The public as infrastructure in policy processes: The case of the abolition of the Swedish alcohol rationing system.

BACKGROUND: The Swedish political system is based on a strong tradition of commissions of inquiry, which work over the long-term to develop knowledge-based policy. This study explores knowledge processes associated with the work of such commissions, focusing on the case of the abolition of the Swedish alcohol rationing system. The point of departure is the 1944 Temperance Committee and its internal committee work, the committee's reports, and also the resulting governmental bill that led to the abolition of the rationing system in 1955. The focus is directed at how the public was used in arguments for and against the abolition of the system. METHODS: The article adds to studies of knowledge production in policy by presenting a case study of the various ways in which the arguments used in political processes rely on the public as a carrying infrastructure over the course of a political process. We use the concept of the infrastructure (Star, 1999) as a metaphor to engage with the way the public is taken for granted in policy processes, and with the discursive resources needed to move arguments forward within a political process. RESULTS: Political processes involve many activities related to the movement of knowledge, of which we have explored the use of the public as an activity required for the movement of arguments. The public is understood as providing both conversational and legalistic resources for moving arguments from one context to another. While the internal committee documents and the final bill allowed for an everyday use of the public in relation to arguments on hassle, annoyance and freedom, the committee reports combined the use of the public with formal arguments on legal processes and the public's sense of justice. CONCLUSION: Explanations of the movement of knowledge often miss the articulation work (Star, 1991) that takes place within policy processes. The public is indirectly present, as well-behaving witnesses used to emphasize arguments, and as such, they do plenty of work. At the same time, it is the committee documents that facilitate the presence of this public, which often lie far from the publics' actual potential to make their voices heard. Although a perception of the rationing system's lack of support in popular opinion constituted a backdrop to the work of the committee, there was little knowledge of the publics' actual views on the rationing system. We show that the public constitute a spoken rather than a material resource that proves quite effective: the public is rarely questioned as long as it is a restricted singular public that behaves well. To date, little attention has been focused on understanding the role of the everyday actors in relation to alcohol policy and other forms of drug policy. We argue that research needs to engage more with the way publics are allowed to indirectly or directly participate in policy processes and what knowledge and policy consequences this participation produces.

Förnuft och känsla - Kunskapsbruk hos gårdagens förbudskritiker och dagens alkoholliberaler.

Aim: The aim is to study non-governmental actors' production and use of alcohol policy knowledge in the early 20th and the 21st century respectively, by analyzing their main arguments, knowledge substantiation and their overarching discursive legitimacy. Design: The first impact focuses on prohibitionist-critical actors' engagement against the alcohol ban in the years 1916-1922. The second impact focuses on the Swedish think tank Timbro's engagement in alcohol policy in the years 2012-2020. The analysis of the two empirical cases was based on an open coding strategy with a focus on what type of knowledge claims that were made and how which reasoning was put forward in relation to these. Results: Great similarities are distinguished between the two time periods. Alcohol is an issue of freedom and at the same time a threat of crucial importance for the future society. The arguments are supported by historical, international, media and scientific evidence. The biggest difference lies in the legitimization of the argumentation. In the early 20th century this is rooted in democracy and the will of the people while the arguments of the 21st century are rooted in public health and governmentally sanctioned knowledge. Conclusion: The knowledge processes are explored as matters of political appropriation that takes place through processes of directing and stealing the spotlight. These processes show how the aspiring democracy and the existing public health policy respectively are productive preconditions for what kind of knowledge that can be brought forward. This enables a renegotiation regarding what democracy and public health policy can involve.

Great expectations: The bureaucratic handling of Swedish residential rehabilitation in the 21st century.

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".

A weak scientific basis for gaming disorder: Let us err on the side of caution.

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.

How can we conceptualize behavioural addiction without pathologizing common behaviours?

Following the recent changes to the diagnostic category for addictive disorders in DSM-5, it is urgent to clarify what constitutes behavioural addiction to have a clear direction for future research and classification. However, in the years following the release of DSM-5, an expanding body of research has increasingly classified engagement in a wide range of common behaviours and leisure activities as possible behavioural addiction. If this expansion does not end, both the relevance and the credibility of the field of addictive disorders might be questioned, which may prompt a dismissive appraisal of the new DSM-5 subcategory for behavioural addiction. We propose an operational definition of behavioural addiction together with a number of exclusion criteria, to avoid pathologizing common behaviours and provide a common ground for further research. The definition and its exclusion criteria are clarified and justified by illustrating how these address a number of theoretical and methodological shortcomings that result from existing conceptualizations. We invite other researchers to extend our definition under an Open Science Foundation framework.

Scholars' open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal.

Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.

Transnational Nationalism and Idealistic Science: The Alcohol Question between the Wars.

