An interview with: Dr Axel Klein
Interview by: Margaret Adolphus
Print view Dr Axel Klein is Lecturer in the Study of Addictive Behaviour in the Centre for Health Service Studies at the University of Kent, UK. A social anthropologist by training, he has worked for both the charity sector (ISSD, DrugScope) and inter-governmental agencies (EC, UNODC), and has conducted fieldwork and evaluations in over 20 countries, including Afghanistan, China, Jamaica and Nigeria.
His interests include problematic and recreational substance use, the culture of consumption, drug policy and criminal justice reform.
About the journal
Drugs and Alcohol Today aims to bring readers the best in new thinking on drugs and alcohol practice, in a jargon free and accessible way. It is aimed at anyone interested in drugs and alcohol issues, and in particular those involved in tackling the problems associated with their misuse.
The journal is one of a number of Pier Professional journals (www.pierprofessional.com) on health and social care topics that were acquired by Emerald in February 2011.
Editorial focus
Can you describe the aims and mission of the journal, as well as its audience?
The aim is to contribute to the formulation of more accepted, realistic and humane policies, to promote good standards and practice, and to engage in a series of overlapping debates.
The audience is a curious mix, which reflects the fact that the field is both one of theoretical enquiry based on an interdisciplinary model, and one of policy and practice. So, we appeal to a multi-constituency audience of practitioners, researchers and policymakers.
How do you see the journal developing now you are part of the Emerald stable? What are your current and future plans for the journal?
The journal’s focus won’t shift and the debates won’t change, but we shall have a better opportunity to promote it and reach a wider audience.
We will also gain a greater academic credibility from being part of the Emerald stable, and I think the recent attention caused by the article by Fiona Measham [on Methodrone and Bubble, which was picked up by The Observer, see Measham et al. 2011] will help.
I also hope we shall gain more credibility among practitioners, and have an impact on policy, difficult though that is.
Will you try to extend the journal’s international appeal, if so, how?
By its very nature this is an international field. Drug control was always considered an international issue both in policy and practice.
So in the UK as elsewhere we are very much restricted by international agreements, and, in order to push radical change at local level, we need to address international conventions.
There are three international treaties (1961, 1971, 1988) which define the framework within which national drug policy is made, and these need urgent revision.
It’s interesting that in the UK there is much discussion about subsidiarity and the European Commission, but you never hear any complaints about how the UN drug conventions restrict the policy options for the UK government.
These are restrictions which every country faces, so policy discussions are by their nature international. I would hope to engage with an even wider audience, and find more practitioner contributors.
Some of our main concerns are: how you deliver treatment, how you avoid the spread of infectious diseases, how you engage drug users, how you avoid stigmatization. These are generic issues which are relevant to practice everywhere.
On the other hand, I wouldn’t want to publish something which had only local relevance, and which was therefore outside the experience of our core, UK-based readership. I’m looking for topics which have enough commonality so that readers can draw their own inferences and conclusions.
What are the sorts of issues on which UN conventions rule?
There’s a whole range of issues, but the conventions stipulate that a growing list of previously traded substances are controlled, and that there production, distribution and use is criminalized.
This in itself generates criminality at an international level, ranging from property crime to civil war. So our editorial position is to urge a shift toward a regulated drugs market. That way you would have regulated substances available to people who need or want them, and we would need to develop and experiment with various models for regulation and use.
Do you hope that the journal will contribute towards a change in policy?
That’s a big ambition. What I would say is that there are a whole range of journals in the field of drugs and alcohol, most of which are either not involved in policy discussions, or tacitly support the current control system.
I think that many of the problems around drug control, not only the medical issues but also those of criminal justice, are a direct result of our policy environment.
It is one of the unique selling points of Drugs and Alcohol Today that it is openly critical of the policy environment, and tries to open a debate on alternative policy.
Audience
How do you achieve a balance between research, policy and practice, and the various professional communities?
I think we have to distinguish between between policy and practice. There is a definite link between research evidence and practice, but none between research and policy.
There are various examples but the most interesting one is cannabis classification. Cannabis was first downgraded to Class C in 2004, and then re-upgraded to Class B. This was completely against the evidence, which showed firstly that cannabis consumption fell during that period, and secondly that its use caused no medical harm. On the other hand, there are significant problems for people who have criminal records as a result of their involvement with cannabis.
Then there was the whole business with the UK’s Advisory Council on the Misuse of Drugs, when the chair, Professor Nutt, was sacked for openly saying that more people suffer injury from horse riding than from taking MDMA. This was a statement of fact but it was an unacceptable statement of fact because it ran counter to a government policy.
It’s almost as if the political capital which people make out of taking a particular line on drugs outweighs all the benefits that alternative policies would yield. So there is no link between evidence and policy.
However, practice is strongly influenced by policy. In the UK, drug treatment has benefitted immensely from an investment made by the last government, the rationale of which was crime reduction.
