Johan Edman. Drugs and Alcohol Today. Volume 13, Issue 1. 2013.
We live in the era of evidence. On a more general level, this is our modernist heritage, a centuries-old quest for science, precision and rationality. Beliefs, opinions and superstition must be sacrificed in the name of progress. It is engineering that keeps bridges from falling down and makes airplanes fly, not blessings and pious hopes. It is progress in medical science that heals and eradicates diseases, not faith healers and household remedies.
In recent years, this trend has been reinforced as ever more fields of activities seek to implement evidence-based methods—especially health care has been the subject of these endeavours. Judging from the latest Swedish public inquiry on the subject (SOU, 2011:35), substance abuse treatment is also expected to follow this path. Superstition should be replaced by knowledge, ideologically coloured conceptions by truth seeking. This very aspect, that the rational and effective solution should free itself from its ideological luggage, has been a common point of departure in research on this topic (Fridell, 1996; Bergmark, 1998; Johnson, 2003; Bergmark and Oscarsson, 2009). My starting point is slightly different and unlike those scientists and politicians who have lamented the ideological element in Swedish drug policy and drug rehabilitation, I do not think it could be otherwise. I do not even think it would be preferable.
The aim of this article, then, is to analyze the role played by ideology by examining the political discussions on the drug problem and the bureaucratic management of drug treatment in Sweden during the years 1960-2000. I will discuss various approaches to drugs, drug abuse, society and the individual as these have characterized the political discussions and the bureaucratic handling of drug treatment. The empirical basis for the analysis consists mainly of parliamentary bills (PB) and parliamentary records (PR) from the Swedish Parliament, as well as archive material from the central bureaucratic management of the Swedish treatment centres.
The article begins with some theoretical reflections on ideology and de-ideologization. Next, I examine the national political consensus on the drug issue, the national political battles around the drug issue’s ideological status and the treatment services ideological content. The article concludes with a summarizing analysis.
The Drug Problem as an Ideological Battlefield
Since the late 1960s the drug problem has been the problem with a capital P in Sweden. The closed conversation circumscribing this problem has in several historical-sociological studies of the drug problem been described as a doxa (Bergmark and Oscarsson, 1988; Olsson, 1994; Tops, 2001), a concept borrowed from the French sociologist Pierre Bourdieu. The problem is portrayed in one way and one way only, and can be questioned only with the utmost difficulty. This discursive practice makes political consensus on the topic plausible since, in the words of Bourdieu (1977, p. 164), “when there is a quasi-perfect correspondence between the objective order and the subjective principles of organization […] the natural and social world appears as self-evident”.
On the other hand, the drug problem has proven so difficult to solve that the solution currently practiced can always be subject to criticism. Such problems are, according Room (1978, p. 40), “fertile fields for ideological entrepreneurship”. But, as has been pointed out by Freeden (2003), an intrinsic driving force in the ideology is to de-ideologize political questions. Hence, one of the primary political tasks, is to market ideological perceptions of reality as the only truth. Eagleton (2007) describes this as the doxic character of ideology, or as I prefer: the ideological dimension of the doxa. Ideologies assert legitimacy through universal claims, by presenting themselves as timeless, context-free, in harmony with common sense. Here, scientification appears as one of the more sophisticated techniques to conceal political interests.
Following Freeden (2003, p. 56), “vagueness and elusiveness are frequently necessary to […] the political agenda”. Any ideology must be sufficiently open for multiple interpretations and actions, but at the same time ideologies strive to “champion the ‘correct’ meanings of the political concepts to which they refer”, thereby achieving a closure of discussion (Freeden, 2003, p. 55). The political debate on the Swedish drug problem makes for a good case here, as all political parties agreed on some fundamental characteristics of the problem, but still were able to interpret the causes and solutions to the problem in several—quite incompatible—ways.
