Tuesday, 14 January 2014

Beyond a ratchet model of drug policymaking

Today I read a ‘for debate’ academic article published in Addiction: Alex Stevens and Fiona Measham arguing that current British drug policy operates according to a ‘ratchet’ process, whereby the tendency is for restrictions and controls to be applied, and this is a one-way street as the restrictions are (almost) never downgraded.

Stevens and Measham obviously feel the need to justify the article, as they acknowledge that many people will feel the argument is so obvious it doesn’t need an article dedicated to it.  However, it might seem necessary in light of the reclassification of cannabis downwards (before it came back up) and the coverage of Peter Hitchens in the media arguing that there has been no war on drugs.

The analogy of the ratchet is chosen because (in general) the argument is that once action is taken, it’s unlikely that it will be scaled back later.  However, in itself this is not negative – or perhaps even worthy of comment.  If we believe in a particular approach or action that is being ratcheted up, we can see this as progress in a consistent (and positive) direction.

The reason Stevens and Measham see the ratchet as a critique is the direction policy is heading in: towards control and prohibition.  This, they suggest, is not an effective evidence-based approach for reducing drug-related harm.  That is, the ratchet trend direction is more important than evidence, which is only used (through ‘absorption’) when it fits the pre-determined narrative and policy direction.

This direction of travel is towards something Stevens calls ‘toughness’.  It is more important for policymakers to be seen as ‘tough’ than for them to demonstrably reduce harm.

There are two key elements to the article, then.  First, the ratchet model of policy development.  Second, the idea of ‘toughness’.

Importantly, neither of these implies or explains the other, so while this might be an accurate description of UK drug policy I’d suggest it doesn’t get us any closer to understanding why the policies are developed in the way they are.  (To be fair to the authors, they don’t suggest they’re trying to do this in what is of necessity a very brief article.)

Answering this question of why UK drug policy formation follows this process would, like the distinction between ratcheting and toughness, probably require two sorts of approaches.

First, on the ratchet concept one would need to think through ideas of policy competition.  Maybe there’s some inflation-style model of policymaking, whereby political parties outbid each other and find it hard to step out of the terms of debate.  I don’t know much about these sorts of models of policymaking – that’s something I’d leave to the likes of Paul Cairney and Vittal Katikireddi.

But as I suggested, I don’t find the ratchet model something that would necessarily need changing in itself; it’s what we’re progressing towards that might be questionable – and in the field of drug policy this seems to be an emphasis on policy methods (prohibition, restrictions, criminalisation of new psychoactive substances) rather than policy aims.*

So we need to think about why these policy methods are attractive, even if they’re not really reducing harm.  And here we get to the bit of policy analysis that I find fascinating: attitudes to drugs, pleasure and health.  I would suggest that the fundamental principle driving the direction of travel is the view that substances seen to alter mind or body are considered suspect and unnatural – particularly when they relate to sensory pleasures.  This, I should point out, is something I think Stevens and Measham would agree with – Fiona Measham has actually written a book chapter entitled ‘The criminalisation of intoxication’ and Stevens has blogged about the morality underlying Peter Hitchens' claims regarding evidence.

Of course there are other elements to this trend – and there may be mileage in thinking about what Stevens and Measham refer to as the ‘thoughtworld’ of policymakers.  Civil servants, it could be argued, are likely to recommend policy approaches that have a significant role for government (and thus civil servants), whether through conscious calculation or, perhaps more likely, simply familiarity.  Control or prohibition might be such approaches – but then it would be hard to argue that legalisation and regulation of drugs like alcohol and tobacco doesn’t provide significant employment and funding to the state.

So, I’d suggest the ratchet framework doesn’t actually get us that much closer to the stated aim of the article: to ‘help us to use evidence and public deliberation to fit drug policies more effectively to the prospects of reducing harms’.

The key battleground is really over the definition of these ‘harms’.  Peter Hitchens might see himself as a lone voice, but there remains an assumption – at least in terms of what it is acceptable for politicians to say and do publicly – that intoxication in itself is harmful.  Until that position is challenged head-on I can’t see the ratchet mechanism changing.

*This isn’t to say that governments are genuinely committed to enforcing prohibitionist policies.  Peter Hitchens could be said to have a point that much of drug policy is more about rhetoric than effects – and in fact that’s something Stevens and Measham might agree with.

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