follow-up of Residentially Treated Drug Abusers, and Swedish Alcohol Treatment in Transition? Social Conditions of Treatment Programs.

    Gerald Bèroud, China, is a graduate in sociology and has done further study in sinology. He is the Director of SinOptic—Services and Studies on the Chinese World, in Lausanne, Switzerland. For many years, he was on the staff of the Swiss Institute for the Prevention of Alcohol and Drug Problems. He has conducted research on drug problems in mainland China as well as Taiwan and Hong Kong.

    Gerhard Bühringer, Germany, PhD, is the Director, IFT Institut für Therapieforschung (Institute for Therapy Research), Munich. Formerly, he was director of the Addiction Research Group of the Max Planck Institute of Psychiatry in Munich. His research, mainly federally funded, has been in epidemiology; prevention and treatment of addictive behavior (alcohol, illicit drugs, pharmaceuticals); pathological gambling; and the evaluation of treatment programs and facilities in behavioral medicine and psychosocial health care. He is author or coauthor of many publications on substance abuse research. He is a member of the scientific advisory boards of a number of German and international associations and editor or a member of the editorial boards of several German and international scientific journals.

    Wilhelm Burian, Austria, Dr.med., is a psychiatrist and Director of the Department for the Treatment of Drug Addicts, Anton Proksch Institute, Vienna. He is also a Member of the Vienna Psychoanalytic Society (IPA). Since 1972, he has published papers and three books on the treatment of alcoholism and drug addiction, psychoanalytical treatment, and sociology and the addictions.

    Cheng Maojin, China, is Deputy Director of the Institute of Social Medicine, Tongji Medical University in Wuhan; Vice-Dean of the School of Public Health; and Director of the Department of Health Education. He has conducted a project supported by the World Bank on health facilities in some medium-size cities.

    Chen Shirong, China, is Director of the Institute of Social Medicine, Tongji Medical University in Wuhan, where he teaches health education, social medicine, and mental health.

    Jack T. M. Derks, Netherlands, PhD, is adjunct professor at the International Institute for Psycho-Social and Socio-Ecological Research, University of Limburg. He was with the Netherlands Institute of Mental Health from 1980 to 1996 and was founder and director of the drugs and gambling research unit of the Amsterdam Institute for Addiction Research, 1993–1995. He is on the executive board of the European Methadone Association; vice-president of the COST A-6 program (Evaluation of action against drug abuse in Europe) of the European Commission; co-coordinator of working group 1 of COST A-6 (Evaluation of drug policies, drug policy changes, and societal responses to drug policies); and scientific coordinator and vice-principal-investigator of the IPTRP/BIOMED 2 program of the European Commission.

    Irmgard Eisenbach-Stangl, Austria, Dr.phil., Univ.Doz., is a researcher at the Ludwig Boltzmann Institute for Addiction Research and a lecturer at the Institute of Sociology of the University of Vienna. Her main research interests are the social history of alcohol and illicit drugs, especially in Austria; gender-specific consumption patterns of psychotropic substances; development and structure of professional treatment of addiction (institutions, programs, methods, especially psychotherapy); and nonprofessional mutual aid. Her publications include A Social History of Alcohol: Consumption, Production and Social Control of Alcoholic Beverages in Austria, 1918–1984; Haschisch: Prohibition or Legalization (with W. Burian, ed.); and Alcoholics Anonymous as a Mutual-Help Movement: A Study in Eight Societies (with K. Mäkelä et al.).

    Zsuzsanna Elekes, Hungary, is a sociologist and associate professor in the Department of Sociology of Budapest University of Economic Sciences. Her main field of study is the sociological analysis of deviant behavior, with special emphasis on drug epidemiology. She has published numerous articles in Hungarian and international journals. She has participated in a number of international research projects, the most recent a European project on drug consumption and attitudes toward drugs, reported in Alcohol- and Drug-Consumption Among Secondary-School Students in Hungary (1996).