The doxic nature of the drug problem, including the naturalization and de-politicization of the problem description, are in many ways central to this investigation. First, this basic assumption helps to explain the power of the problem description and proposed solutions. Second, it should increase vigilance in the analysis of policy initiatives portrayed as uncontroversial matters of course, often supported by a massive political majority. Third, this description of the problem gives us tools to analyze the apparently nature-given cultural order, when energy and effort is spent on making party interests appear as self-evident.
The analysis requires a politicization of arguments and facts described as apolitical (Greven, 2001). In the study that follows, it is my ambition to show how problem descriptions and solutions have been anything but inevitable consequences of an unequivocal and objectively formulated phenomenon. The drug problem is highly political and the problem description has exceeded all bounds. Based on a solid political consensus that this has been the most serious social problem, representatives from different political camps have described and analyzed the drug problem in accordance with their general ideological point of views.
The Battlefield of Consensus
Just as the alcohol problem at the turn of the twentieth century, the drug problem has from the 1960s onwards come to illustrate a dissonance between the lives of some citizens and society’s demands. This characteristic paved the way for the ideological breadth of the descriptions of both the problem and the solution, when representatives from different political camps naturally saw the good citizen and the good society in different ways. At the same time there was a broad consensus on some basic features of the problem. Members of Parliament (MP) from the far left to the far right, agreed that the drug problem was the most serious contemporary problem, that it was a culturally alien problem that required extraordinary solutions, and that it was a problem whose severity could not be questioned. The Swedish parliamentary material is full of these consensual foundation bolts and here I will only share some illustrative examples.
The drug problem was not only serious, it was the most serious problem. There was talk at the end of the 1960s of a “unique” situation (Lower House Bills (LHB), 1967:231, p. 10) and that drug use could be considered “more dangerous than the atomic bomb” (Lower House Records (LHR), 1967:20, §14, p. 25). One distinguishing characteristics was the constantly deterioration situation, with increasing number of drug abusers, the declining age of drug use initiation, and the occurrence of drug problems over an expanding geographical area. The descriptions of the most serious problem never lost momentum and in the 1980s MPs still considered action against the drug problem as one of the most important tasks, more important than for instance measures against environmental problems, disarmament or development assistance (Bergmark and Oscarsson, 1989). Even in the 1990s, there was general agreement that this was an eternally important question. Warning cries were heard from all parties but none surpassed the Conservatives in the description of the problem’s fatal character, this “cancer in the Swedish society” (PB, 1982/1983:267, p. 3).
There was also cross-party agreement, tentatively proposed in previous research, elaborated on the drugs issue’s nationalistic undertones (Tham, 1992; Tops, 2001; Törnqvist, 2009). The evil came from outside and salvation lay in Swedishness and countryside. The unanimity across the political spectrum and the persistence of these views over time are striking. Just as the Communists had found a remedy to drug problems in the Swedish nation’s “culture” and “values” in the early 1980s (PB, 1982/1983:1840, p. 16), so could the Conservatives at the end of the 1990s declare that drug use “in our country is not [included] in our normative behaviour” (PR, 1998/1999:58, §3, p. 5). As something of foreign origin drugs represented the culturally obnoxious. The drug abuser’s lifestyle, for example, was “disordered, with jerky working and living conditions in the tracks of the so-called ‘fuzzy culture'” (PB, 1981/1982:207, p. 1). The repudiation of youth and music culture by the MPs forms a continuing theme throughout the period. A cultural war was imminent and the enemy was “the large so-called alternative culture”, populated by “rock musicians, prophets of the mystery religions, etc.” (PB, 1982/1983:267, p. 11). In the late 1990s, drugs were still the absolute antipode to a desirable bourgeois life and the cause of everything from “neohinduism, sects and gurus” to “desecration of graves, church fires and even murder” (PR, 1998/1999:58, §3, p. 4).