This article studies the interwar international conferences on the alcohol problem. How did they view the alcohol problem and its causes; what were the consequences for the individual and the society as a whole; and which solutions merited discussion? The first post-war conferences enjoyed an optimistic and internationalistic atmosphere, added to by American prohibition, which had given the temperance movement plenty to be hopeful about. But when the 1920s turned to the 1930s, the conferences were transformed into arenas for national solutions and into outright propaganda pieces. The responses to the alcohol problem debated in the interwar conferences built on a combination of scientifically masked ideological conviction and ideologically inspired passion for science. The apparently neutral ethics of such thinking was manifested in various radical measures to combat alcohol abuse.

Depoliticising the political: Market solutions and the retreat of Swedish institutional drug treatment from state management.

BACKGROUND: This article examines developments in the Swedish drug treatment services in 1982-2000 and explores the ways in which political initiatives and the state administration's management have contributed to the major privatisations of institutional drug treatment during this period. METHODS: The empirical basis for the textual analysis lies in official reports, parliamentary material and archived records from the Stockholm County Administrative Board's management of treatment facilities. RESULTS: The major privatisations of drug treatment services in the 1980s were both unintentional and unwanted and mainly arose from a lack of bureaucratic control and ideological anchorage. The privatisations were, however, reinforced by ideologically driven NPM-oriented political initiatives in the 1990s. CONCLUSION: The market-oriented treatment services have failed to fulfil the needs for diversity and availability within a publicly financed sector, which deals with unevenly informed and often socio-economically weak citizens. New management models in this field must ensure that ideological considerations are taken into account to meet politically decided goals and means.

Conceptual carpentry as problem handling: the case of drugs and coercive treatment in social democratic welfare regimes.

BACKGROUND: The drug and alcohol fields are characterised by continuous contestations of key concepts and the competing uses of concepts by various actors, in different geographies and over time. This study investigates the political processes leading to legislation enabling coercive treatment of (non-psychotic) drug users in Finland and Sweden from the 1950s until the early 1980s. The drug treatment policies are analysed through conceptual changes and innovations. METHODS: The article analyses conceptual discussions in public reports in Finland and Sweden, focusing on the work preceding the first legislations where both alcohol and drug treatment were included (in Finland 1961, in Sweden 1982). Theories from conceptual history are applied. RESULTS: The Finnish and Swedish discussions carry arguments from two periods of the Nordic welfare state: in an early development stage and a fragile situation in Finland, and in a more mature and affluent time in Sweden. The paternalistic arguments vary over time and between countries. Still, in both countries and time periods, the view of the drug problem as a youth issue, as particularly enslaving and on society's obligation to protect drug using individuals from damaging their future give enough motivation for coercive treatment. The conceptual work included avoidance of certain terms but in other cases, a broadening of their meaning, to adopt them to the political goals. CONCLUSION: Close analyses of conceptual history can reveal new features of drug policy struggles and show how central concepts in drugs and alcohol field are continuously contested.

An ambiguous monolith - the Swedish drug issue as a political battleground 1965-1981.

BACKGROUND: The drug problem has been a highly ideologized topic in the political debate in Sweden ever since the mid-1960s. The aim of the article is to investigate dominant conceptions of drugs, drug use, society and the individual in the political discussions on drug use in Sweden during the years 1965-1981. METHODS: The empirical basis for the textual analysis consists of 146 parliamentary bills and 135 parliamentary protocols. RESULTS: The unwanted drug appear as a sensitive litmus paper, an indication that something had gone wrong in society and as a suggestion of how the good society could be accomplished. The drug problem was connected to ideological core values such as class struggle, Christianity or criticism of urbanism and modernity. CONCLUSION: The analysis suggests that the drug problem was used as political ammunition, to pick holes in political opponents and to highlight one's own ideological stance. The hegemonic conversational order, the consensual spirit and the agreement that this was the most serious problem, did not hamper these political moves. Rather, the cross-party conception of the problem's severity and accelerating deterioration contributed to a common ground for political arguments and ideological visions. It also meant that the political discussions moved away from the more obvious drug policy issues.

An all-embracing problem description. The Swedish drug issue as a political catalyst 1982-2000.

BACKGROUND: This article examines the political formulation and ideological solution of the Swedish drug problem in 1982-2000. How was the drug problem described in the Swedish parliament at the time? How serious was the problem and what solutions were proposed? What were the ideological implications of the problem description, and how was the general political and ideological solution formulated? METHODS: The empirical basis for the textual analysis consists of parliamentary bills, government bills and parliamentary records discussing the drug issue during the years 1982-2000. RESULTS: In the prevailing spirit of consensus in the Swedish parliament at the time, both left-wing and right-wing parties portrayed drugs as a threat to the nation, people and the welfare state. Still, as the ideological dimension kept growing stronger, the drug question functioned even better as an arena for political discussions and ideological positions than in the 1970s. CONCLUSION: Compared to previous decades, the problem description broadened during the 1980s and 1990s, and the drug problem could be used to support arguments on almost any topic. The drug problem became a highly politicized issue about whom or what to change when the individual and the society clashed, but also about what the individual and/or society should be changed into.