    Rosa Encarnaçâo, Portugal, is a medical graduate of Oporto University and a specialist in psychiatry. In 1994, she instituted the multidisciplinary team of the Oporto Regional Alcohology Center and is in charge of its day hospital. She works in prevention of alcohol-related problems in schools, municipalities, and prisons. Her interests are group therapies, alcohol-related problems of young people and women, rehabilitation programs, and epilepsy. She is co-author and author of papers on alcohology, epilepsy, and group therapies, and she is an associate member of the Portuguese Family Therapy Society, the Portuguese Association of Mental and Psychiatric Problems, and the Portuguese Epilepsy League.

    Yakov Gilinskiy, Russia, PhD and Doctor of Science in Law, Leningrad State University, is professor at the Institute of Sociology of the Russian Academy of Sciences in St. Petersburg, as well as Head of the Department of Sociology of Deviant Behavior. His current research is in criminology, the sociology of deviant behavior, and social control. He has published more than 210 works, mostly on sociology and criminology.

    Marten J. Hoekstra, Netherlands, is managing director of the Dutch Association of Addiction Treatment and Care Centers. He has a degree in sociology and has worked in several umbrella organizations and institutes of mental health, primary health, and addiction. Topics on which he has written include alcohol and drug policy and organization of treatment. He is on the board of directors of the International Council on Alcohol and Addictions.

    Charles D. Kaplan, Netherlands, PhD, is Director of the Division of Drug Use and Abuse, International Institute for Psychosocial and Socio-Ecological Research, University of Limburg, Maastricht, and adjunct professor, Division of Social and Policy Sciences, University of Texas, San Antonio. He was visiting professor at the Johann Wolfgang Goethe Universität, Frankfurt, 1977–1984, and held the Tinbergen Chair at the Institute for Preventive and Social Psychiatry, Erasmus University, Rotterdam, 1984–1992. In addition, he founded the European Addiction Research Institute in Rotterdam. He is on the advisory board of the Journal of Psychoactive Drugs and on the editorial board of the Scandinavian Journal of Social Welfare. He is principal investigator of the IPTRP/BIOMED 2 program of the European Commission.

    Eva Katona, Hungary, is a psychiatrist and was a founder of Hungary's first crisis intervention center. From the late 1980s, she was active in setting up the national drug program, and she became a member of the planning and executive board of the National Health Promotion Council and of the National Education, Training and Research Board on Drugs while she continued to practice. She helped to establish the first outpatient clinic for drug addicts in Budapest and another in the country. She is a senior lecturer at the Budapest Postgraduate Medical School/Institute of Public Health. She has done collaborative research with American counterparts on drug epidemiology and has represented Hungary in the Multi-City Network of the Pompidou Group/Council of Europe in 1995–1996.

    Aarne Kinnunen, Finland, is a criminologist at Finland's National Research Institute of Legal Policy. He has published books and articles on pretrial investigation, victim surveys, credit card fraud, violence in workplaces, drug use patterns, and drug markets. He is now studying criminal careers and socioeconomic background factors of drug offenders at Statistics Finland. He is also Secretary of the Finnish Commission on National Drug Policy.

    Hans-Dieter Klingemann, Germany, PhD, is Professor of Political Science at the Free University of Berlin; director of the Research Unit on Social Institutions and Social Change at the Science Center for Social Research, Berlin; and permanent Research Fellow in Politics and Society at the University of California, Irvine. He has authored, coauthored, or edited 21 books, two book series, and numerous journal articles and book chapters. Recent coauthored publications include A New Handbook of Political Science and Citizens and the State (Oxford University Press); and Parties, Policies and Democracy (Westview Press). His current research is on democratic transition and consolidation in Central and Eastern Europe.

    Kyohei Konuma, Japan, MD, is a psychiatrist and Director of the Department of Drug Dependence Treatment and Research at the National Psychiatric Institute of Shimousa. He has long been engaged in treatment and clinical research and is leading a national epidemiological survey on drug dependence and psychiatric services for drug dependents. His most recent work is on the use and abuse of amphetamines in Japan.