It is in the light of this serious, accelerating and culturally alien drug problem that one should consider the proposals for drastic measures. A kind of anti-intellectual opposition against arguments and nuances is evident: there was no need for new investigations, what was needed was “action” (PR, 1981/1982:153, §3, p. 181). Loud but unspecific calls for “vigorous efforts” (PB, 1982/1983:267, p. 3) were heard, and “a new determination against drugs” (PB, 1985/1986:Ju616, p. 1). Attempts to nuance the debate were something that must be “confronted” (PB, 1982/1983:267, p. 11). The drug abusers were not to be shown any exaggerated considerations, since they had already “lost their integrity precisely because of their abuse” (PB, 1985/1986:T256, p. 13). Drug dealers were even harsher judged and here a kind of death penalty with biblical resonance was advocated during the late 1960s: “It is better that a millstone was tied to his neck and he was drowned in the depth of the sea” (Upper House Records (UHR), 1967:45, p. 15).
Faced with the drug problem all political antagonism faded, and with it discussion over the extent of the problem. The party truce in these matters has been described as a Swedish feature in comparative research (Hakkarainen et al. , 1996a; Tops, 2001), but there are also signs that this doxic conversational order has permeated the discussions on the drug problem in countries like Norway (Christie and Bruun, 1985) and Great Britain (Jenkins, 2012). Towards the end of the 1960s Sweden’s Social Democrats, had noted a “relaxed and almost nuance free spirit” when discussing the drug question (UHR, 1968:10, p. 136). Parliamentary debates in the 1980s and 1990s were characterized by a possibly even greater consensus, both regarding the problem description and the preferred solutions. The mere suspicion of being mistaken for drug liberal, i.e. soft on drugs, disarmed all opposition and conceded an ever tougher drug control as well as a broad resistance to substitution therapies (Lenke and Olsson, 2002; Johnson, 2003; Skretting and Rosenqvist, 2010).
The spirit of consensus, the ambition to have the parliament working as a “coalition government facing a looming threat of war” (PR, 1996/1997:94, §5, p. 14), constitute in itself a democracy problem and may also explain why the policy area has retained its essential features ever since the late 1960s. At the same time, this consensus functioned as a background for ideological battles of a rather different kind.
The Ideological Battle
While there was consensus on a definition of drugs as constituting the most serious problem and the need for drastic solutions, there were significant differences over the link with overall social structural issues. All sides concurred on the link with modernization and urbanization, a well established explanatory model that had been used extensively in the turn of the century’s debates on prostitution and emigration as well as when the vicious youth was being discussed (Broberg and Tydén, 1990; Svanström, 2000).
The 1960s and 1970s were decades with big changes in the labour-market structure and a continued increase in urbanization, but also with a widely flourishing modernization criticism. The agrarian Centre Party gave political voice of the criticism levelled at the modern, urban society. The green wave, opposition to nuclear power and environmentalism found a sounding-board in the old peasant party and in 1976 the Centre Party made an outstanding election and won 24 percent of the votes, thus becoming the largest bourgeois party (Swedens Official Statistics (SOS), 1976). Therefore, it was with some confidence that the Centre Party took on people’s concern for the modern urban society that could be blamed for the drug problem. The cities were described as unnatural and destructive, as fertile soil for all sorts of social problems: “Much of the enormous problems we have today are results of the concentration philosophy, since it broke a big part of the community that is so fundamental to human security” (PR, 1978/1979:114, §4, p. 15).