The idea is to use drug treatment as part of a crime reduction strategy, and possibly because of this unusual goal for a public health initiative, there is a lot of interference by bureaucratic agencies. One result is that the more care-giving, therapeutic aspect of treatment has almost disappeared. We had a couple of papers on this topic, where practitioners were writing about their own experience, where they have no time to talk to their clients.
All they do is run through computerized risk assessments, and then the data goes back to the National Treatment Agency which designed them with good intent, to measure the effectiveness of policies. But it’s turned into a sort of self perpetuating end in itself, where you just gather data for the sake of feeding a wretched machine.
The problem with the data is that it’s just descriptive, it’s no longer analytical and as a result client care has been lost. This an example of an area where we are trying to expose problems and say look, we have to keep a focus on care provision and on what the research is telling us.
How ready are the practitioners in this field to read about the research?
I teach practitioners, so I know that they read. We have to change the format of what we are asking them to read. People in practice are very uncomfortable and impatient with the standards of the academic genre, the way authors cover their bases or explain their conceptual positions.
The first thing I did when I took over as editor many years ago is to try and divide papers into different sections so they can be read by different audiences: descriptive or exponential papers about a particular programme or intervention, and the more academic papers.
I hope that practitioners will read the latters’ abstract at least, indeed some may read the whole article. However, most don’t have much time to read, although they want to know what is going on. The research will get through to them, through the ongoing training which they have to do.
From what types of backgrounds (i.e. disciplines, practice areas etc. ) do your authors come?
Generally it divides into two groups – there are those doing social research, coming from a background in sociology, criminology or anthropology.
Then you have psychologists and others working in the field of mental health. I’ve also had people writing about the chemistry or pharmacology of drugs, but the real topos of the journal is the social aspect of drug use and drug control.
Content
Can you give me a broad indication of the types of themes you cover?
First of all, the journal looks at substance use, rather than abuse. That word prejudices you to linking drugs with problems.
Obviously there are problems and risks, but drugs are also a great source of pleasure. The vast majority of drug experiences are non problematic but that’s occluded from public view, and this is one of the things that I’m trying to bring out.
What are the patterns of drug use and what do they tell us about both risk and problems? What do they tell us about society? What do they tell us about policy, because may be we have to adjust and adapt it?
(I’m talking about mind-altering, habit-forming drugs which are used recreationally. Things like nicotine addiction tend to be a separate discourse, and if you show up at a drug treatment centre you will be referred somewhere else.)
That is one focus; the others would be policy, which we have already talked about, and then the delivery of treatment for people experiencing problems.
As an example of the latter, we like to publish papers which describe new models of practice, which can offer new evidence and which can hence shift perceptions.
For example, in the field of alcohol, there’s a longstanding tradition that the goal is total sobriety.
But evidence is emerging that you can get people in the position of being controlled drinkers, which is where they want to be. The idea of sobriety may be off-putting and cause them to give up treatment [see Coldwell, 2004 and 2005].
These three strands are closely interrelated at the point of practice, because practitioners work within a policy framework which has generated a number of problems both medical and in the criminal justice field.
What are the qualities you look for in an article, and how to you maintain quality?
I have a review process for academic papers, which looks at the way the research is tied into the literature, how authoritative are the methods, the claims of the evidence, and whether the findings are convincing.
For ones written by practitioners, I am looking for the way people present their experience. I’m not too concerned about a particular writing style providing it’s accessible and fresh.
Often an article will be merely an advertisement for a particular agency, which is no use for the journal; I am looking for critical reflection and experience (bad as well as good) presented in such a way that people can learn from it.
Fiona Measham’s research on mephedrone has had great impact: Measham et al.(2010) won an award from the European Monitoring Centre for Drugs and Drug Addiction, and a follow-up article (Measham 2011)was featured in The Observer. Why do you think that the work has such an impact?
Measham and her group of researchers have been conducting a longitudinal study of particular party drugs and their misuse, and we’ve been lucky enough to be chosen as publishers for the last two articles.
I think it was the title of the second article which attracted The Observer. Mephedrone hit the headlines last year because of its association with a number of deaths.
The initial deaths were then subsequently revealed to be completely unassociated with the drug but the government committee on drugs rushed through a very superficial assessment to allow the Home Office to bring the substance under control.
So the paper looks at the impact on patterns of use in clubs. It found that although mephedrone is still being used, it’s mainly been replaced by a whole range of other similar substances which are no longer identified.
Whereas previously people could obtain mephedrone legally from Internet suppliers, now they are taking other substances and they don’t know what’s in them.
The argument is, people will carry on using mind-altering substances, whatever they can get hold of, so isn’t it better better to use devils we know, which are less risky than unknown substances.
The previous article that won the award brought out similar findings about patterns of consumption within the clubbing community. It had a good fieldwork method, talking to people who are actually in the process of using drugs.