    Takeshi Koyanagi, Japan, is a psychologist and director of the Kushiro Juvenile Classification Home of the Ministry of Justice. He has been engaged in treatment of offenders and research on mainly drug-related offenses. At present, he is a professor at the United Nations Asia and Far East Institute for the Prevention of Crime and the Treatment of Offenders. He has published several works, most recently Current Trends of Foreign Prisoners in Japan (Gyosei Press, 1995).

    Antonio Lara-Ponce, Peru, is a graduate in psychology of St. Mark's National Major University and a member of the Peruvian College of Psychologists and the Committee of Community Psychology Consultants. He coordinates the fieldwork and heads the Jungle Program of the Center of Information and Education for Prevention of Drug Abuse. He is designing a community preventive program for zones at high risk of production and use of drugs, jungle territories exposed to terrorism, and shantytowns. He is the national representative of the local chapter of social psychology of the Interamerican Society of Psychology, a member of the Regional Office of Health Education for Latin America, and a volunteer for the Andean area at the European Center against Drugs.

    Juhani Lehto, Finland, is professor of social and health care management at Tampere University and head of the Services and Quality Unit at the National Research and Development Centre for Welfare and Health in Helsinki. He has been a consultant at the Regional Office for Europe of the World Health Organization and a researcher at the Finnish Foundation for Alcohol Studies. Recent publications include studies on evaluation of alcohol and drug policies, economic aspects of alcohol policy, and financing and management of social and health care.

    Susanne MacGregor, England, MA, PhD, is Professor of Sociology and Social Policy at Middlesex University. Recent books of which she has been coauthor or coeditor are The Drugs Treatment Services in England, The Other City People and Politics in New York and London, Activating Local Networks: A Comparison of Two Community Development Approaches to Drugs Prevention, and Transforming Cities: Contested Governance and New Spatial Divisions. She has been scientific advisor to the Department of Health and is the London Co-Coordinator of the Mega-Cities Project, an international action-research project on issues of poverty, environment, women, and governance. Her research interests include drug treatment and prevention, urban regeneration, and poverty. Current work includes research on community development and drug prevention, contributing to the REITOX program of the European Monitoring Centre for Drugs and Drug Addiction, and directing an evaluation of drug action teams.

    Enrique Madrigal, USA, is Doctor of Medicine and Surgery, University of Costa Rica, and a specialist in adult and child psychiatry, Columbia University, New York City. He is also Regional Advisor, Prevention and Control of Addictive Behaviors, Pan American Health Organization/World Health Organization Regional Office for the Americas, Washington, DC. Former appointments have been Medical Director, Department of Community Psychiatry, Saint Luke's Roosevelt Hospital Center, Columbia University, New York; Clinical Director, Children's Aid Society, New York City; and Director General, National Institute on Alcoholism, Costa Rica.

    Jacek Moskalewicz, Poland, PhD, is a researcher at the Institute of Psychiatry and Neurology, Warsaw. His major interests are alcohol and drug policy and the sociology of social problems. He is a member of the WHO Expert Committee on Drug Dependence and Alcohol Problems. He has coauthored the chapter “Changing Definitions of the Drug Problem” in an international report from the Baltica Study, Social Problems in Newspapers: Studies Around the Baltic Sea; a chapter on Poland in International Handbook on Alcohol and Culture; and an international report from the WHO study on community response to alcohol-related problems, Alcohol and the Community.

    Philippe Mossè, France, is a research economist at the Laboratory for the Study of the Economics and Sociology of Work at the National Center for Scientific Research, Aix-en-Provence, and a board member of the French Social Economics Association. His studies are mainly on reforms of the French social security system and hospital management. His current studies are on hospital industrial relations and financing reforms (in Germany, Italy, and France), and on the working-time issue in several industrial and services sectors in France and Great Britain. He teaches postgraduate courses in work economics and health economics and assesses the local impact of social policies. Recent publications in English are “Towards a Professional Rationalization: Lessons From the French Health Care System” (American Journal of Economics and Sociology); Private Markets in Health and Welfare, France (N. Johnson, ed.); and Industrial Relations in Health Care.