All parties in the non-socialist group included representatives of a Christian perspective who traced causes of the drug problem to an ungodly society with an open door for substitutes in the form of Eastern religions, drugs and sex. A more common approach, however, was to see class background and class society as contributing to the problem. The argument can be found with both the bourgeoisie and the social democrats, but especially in arguments made by the Communists. In its mildest form, the Communist’s criticism was in line with other parties in parliament, and called for work, education and housing for people at risk of exclusion. But just as the Centre Party was obviously representing the views of rural constituents on the drug issue, so the Communists applied a typical Communist analysis. Accordingly, drug abuse was a symptom of class stratification and exploitation. The struggle should be conducted against drugs and drug abuse, but ultimately against the structures that favoured the social order. Individualization of drug abuse was described as a manifestation of “the most narrow-minded petty bourgeoisie sententiousness” (PR, 1977/1978:159, §1, p. 161). The drug culture was in fact “the bourgeoisie’s effective weapon against organized trade union and political activities with young people” (PB, 1979/1980:1885, p. 8). The Communist’s analysis of the drug problem became a “devastating critique of capitalist society’s way of functioning” (PR, 1979/1980:160, §2, p. 17), something a right wing government was not able to handle. “From the point of view of capital”, the Communists stated in a parliamentary bill in January 1980, “it is basically the same story whether you launch medium strength beer, amphetamine and heroin as launching skateboards, burgers or Travolta” (PB, 1979/1980:1885, p. 9). The Communists were also quite unique in explicitly describing the drug problem, as well as other political issues, as an ideological question:
We have a compass that determines our course. Faced with difficult social problems we always ask: What kind of outlook on people do a certain policy lead to, what kind of society will we get, what view do we take on the excluded and marginalized? (PR, 1984/1985:56, §3, p. 24).
It was clearly an ideological issue in both analysis and suggested actions. Representatives of other political parties were simply allowing themselves to be guided by false ideologies, such as “the faltering social liberals who now so tragically let themselves be bound as slaves to the triumphal chariot of the right wing” (PR, 1984/1985:56, §3, p. 25).
The Conservatives, by contrast, cultivated a more individualized causal analysis, where the drug problem was seen as a manifestation of “the welfare system’s failure” and the solution was sought in “a new spirit and knowledge demands in school, new attitude to work, a new approach where rights and obligations are set against each other” (PR, 1979/1980:160, §2, p. 37). In addition to socially and individually oriented explanations and proposed solutions there were arguments focusing on the family, predictable, perhaps, in a policy field where the problem often has been defined by putting various groups against one another. In the terminology of Bauman (1990) the drug abusers had become an out-group to contrast against one of the most common in-groups: the ideal family.
The bourgeois parties frequently argued for the need for family cohesion during the 1980s and 1990s. In one parliamentary bill from the Conservatives, it was stated that “the central role of the home and the nuclear family must be emphasized” (PB, 1982/1983:267, p. 10). Christian democratic solutions were spelt out as “authorization of marriage as a form of life together and of the parental responsibility”, financial assistance to families with children, including a sort of child-care allowance to parents with young children, and a cultural policy that promoted “the sanctity of human life” (PB, 1985/1986:So253, p. 2). From the 1990s onwards, the Conservatives made it clear that this family-centred problem description also was part of a larger ideological package, where the small world (family, friends, the local society) had to be organized to find collective solutions for broader problems. The families should be strengthened by “reduced pressure of taxation, childcare support and freedom of choice in child care arrangements” (PB, 1990/1991:So215, p. 4f), something that was expected to contribute to civil society’s responsibility for those at risk of falling into substance abuse. At the end of the 1990s the Conservatives completely let go of traditional problems descriptions and now the argument span around individual responsibility, the “natural” social networks and the tax systems corrupting effects on the individual responsibility (PB, 1997/1998:So615, p. 1).
The Ideological Treatment
On the stable foundation of consensus, the drug problem came to be politicized in the Swedish Parliament. General political matters such as housing concentration, secularization, class society or the pressure of taxation found a potent arena in the drug issue, a battleground for fighting broader ideological battles. The design of drug treatment services was delegated to the public administration, first to the National Board of Health and Welfare and from the early 1980s to the County Administrative Boards. These authorities issued permits, granted state subsidies and inspected the treatment centres. In the processes they elucidated what kind of treatment was regarded legitimate, but also what treatment the state would rather decline. In my study of the way in which bureaucracies dealt with 73 treatment centres between 1960 and 2000 it emerges that judgements are only rarely made about the effects of the explicit treatment modality. It is therefore possible to analyze the concretized drug treatment as an ideological project, by contrasting those drug rehabilitation programs that received permits and financing with others that were opposed by the central bureaucracy.
