NAD
Editorial
NAD
Down and out in Norden
Kerstin Stenius
Susanne Alm’s article on what happened to the Swedish
problem drug users of the 1960s and 1970s (2015) in this issue
documents the social exclusion of drug users in Swedish society.
Alm uses a large data set of persons born in Stockholm in 1953 and
still living there at the age of 10 (Stockholm Birth Cohort Study).
Within this cohort, 431 persons were identified during their teenage period by the social authorities as having drug problems and/
or received hospital treatment for drug abuse and/or were identified by the police as injecting drug users before the age of 30. The
author compares the life course of this group from 1990 until the
age of 56 with the life course of the rest of the cohort by examining
registers describing death rates and social inclusion/exclusion, here
operationalised as strong, weak or no connection to working life.
Strong connection is defined as an income from work that in today’s
currency would be about 13,000 SEK/month, or being a student. A
weak connection is an income from work below this but at least
1900 SEK/month, or receiving unemployment benefits. Those who
have less income, have a disability pension or receive social support are categorised as having no relation to working life.
Sixteen percent of those with identified drug problems had died
by the age of 37. The share had grown to 38% by the age of 56. This
should be compared to 2 and 5%, respectively, in the rest of the
cohort. Among those with documented drug problems in youth, the
number of persons with a strong connection to working life is highest when they are in their late 30s. Their situation then deteriorates
steadily but slowly, and only about 18% (a third of those alive) have
a reasonably well-paid job when they are 56 years old. In 2009,
more than half of those still alive had no connection to working life.
In contrast, in the rest of the cohort, as many as 75% had a strong
working life connection at that point.
As Jessica Storbjörk (2015) notes in her commentary to the article,
it is particularly depressing that so few of those with drug problems
in their youth are able to establish a firm position in society in the
long run. We know that the Swedish system for treatment and care
of alcohol and drug abuse focuses on the marginalised. Those who
have been treated for drug problems seem after six or seven years
to do better in terms of social networks, housing and work (Stenius
10.1515/nsad-2015-0012
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V O L . 32. 2015 . 2
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NORDIC STUDIES ON ALCOHOL AND DRUGS
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Editorial
et al. 2011). Alm’s findings indicate, however,
this may be only a temporary improvement.
All in all, the article highlights serious
shortcomings in the Swedish/Nordic welfare
The Swedish and Nordic welfare systems
systems. As researchers, we need to docu-
have been recognised as emphasising work as
ment the excluding mechanisms. Studies
a civil duty and a key requirement for citizen
such as that by Susanne Alm, based on our
rights and benefits (Janoski, 1998). Even if
relatively good registers, are very valuable.
our welfare system (still) is extensive it does
Register studies should also enable us to
not seem able to pave routes (back) to work.
better understand what makes it possible to
There are several obstacles. In the Nordic tra-
escape exclusion. As Storbjörk (ibid.) points
dition, the social stigma of having once devi-
out, almost a fifth of those with drug problems
ated from the role of a conscientious, hard-
in their youth seemed to have done all right
working citizen is hard to erase and prevents
in the end. Finally, we can agree with Kainu-
per se entrance into the work force. Persons
lainen (ibid.) that we need more research on
with drug problems are probably more hit by
the drug-using persons’ own experiences of
this than most other groups (Hübner, 2001). In
control, support and excluding mechanisms.
her commentary to Alm, Edle Ravndal (2015)
reminds us of the fact that many of those with
more extensive drug use in their youth have
already had other social or personal problems and may have more than one stigma to
carry. The changes of the labour market, with
fewer and fewer unqualified or seasonal jobs,
have also contributed to a more permanent
exclusion of individuals whose lives at some
point have been less stable. This is not only
a Nordic phenomenon. Heini Kainulainen’s
commentary (2015) refers to international
research on contemporary policies of exclusion and control in Western market societies.
The fact that the Nordic social welfare system
takes a strong and sometimes paternalistic
grip of the lives of, for instance, problem drug
users, cannot mend this problem. And even if
Sweden is currently liberalising the rules on
needle exchange and substitution treatment,
this is only a very short step towards real social inclusion of persons with drug-related
problems.
108
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References
Alm, S. (2015). Hur gick det för 1960- och
1970-talets svenska narkotikamissbrukare?
Nordic Studies on Alcohol and Drugs,
32(2), 109–132.
Hübner, L. (2001). Narkoitka och alkohol
i den allmänna opinionen. Published
dissertation. Stockholm, Stockholm
university.
Janoski, T. (1998). Citizenship and civil
society: A framework of rights and
obligations in liberal, traditional, and
social democratic regimes. Cambridge,
Cambridge University Press.
Kainulainen, H. (2015). Samhället måste
se sig självt i spegeln: Hur behandlar vi
narkotikabrukarna? Nordic Studies on
Alcohol and Drugs, 32(2), 141–144.
Ravndal, E. (2015). En gang marginalisert –
alltid marginalisert? Nordic Studies on
Alcohol and Drugs, 32(2), 137–140.
Stenius, K., Ullman, S., Storbjörk, J., & Nyberg,
K. (2011). En långtidsuppföljning av
personer med tungt missbruk i Stockholms
läns missbruksvård. Stockholm, SoRAD –
Forskningsrapport 62.
Storbjörk, J. “Jag har hört att du dött några
gånger”: Vilka gick mot strömmen och
blev social integrerade? Nordic Studies on
Alcohol and Drugs, 32(2), 133–136.
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