Controlling Illegal Drugs: A Comparative Study

Sandro Segre
Aldine de Gruyter: New York
0202307174 (pb); 0202307166 (hb)
$ 26.95 (pb); $ 53.95 (hb)
v + 237pp.

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Front Cover Controlling illegal drugs is an important goal for many governments and it is difficult to decide which policies are most effective in achieving this aim. Professor Segre aims to answer this question by comparing the drug policies of three countries, Sweden, USA and Italy. These countries are chosen because of their different approach to the provision of social welfare. Sweden, at one end of spectrum, has extensive government welfare and social services. Italy occupies the middle ground and the USA adopts a relatively non-interventionist approach.

Chapter 1 describes and compares the main drug policies of Sweden and the USA, particularly those aimed at preventing drug use or reducing drug use and drug harms. Included are drug enforcement, social justice, drug education, drug treatment, and social welfare policies. Social welfare policies, which include social benefit payments, employment and housing initiatives, are of particular interest and represent a departure from the traditional health policies familiar to most public health specialists.

Chapter 2 outlines the theoretical benefits of the drugs policies and suggests the higher rate of drug use in the 1990s in the USA (4.4% of the population) compared with Sweden (0.23% of the population) is attributed to the differences in social welfare policy. Chapter 3 assesses the possible evidence for this theory and concludes that compared with the USA, Sweden spends proportionately more of its Gross National Product on welfare interventions and less on drug enforcement measures.

Chapters 4 and 5 further assess the consistency between the policies and the expected outcomes. Chapter 4 establishes a link between deprivation and drug use and concludes that policies which seek to improve social conditions such as housing, employment, education and health are likely to succeed. Thus Sweden is better placed to limit the disadvantages of poverty and deprivation including drug use. Conversely repressive policies, that dominate the USA agenda, seek to criminalise and imprison drug users, and lead to further marginalisation, social deprivation and ultimately more drug use (Chapter 5).

Italy's drug policies are described in Chapter 6 and in Chapter 7 the potential benefits of these policies are compared with those of the USA and Sweden. Segre returns to a similar thesis postulated in Chapter 4 that the difference in the prevalence of drug use (this time drug injecting) between Sweden (0.7% of the drug using population), Italy (5.4% of the drug using population) and the USA (23% of the drug using population) is attributed to the expenditure on getting people off drugs. The general conclusion reached in Chapter 8 is that high government expenditure on social welfare and health programmes compared with repressive legalistic policy favours less drug use (p203).

On the whole this is an interesting book because it raises the possibility of tackling drug use through social policy. This theory is appealing, however much of the book consists of statements that are unsupported by empirical evidence. Thus, we are left with the theoretical possibility that these policies might work. Important questions are left unanswered: How effective are these policies in reaching extremely marginalised groups such as chronic injecting drug users? Is there any evidence that they are able to prevent drug use or fully rehabilitate chronic drug injectors into society after many years of unemployment and crime?

I found the book rather long and much of the argument underpinning the theories seem abstract and disconnected from the subject of the study. The main theories could be outlined in an average sized academic paper (perhaps they already are). In fact I would recommend you read the final chapter (p189-p205), which aptly summarises the book. It is also difficult to make systematic comparisons between the three countries. Italy, for example, is introduced for the first time half way through the book. There is a lack adequate sub-headings and tables are rarely used to compare the policies of the three countries. Admittedly some of these problems may be attributed to translation from the original Italian text. The overall result is that important points are often difficult and frustrating to find. This is unfortunate given the potential importance of the work.

Lawrence Elliott
School of Nursing and Midwifery, University of Dundee