In the 1960s and 1970s, treatment of drug abusers came to work as a kind of microcosm of ideological conflicts over various modernization tendencies. This was a public program that took shape at a time when the Swedish countryside was depopulated and the cities grew. The urbanization that since the mid-1800s had filled the cities with an increasing proportion of the population did not slow down until the 1970s, and drug treatment services found their forms during decades when old poems about the cities destructive features were heard once again. The drug problem was clearly linked to this urban complex of problems and the green wave appeared as a background when seeking new solutions. Following a trend first set by institutional alcohol treatment in the late nineteenth century, many drug treatment centres were located in rural areas, as the country side was believed to have therapeutic properties (Prestjan, 2004).
From the descriptions of attractive treatment settings you can learn that a treatment centre in 1969 was situated in a “pleasant and protected environment” 60 kilometres from the nearest big city (Sjukvårdsförvaltningen, 1969), and in the late 1970s distance from the main cities was still considered as something positive. A certain rural romance marked several of the treatment initiatives as they wanted to treat the drug abusers in scenic locations, for example near a lake. It appears at times like a condemnation of modern and urban life, as treatment centre after treatment centre opened in beautiful rural settings, where clients were encouraged to cultivate, keep animals and set up a loom in the attic.
While there was no articulation of the physical environment as a treatment method in itself, many therapists were happy to stress the therapeutic qualities of the environment. Moreover, one of the most common methods—the therapeutic community—accounted for a very deliberate loosening of this boundary. Therapeutic communities represented an all-encompassing approach to the individual’s rehabilitation, the role of the collective, the surrounding environment and the content and meaning of the daily activities. The method was rarely clarified in the investigated material; all concerned were expected to understand what was meant by it, how it worked, that it worked. In the mid-1970s, most treatment centres also described themselves as therapeutic communities or milieu therapies (Sundin, 1975).
One can detect here the dissolution of the Gordian knot that came with social critical individual treatment. By creating an attractive treatment environment and by forming a therapeutic community, you could maintain your critique of the dysfunctional society while offering an alternative to this: a caring, compassionate, democratic and healing miniature society. Democracy was a prestige word within the drug treatment services, one of the many concepts that signalled good treatment. As a treatment principle, democracy became an important part of the treatment centres’ idea of themselves, certainly something of an antipode to the traditionally repressive institutional care of alcohol abusers in big institutions under strict disciplinarian regimes (Edman, 2005).
In several of the treatment centres studied, democracy simply spelled collectivism and quite often this was also understood as a form of socialism. This aspect of the Swedish drug treatment services as a state-sponsored political activity has been recognized by previous research and the reasonable question has been asked whether publicly funded social services should be allowed to adopt these forms. But this is also a highly understandable consequence of the drugs issue’s ideologically impregnated problem description. The symptom theoretical diagnosis is more or less predisposed to end up here, in suggestions on how to solve the real and underlying problem. If the real problem is a fragile psyche you will have to work on that; if it is about the degeneration tendencies of modernity, the solution might be sought in some kind of antipode to that, and; if we have identified capitalist society as the root of evil, it would be strange if socialism could not be considered a cure. The fact is that the entire rural craze to a high degree fed from a kind of anti-modernist feature with broad support in Parliament, where agrarian life and manual labour struck a chord with both the Communists and the Centre Party (Edman, 2013).
The authorities hardly tried to suppress this ideological element. On the contrary, the National Board of Health and Welfare quite often took for granted that the treatment centres should think big thoughts about society and the individual, noting acidly about one treatment centre: “Apolitical. Not very theoretical” (Harggården, 1978). Unsurprisingly, the treatment centres also allowed themselves more comprehensive goals: the clients should “act in political parties, trade unions and non-profit associations”, get “insight into the economic and political system”, take “their stand about their own cultural heritage” (Gälegården, 1978). The long list of positively connoted markers adds up to a grid for ideologically attractive treatment.
