Background: Drug policy is a polarized and value-laden policy area with divergent interests of stakeholders. Through a Swedish case study, this article examines stakeholders’ strategies to influence drug policy, and perceptions of their own and others’ opportunities to influence drug policy—a topic that has not been systematically analyzed previously.

Methods: The analysis of 38 semi-structured key informant interviews with stakeholders within the national-level drug policy field drew on concepts from research on political access and influence strategies.

Results: Most stakeholders used both ‘direct’ and ‘indirect’ strategies when trying to influence drug policy. The majority perceived having opportunities to influence but they agreed that the voices of people who use drugs (PWUD) and significant others remained unheard. Stakeholders’ power and interest varied within the drug policy field, as did their resources, often serving as a doorway to political arenas and greater influence.

Conclusion: This study highlights the variety of strategies stakeholders use in drug policymaking, and how stakeholders’ resources are connected to their power and opportunities to influence drug policy. Consequently, power outweighs interest, leaving PWUD and significant others in a weak position. A political will is necessary to ensure more equitable stakeholder involvement in drug policymaking.

In April 2024, the Department of Public Health Sciences and its Center for So-cial Research on Alcohol and Drugs (SoRAD) at Stockholm University, hosted a Nordic conference for social science researchers in the field of ANDTS (Al-cohol, Drugs, Doping, Tobacco, Gambling). The conference was prompted by the decline in Nordic cooperation and comparative research in this area. It was funded by Forte (the Swedish Research Council for Health, Working Life and Welfare), and brought together about 70 researchers. The conference focused on comparative research on different addictive substances and behaviors, countries, research methods, and themes, e.g., policy, youth and migration. The conference opened with a theoretical presentation on Nordic cooperation, the relationship between Nordic cooperation and the Nordic welfare state, and the Nordic as a political concept. This was followed by an exposition of the visions and advantages as well as the challenges and reality of conducting Nordic regis-ter-based research. Next, the first day offered an overview of some recently finished Nordic comparisons. These looked at adolescents use of novel tobacco and nicotine products, labor market integration of adults with substance use problems, privatization and marketization of substance use treatment, emerging trends in harmful types of gambling according to helpline data, and older peo-ple’s drinking habits. These presentations covered Denmark, Finland, Green-land, Iceland, Norway and Sweden. The day was concluded with reflections on 35 years of experience in conducting Nordic comparative research. The second day was devoted to an in-depth look at topics of great interest and comparison in recent years: Drug policy, harm, reduction, and drug-related crimes; Regis-ter studies, mortality, and migration; and Adolescents/young adults’ substance use and well-being. On the last day, the conference looked ahead towards pos-sible comparisons by focussing on the importance of regulating harmful indus-tries, like alcohol and gambling. Two big research programs were presented: one on deaths of despair among young people, and one on the future of social work with substance use in a changing treatment system. Finally, new ideas on how to return to the study of organized activities of people who use drugs in the Nordic countries were outlined. The conference was well-received by the participants, who called for continued opportunities to gather and discuss re-search. Possibilities for continuing this work will be explored.

Background. Drug policy is prone to build on rationales based on different moralities rather than evidence. Less is known about how moralities influence drug policy implementation in practice. The aim was to analyze expressions of moralities among local policy-makers, professionals, and drug users in the context of the Stockholm needle and syringe exchange program (NSP).

Methods. Using political documentation from Stockholm (2003–2016), focus group (12 NSP staff), and 32 drug user interviews, moralities concerning drug policy and harm reduction were analyzed based on moral foundations theory and boundary work.

Results. Three main moral dilemmas were identified concerning the subjects, aims, and orientation of drug policy: whether drug users are worthy of inclusion to society; if the general public should be prioritized or the health of drug users, and the orientation of practices as based on control or autonomy. Policy debate was driven by virtues such as purity and authority, whereas staff and drug users valued care, fairness and liberty.Conclusions. The prohibitionist and abstinence-oriented Swedish drug policy has created social boundaries on the practice-level. Hence, users’ perspectives, and those who care about them, should be extensively involved in political discussions to foster a more moral and humane drug policy.

Varför påstår människor saker om hur tillståndet i samhället är och borde vara? Mot vilken bakgrund görs anspråk på att veta vilken väg som är den rätta? I Den svenska berusningspolitken under­söker författarna detta genom att gräva djupt i över hundra års historia. Vi får följa ­utvecklingen från förbuds­omröstningar, forskning, styrning, experimen­tell ­narkotikaförskrivning till nu­tidens debatter om Systembolagets framtid. Dessa exempel belyser hur Sveriges restriktiva syn på berusningsmedel har varit allt annat än enhetlig. Innovativa lösningar har prövats och berusnings­problemet har betraktats på olika sätt beroende på substans och tidens normer. Boken visar att kunskap oavsett om den är erövrad, påstådd eller erfaren ofta gynnar dem som har en agenda för sitt agerande, vilket synliggör att kunskapsbaserad ­politik ofta består av politikbaserad ­kunskap. Det här är en bok som manar till eftertanke om hur vi hanterar kunskap om berusning och samhälle.