Much drug research is based on people in prison or in treatment, so they are talking retrospectively once they have been compromised. The paper we published was based on talking to people who are active drug users, but still in control of their lives, and you get good data on their choices and preferences.
I like the idea of ethnographic research, however you mustn’t overwhelm people with detail or descriptions. The art lies in abstracting enough information from the data and then, as Measham and her colleagues did, drawing some interesting conclusions.
Maybe this is something that we can do with Drugs and Alcohol Today, provide a forum for this sort of ethnographic, descriptive and exploratory research.
Would this need to be followed up with quantitative research?
I’m not sure what more quantitative work would add, but I would like to see more articles giving a pharmalogical viewpoint on issues connected with the delivery of health care and health promotion, and how you can get these messages through to practitioners.
What are the various synergetic risks of different drug combinations, and the physical problems that could ensue, which the people taking the drugs should be aware of?
Similarly, with Briggs’s article on binge drinking in Ibiza (Briggs et al., 2011), it would be quite interesting to do follow-up on what happened when people return from these sorts of holidays; I talked to a Danish colleague who said that unsurprisingly they often get very sick, so what are the risks and medical implications.
Your background
How did you become interested in substance abuse?
I have always liked substances such as red wine and chocolate, and certainly have problems with my use of the latter! (We haven’t published anything on chocolate, but I would always keep an open mind on any submissions.)
I also like the subject’s complexity and the way it is situated in a social context. I found the demonization aspect of the drugs issue fascinating: there’s a rich underlying discourse and an underlying disapproval. There is no strong medical evidence, so what is it? I like the idea of demystifying the issue.
Have you ever taken any mind altering drug?
Well as I consider myself to be an authority in the field, I have to speak to a number of audiences and the audiences will always judge you.
If I speak to people who are advocating drug use or who are former users, then I will try to understand the experience, which I wouldn’t be able to if I haven’t taken it.
On the other hand I also talk to people who are passionately opposed to drugs and, if I said I was a drug user, then they would blame the line I took on that.
So I just take the Fifth Amendment on that and say, I cannot possibly reveal my own personal pattern of consumption, as it would colour the way you perceive my views on anything.
Can you talk a bit about your current research interests, especially your new model for substance abuse?
I’m currently writing about poly-drug use: for example, how do people combine different substances and when, and what does it tell us about the user?
I’m a member of a sub-group of the Advisory Council of the Misuse of Drugs where they talk about poly-use, and the assumption here is that there’s such a thing as mono-use, and that somehow mono-use is fine but poly-use is terrible. I think that this is just a repetition of the discussion on drugs in general that hasn’t led anywhere.
My second interest is to bring systems theory into the drug control debate. I’m using sociological thinking to develop ontological rather than functional systems, which explains the way that drug control can be so resistant and obdurate in the face of contravening evidence.
There are various interests and constituents which interlink, particularly the medical and criminal justice fields. People tend to justify their own position by referencing to explanations delivered in disciplines outside their own, which I call cross domain referencing.
I also want to look more at the way institutions like like the United Nations Office on Drugs and Crime and the International Narcotics Control Board have evolved.
And finally...
What are your views of the effect of the current economic climate, and the budget cuts in the health and social services sector, on services and research in the field? Do you intend to publish on this topic?
We hope to publish a few papers in the area of payment by results, the new model for service delivery.
Also, what will be the effect of cuts in government funding. I think we will see more use of cannabis, which is much cheaper than alcohol.
It will also be interesting to see the effect on the underground economy, as licit employment opportunities decline, more people will become involved in the drugs economy. One result might be cheaper drugs, which ironically might mean less crime!
References
Briggs, D., Turner, T., David, K. and De Courcey, T. (2011) "British youth abroad: some observations on the social context of binge drinking in Ibiza", Drugs and Alcohol Today, Vol. 11 No. 1, pp. 26-35.
Coldwell, B. (2004) "Back in control – putting controlled drinking back on the agenda", Drugs and Alcohol Today, Vol. 4 No. 1, pp. 35-37.
Coldwell, B. (2005) "Abstinence and controlled drinking Success under any name remains a triumph", Drugs and Alcohol Today, Vol. 5 No. 1, pp. 23-26.
Measham, F., Moore, K., Newcombe, R. and Smith, Z. (2010) "Tweaking, bombing, dabbing and stockpiling: the emergence of mephedrone and the perversity of prohibition", Drugs and Alcohol Today, Vol. 10 No. 1, pp. 14-21.
Measham, F., Moore, K. and Østergaard, J. (2011) "Mephedrone, “Bubble” and unidentified white powders: the contested identities of synthetic “legal highs”", Drugs and Alcohol Today, Vol. 11 No. 3, pp. 137-146.
Publisher's note
Dr Axel Klein was interviewed in November 2011.
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