Social welfare and substance abuse treatment then became normalization projects for social drop outs where nation and tradition served as indicators and reference points. The few treatment programs not regarded legitimate by the bureaucracy were described as un-Swedish. The problem itself was identified as an imported phenomenon beginning in the early 1900s with American jazz musicians or in the 1960s with the US-influenced hippie movement. Foreign therapies were not resented by definition but if there were other reasons to object to a treatment program, then a suspicion could be thrown on their foreign character. For example, when Daytop was marketed as “an attempt at a total grip over the drug situation and something of a social movement” where the ambition was to “follow our American pioneers in the tracks” (Daytop, 1980), it was asking for criticism. Without any reference to specific treatment goals or methods Daytop was condemned as incompatible with Swedish culture and society, unworthy of the people’s movement stamp indicated and without basis in substantial tradition. It was a fundamentally nationalist and conservative resistance in which arguments about cultural differences and tradition were assumed to be sufficient. The National Board of Health and Welfare emphasized that this new treatment form differed “markedly from those therapies that have so far been tested in Sweden” and that it was hardly consistent with “the principles that have so far guided Swedish drug treatment” (Daytop, 1981).
Narconon was burdened by their association with Scientology and both organizations had their US origin held against them. Scientology was described as “anti-medical, anti-political and anti-democratic”, motivated by “economic interests” (Narconon, 1969). Frustration over this foreign culture is also reflected in the notes from an inspection in the mid-1970s, when “American terms and expressions, which are alien to us—on placards with graphs and charts and proverbs” were found (Narconon, 1975). Added to this were the scientologists’ and Narconon’s aversion to the symptom theoretical problem descriptions cherished by several agents in the social welfare debate. Scientology was characterized as “extreme in its individualism” and therefore as opposed to “the treatment ideologies that put the main focus of the problem on external conditions” (Nycander, 1977, p. 73). Narconon was, of course, not lacking an ideological agenda, but since they refused to discuss problems and solutions in more explicitly ideological terms they remained an odd player in the Swedish drug treatment services. When Narconon was finally approved as a treatment centre in the 1980s, this should not be seen as an indication that they had adapted to the Swedish authorities’ ideas about attractive drug rehabilitation in any more fundamental way. It is rather a sign of a trend in which the new regulatory and licensing authority—the Stockholm County Administrative Board—refrained from pursuing any ideological line of their own. Along with a number of favourable factors, this contributed to an unprecedented privatization of substance abuse treatment in the 1980s and 1990s (Ds, 1992:67; Oscarsson, 2000; Söderholm and Wijkström, 2002). Drug treatment was no longer an exclusive concern of passionate enthusiasts, but just another market during a period when more and more components of the welfare services were opened up to the private sector. The market solution more or less made the experimental method permanent, this being based on the implicit assumption that the best treatment initiatives would assert themselves on behalf of on the poorer.
The almost unregulated privatization of substance abuse treatment owes much to the County Administrative Board’s passive management (RRV, 1985:300; Ds, 1992:67; SOU, 1994:139; Söderholm and Wijkström, 2002), which in turn can be explained by the County Administrative Board lack of ideological engagement, a feature that had characterized the National Board of Health and Welfare’s bureaucratic management. But this less ambitious management also corresponds with a shift towards a liberal market ideology influencing the production of welfare services. Arguably, the creation of a pseudo-market for treatment services was one way of dispelling methodological uncertainty. This line of reasoning rests on the assumption, in this case false, of strong consumers (municipalities, clients, etc.) making well-informed choices about the best treatment. Also, since the liberal market ideology tends to de-ideologize other opinions on good and bad treatment, this would call for a bureaucracy with an articulated agenda of their own. But, as the passive administrator of the treatment market the County Administrative Board lacked this agenda, thus becoming significantly less inclined to control the treatment service provision and modality. As a consequence, treatment programs well adapted to the market solution grew during these years, especially 12-step programs (Stenius, 1991).