    Kaj Noschis, Switzerland, PhD, has worked as a Jungian analyst in private practice in Lausanne, Switzerland, for the past 12 years. He has also taken part in research projects on alcohol-related problems.

    Alan C. Ogborne, Canada, PhD, is a senior scientist at the Department of Social and Evaluation Research of the Addiction Research Foundation of Ontario. He has conducted research on many aspects of substance use and abuse and addiction, including many studies of treatment systems and services. His recent research has concerned the characteristics, beliefs, and training needs of specialists in addiction services.

    Borbála Paksi, Hungary, is a sociologist who has been engaged over the past 10 years in sociological analysis of various forms of deviant behavior, with special emphasis on suicide and drug consumption. She has published numerous articles on the topic, and several articles and studies have cited the results of her research. She is coauthor of Alcohol- and Drug-Consumption Among Secondary-School Students in Hungary (1996).

    Augusto Pèrez-Gómez, Colombia, PhD, is Full Professor at the Department of Psychology, University of the Andes, Bogota. He founded the La Casa Program in 1986, a center for prevention and treatment of, and research into, drug-related problems, AIDS and suicide, and, more recently, social violence, mainly kidnapping and extortion. In 1994, he was visiting professor at the Chelsea and Westminster Medical School, London, and consultant to the Riverside Mental Health Trust. He has published five books and more than 100 papers and book chapters in Spanish, English, and French. He is vice president for Latin America of the International Federation of NGO Against Drugs, and a representative of SOS Drogue International for Latin America and the Caribbean.

    Juan-Luis Recio Adrados, Spain, PhD, is Professor of Sociology at the Madrid Universidad Complutense and a member of the editorial staff of the journal Adicciones, of the Technical Commission of the Foundation for Help Against Drug Addiction, and of the Complutense Institute for Drug Dependencies. He is scientific advisor to the Spanish National Plan on Drugs. He was project director of the first population survey of drug misuse in Spain (1980). In 1988–1989, he directed a longitudinal study on the role of the family in adolescent drug misuse among Madrid high school students. He was visiting scientist at the United States National Institute on Drug Abuse (NIDA) in 1991–1992 and coedited NIDA Research Monograph No. 130 on the theoretical and methodological issues of drug misuse among U.S. minorities.

    Brian R. Rush, Canada, PhD, is a senior scientist with the Addiction Research Foundation of Ontario. His research interests include the evolution of Ontario's addiction treatment system, the cost-effectiveness of treatment, and forecasting models for addressing the need for treatment services.

    Martin Schmid, Germany, is a graduate of the University of Frankfurt am Main and a sociologist at the Institute for Social Work and Social Pedagogics (Institut für Sozialarbeit und Sozialpädagogik), Addiction Research Group, in Frankfurt am Main. He has worked for 5 years for a drug-counseling institution. His main areas of research are the evaluation of pilot programs for drug addicts and the development of the drug treatment system. His publications include articles on low-threshold centers, drug scenes, and drug policies. He also takes part in the training of drug counselors.

    Shinji Shimizu, Japan, MS, is head of the Mental Health Planning Section, National Institute of Mental Health, Tokyo, and one of the few sociologists who studies alcohol and drug problems in Japan. He is also a family sociologist who deals with clinical issues, specifically in family health and addiction. He has been associate professor at Osaka City University and is a member of the Expert Committee on Alcohol-Related Problems at the Ministry of Health and Welfare. He has published several books, most recently Hungarian Society and Health/Alcohol Problems.

    Janusz Sieroslawski, Poland, is a sociologist at the Institute of Psychiatry and Neurology, Warsaw. His main areas of interest are social problems related to alcohol and drug consumption, the epidemiology of alcohol and drug dependence, international comparability of epidemiological indicators, social response to alcohol and drug problems at the local and national level, and prevention and policy issues. He is an epidemiology expert of the Pompidou Group at the Council of Europe, as well as coordinator of the Warsaw Multi-City Study and the Polish part of the European School Survey Project on Alcohol and Drugs.