This article explores morality and credibility struggles in connection to two officially sanctioned public Swedish experiments launched in the late 1960s to investigate the (ab)use of alcohol and illicit drugs, especially in relation to young people, and the subsequent decisions to terminate the experiments and research. We argue that these 1960s struggles on how to analyze the effects of increased availability of psychoactive substances must be understood in the light of a simultaneous development of modern (social) science studies. The public display of conflicting expert views on how to investigate and interpret questions of alcohol and drugs in modern society played out in concordance with the growth of social science alcohol and drug research and expertise. The article focuses on the 1960s, a decade that was characterized by profound transformations in Swedish society. In so doing, the article contributes from the perspective of history to debates on the nexus between knowledge production and policy in modern societies.

Sweden and the other Nordic countries have held an alternative way to many other countries of understanding and responding to substance use and addiction. The non-medical approach grew particularly strong in the 1960s, but this social perspective has, since the 1990s, become increasingly challenged. This chapter outlines the social understanding and the developments within substance use treatment (SUT), policy, and everyday society in Sweden. A renewed medicalization began at the turn of the millennium, and has accelerated in more recent years, increasingly so due to an underlying brain disease model of addiction (BDMA) and sometimes also by outspoken BDMA arguments. Some explanations for the BDMA’s entry into the Nordic non-medical stronghold are: the medical perspective embedded in both evidence-based practices (EBP) and New Public Management (NPM), and the related fragmentation of the treatment system and demands for cost-effectiveness, communication and public outreach. Explanations are also found in worldwide trends, e.g., a mainstreaming of diagnoses; the public health movement; drug-related deaths and a push towards medical harm reduction measures; and, most recently, by a BDMA rhetoric emerging in public and policy debate and SUT. Understood from processes of ‘copresence’ and ‘vaguification’, the BDMA is in line with these forces driving towards a biomedical understanding of substance use problems.

Vetenskap syftar till att säkra kunskap, men är samtidigt en osäker process. Det märks exempelvis om man skärskådar relationen mellan vetenskap och politik i den svenska välfärdsstaten. I detta häfte undersöks och diskuteras utifrån ett vetenskapshistoriskt perspektiv hur berusningspolitiken utformades och begripliggjordes under 1960- och 1970-talen. Särskild vikt läggs vid den betydelse som statistiska kvantifieringar kom att få för att etablera kunskap.

Background and aims: Increasingly, efforts to counteract perceived problems in drug treatment at residential rehabilitation centres have come to rely on measures drawing on evidence-based practice (EBP). However, the Swedish media, government inquiries, and international research have identified a number of problems regarding both residential rehabilitation and EBP. This suggests that caution should be exercised when placing expectations on EBP. The aim of this study is to investigate how the responsible authorities have handled increasing demands for EBP with administrative control while facing critical evaluations of their steering and implementation efforts. The study examines the maturation of a widespread treatment ideology, which aims to be based on evidence, in a country known for its restrictive drug policy and its goal of becoming a drug-free society. Methods: Through a qualitative textual analysis of 17 years (2000-2016) of inquiries, directives, and authority archives we have traced the interplay between problem descriptions, intended goals, and implemented solutions. Findings: The analysis shows that the ambition to provide care and welfare based on EBP is still an ambition. Also, the authorities' control over the care actually provided still leaves room for improvement. Recurring criticism and the empirical material indicate that the expectations have not been met. Conclusions: We would like to suggest that continued frustration can be traced to the misconception that EBP is the opposite of values and ideology, and hence preferable. As drug treatment strives for scientific credibility to give it legitimacy, some types of evidence are preferred above others. We would like to suggest that we need to bring ideology to the fore, and openly discuss our restrictive policy goals and choices of evidence.

Since the turn of the millennium, calls for evidence-based drug policy have become increasingly louder. In response, researchers have generated a large body of evidence in support of measures such as needle exchange programs (NEPs), while another strand of research testifies that policy makers often neglect to take the research evidence into account and hence fail to introduce these programs. This article studies the interplay between research-based knowledge, values, and policy making during 16 years of intense parliamentary debate in Sweden on the needle exchange issue. In 2000, the future of the two existing experimental NEPs was uncertain; in 2006, the regulations were reformed; and in 2015, they underwent a government inquiry. Both the reform and the inquiry aimed at regulating and expanding the programs. The analysis is guided by work done within the tradition of science-policy nexus, where the increased emphasis on evidence-based political measures is problematized. As drug policy arouses normative and ethical concerns, the analysis also explores values. The study illustrates the central role that values play in a policy field which is repeatedly declared to be science based. Within the overall framework of the Swedish drug policy ideology of a drug-free society, the advocates of NEPs framed drug misuse as a consequence of either an unjust society or a disease, arguing that because misuse is a condition beyond the control of the individual, the Swedish welfare state has an obligation to take care of those affected. For their part, the opponents framed drug misuse as a result of misguided attitudes, which would only be corrected by restrictions and prohibition. In their view, NEPs are a tool for drug policy liberalization. In the debate between the two positions, research evidence played only a minor role.