The drug problem could not be resolved in Parliament. However, the lack of research and evaluation, unpredictable methodology and the common understanding of the seriousness of the matter contributed to making this into an excellent battlefield for ideological battles. The unwanted drugs appear to be a sensitive litmus test, an indication that something has gone wrong in society and an indication of how the good society should be formed. Because of this the drug problem could be linked to ideological core values such as Christianity, class struggle or criticism of urbanism and modernity.
But these visions did not limit themselves to the parliamentary discussions. The treatment centres can be seen as carriers of ideology and at least until the early 1980s the treatment services stand out as a political left wing project. In relief against what may have been perceived as a solidified social democratic reformism, this alternative left wing movement was inspired by an existentialist pathos with the power of the collective and the individual responsibility as two driving forces (Salomon, 1996). But the practiced treatment initiatives did not only satisfy left wing urges for collectivism or a more manifest socialism. Rural settings and activities, Christian treatment homes and family home treatment are all responses to concerns about modernity, urbanism, secularization and the role of the nuclear family widely shared by the parties of the right. In that way, the drug treatment services that were set up satisfied a wide political field.
If we turn our attention to the non-legitimate treatment initiatives, we see clear examples of how the drug problem was made intelligible in terms of Swedish and foreign. Goldberg (2005) has in this tendency seen how drugs have been linked to euphoria and irresponsibility, a threat to what he regards as the strong position of industrious work ethics in Sweden. Drugs are something strange in this context, frightening and un-Swedish. Hakkarainen et al. (1996b) share this understanding as they emphasize strong conceptual impact in Sweden of the welfare state, how the universalist welfare idea could be threatened by drug use and drug users, and how measures against drug abuse therefore adopted almost patriotic forms. Tham (1992) has also traced the Swedish drug question’s nationalist undertones, but, as suggested by Ehn and Löfgren (1982), this othering of an experienced serious problem might actually be considered as a basic cultural technique for managing complex issues.
Some kind of meta-ideological passion for Swedishness will still be able to explain parts of the doxic consensus that constitute the battlefield of drug treatment. As reminiscences from the former turn of the century, the degenerated and contaminating modernity and urbanism is here contrasted to the natural and healing and life in the countryside. When one examines the arguments against Narconon’s and Daytop’s establishment, this nationalistic undertone returns. The foreign origin and the foreign influences, poor adaptation to Swedish conditions, all spoke against them.
The market-oriented development during the 1980s and 1990s walked hand in hand with new management models, quasi-market systems that took heterogeneous treatment contents for granted. A focus on efficiency and cost effectiveness, and the only vaguely articulated conceptions of preferred treatment by the authorities, contributed to a shift from control to evaluation (Krantz, 2009). The treatment services’ ideological content became less and less important. In addition to cost-efficiency, treatment quality came to be settled in assessments which gradually turned into the late 1990s and early 2000s medicalization of addiction and a craze for evidence-based solutions (Edman and Blomqvist, 2011).
However, drug treatment must be considered as an activity that in its entirety, from initial problem descriptions to proposed measures, is permeated by ideological conceptions. Recognition of this and other political issue’s ideological dimension is crucial for their democratic support and practical political development. As shown by Freeden (2003) and Eagleton (2007) and others, ideological structures are often to blame for not allowing discussions in ideological terms. The successful ideologist avoids the ideological conversation, naturalizes the ideology’s own premises and presents solutions as objective, technical and rational. This leads to a distortion of both the political discourse and the practical solution, why we should ask ourselves what the ideological starting-points and implications of today’s quest for evidence-based methods are. To recognize the drugs issue’s ideological disposition should therefore not be seen as way of avoiding discussions about the actual dilemma with drugs, it is rather an opportunity to seriously start a discussion on how to solve the problem.