    Reginald G. Smart, Canada, PhD, is Director of Social Evaluation and Principal of the Addiction Research Foundation of Ontario. His interests include the epidemiology of substance use and abuse, alcohol policy, and studies of prevention and treatment programs.

    Lynne Smith, England, MSc, is research officer at the Social Policy Research Centre at Middlesex University. As a senior manager in the voluntary sector for many years, she was responsible for developing and managing welfare services. She was coauthor of The Drugs Treatment Services in England (1994) and Activating Local Networks (1996). Recent work has included an antipoverty audit for a London borough and research into young people's attitudes toward drugs and the law. Her research interests include women and community development, drug treatment, and drug prevention. Current research is on community development and drug prevention, evaluation of drug action teams, and a typology of drug treatment systems for the REITOX project of the European Monitoring Centre for Drugs and Drug Addiction.

    Luigi M. Solivetti, Italy, is a graduate in law (criminology) and psychology, and he is permanent research fellow and lecturer in sociology at the Faculty of Statistical Sciences, University of Rome “La Sapienza.” He has been research fellow with Italy's National Research Council and visiting professor at the London School of Economics and Political Science, and he has done research and teaching in Africa (University of Sokoto, Nigeria). He is a consultant in crime issues to the Ministry of Justice, Italy and a referee for several international journals. He has been extensively published, mainly on deviance and social control, in such international journals as The Howard Journal of Criminal Justice, Africa (International African Institute, London), Revue Internationale de SociologieInternational Review of Sociology, and Sociologia del Diritto.

    Grazyna Światkiewicz, Poland, MA, is a researcher at the Institute of Psychiatry and Neurology, Warsaw, mainly in social research on licit and illicit drugs. She has been a consultant to a Pompidou Group project on drug use in pregnancy. She coauthored a two-volume publication, Alcoholics Anonymous as a Mutual Self-Help Movement: A Study in Eight Societies, and a chapter on “Changing Definitions of the Drug Problems” in an international report from the Baltica Study, Social Problems in Newspapers: Studies Around the Baltic Sea. She contributed an article on “Using Drugs to Ease the Pain of Transition” to a special issue of Women and Pharmaceuticals prepared for the Fourth World Conference on Women in 1995.

    Michael S. Vaughn, USA, is an assistant professor at the Department of Criminal Justice, Georgia State University. He received his PhD in 1993 from the College of Criminal Justice at Sam Houston State University. He writes on legal issues in criminal justice and cross-cultural crime and social control.

    Irmgard Vogt, Germany, PhD, is a social psychologist and professor at the Department of Social Work of the Fachhochschule Frankfurt-am-Main. Her main research areas are sociological and psychological aspects of alcohol and other psychoactive drug use and abuse in the past and at present; prevention of addiction and addictive behavior; health problems in the female life cycle and family violence; counseling institutions, counselors, and the counseling process for addicts; and sexual abuse in counseling and therapy. Her published books include Für alle Leiden gibt es eine Pille [For all suffering there is a chemical cure]; Alkoholikerinnen [Female alcoholics]; Drogen und Drogenpolitik. Ein Handbuch [Drugs, drug policies and politics: A handbook] (coauthored with Sebastian Scheerer); Beratung süchtiger Frauen: Konzepte und Methoden [Counseling female addicts: concepts and methods] (coauthored with Klaudia Winkler).

    Wang Zhengyan, China, MD, is a senior scientist at the Institute of Social Medicine of Tongji Medical University. Her research interests include the epidemiology of substance use and abuse and studies of prevention and treatment systems.

    Anna Xiao Dong Sun, USA, is a research assistant at the Institute for Scientific Analysis. A Chinese national, she is an undergraduate student in sociology at the University of California, Berkeley. Her research interests are social policy and addiction. She also conducts research into the formation of taste among American art collectors, a project funded by the University of California President's Fellow-ship. Her publications include a paper on Ezra Pound (Paideuma, forthcoming) and a number of short stories.

    Vladimir Zobnev, Russia, PhD, is a senior research worker at St. Petersburg's Psychological Research Institute. His current research is in medical psychology and narcology. He has published more than 50 works.


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