NAD
Research report
NAD
Population, professional and client views on
the dangerousness of addictions: testing the
familiarity hypothesis
ANJA KOSKI-JÄNNES & TANJA HIRSCHOVITS-GERZ & MARJO PENNONEN & MILLA
NYYSSÖNEN
ABSTRACT
AIMS – This study compares how different stakeholder groups in Finland perceive the dangerousness
of diverse addictions to the individual and society. It also tests the hypothesis that familiar addictions
are regarded as less dangerous than unfamiliar ones. DATA – The data consisted of surveys with
1) a random general population sample (n=740); 2) addiction treatment professionals (n=520); and
3) inpatient clients (n=78). The dangerousness of alcohol, hard drugs, cannabis, prescription drugs,
tobacco, gambling and Internet use were assessed by their perceived addiction potential, chances of
recovery and relative gravity as societal problems. RESULTS – The observed group differences, even
if significant, were mostly of degree rather than of kind. The largest disagreements involved cannabis
and prescription drugs. Lay respondents worried more about cannabis while professionals were rather
more concerned about prescribed drugs. Clients saw less difference in the addiction potential of legal
and illegal substances than did lay respondents. Professionals trusted most in treatment but they saw
less need to treat cannabis dependence than the others. All groups ranked alcohol as the greatest
addiction-related societal problem in Finland. The familiarity hypothesis was not consistently supported
by the data. Clients familiar with many addictive substances and behaviours did not downplay their
harmfulness.
KEY WORDS – Dangerousness, addictions, survey, images, professionals, clients.
Submitted 16.07.2011
Final version accepted 29.11.2012
Introduction
The aim of this study is to survey how
treatment. Our interest in these group
different stakeholder groups in Finland
views stems from their possible effects on
perceive diverse addictions and their dan-
public action and the people involved (Ed-
gerousness for individual and society. The
wards 2010).
groups we are interested in include mem-
Previous research has shown that the
bers of the general population or the ”ordi-
”governing images” (Room 1978; 2001)
nary taxpayers”, addiction treatment pro-
and ”conceptions” (Levine 1978) of addic-
fessionals and clients in substance abuse
tive behaviours vary over time, contextual
Acknowledgement
This study was funded by the Academy of Finland and by the Finnish Foundation for Gaming
Research.
10.2478/v10199-012-0010-2
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NORDIC STUDIES ON ALCOHOL AND DRUGS
139
settings and by the groups studied (Chris-
tives on addictions (Nyyssönen 2008)
tie & Bruun 1986). Their role as ”action
have been reported before. The study at
plans” for lay people and professionals
hand has been built on comparisons be-
grants them also political power (Room
tween these three data sets. Cross-cultural
1978; Edwards 2010). For instance, the
comparisons between population perspec-
high belief in the power of some psychoac-
tives in different countries have been re-
tive substances to ”hook” a person and the
ported elsewhere (Hirschovits-Gerz et al.
low trust in the chances of recovery with
2011; Holma et al. 2011).
treatment or self-change may seriously
impair any attempts to solve these prob-
Previous research
lems (Klingemann et al. 2001). They may
Some forms of ”excessive appetites”, such
also lead to ”institutionalized resignation”
as alcohol or drug addictions, have been
(Järvinen 2002) where treatment services
known for a long time, and their core fea-
are not even offered to certain groups of
tures are more consolidated in the minds
clients regarded somehow ”beyond re-
of people. Other forms, such as gambling
pair”. For their part, lay beliefs influence
and Internet use, have only recently been
the ways in which addicted individu-
coined as addictions and as such they
als are treated in everyday life, whether
still seem to have more fuzzy contours.
they are stigmatised or recognised to de-
The open-ended and controversial nature
serve help (Orford & McCartney 1990).
of addictions even among scientists (see
Examples of similar ”interactive effects”
West 2006) makes for an ideal target to
(Hacking 1999) of beliefs on addictive
study images and social representations of
behaviours abound in scientific literature
addictions (Moscovici 1984) in different
(for example, Goldberg 1999; Delos Reyes
groups of actors.
2002; Schomerus et al. 2011). Their many
Popular images about particular ad-
and often fatal effects on public action and
dictions, such as alcohol or drugs, have
the people involved make it important
been explored for decades (Room 1978;
to know how different actors in the field
Furnham & Lowick 1984; Christie & Bru-
think about substances and behaviours
un 1986; Furnham & Thompson 1996;
that are often seen to produce addictions.
Sulkunen 1998; 2007). Many studies have
The study at hand is a part of the IM-
also been conducted on the perception of
AGES Consortium which aims to explore
risk related to certain drugs (such as nico-
the social representations and images of
tine). These studies show that people tend
addictions in different groups and cul-
to see the risk for others as higher than for
tures (http://blogs. helsinki.fi/imagesofad-
themselves (Sjöberg 2003), displaying an
diction; see also Sulkunen 1998; 2007).
”optimistic bias” of personal risks (Arnett
Our task in this consortium is to approach
2000). Other studies have compared the
these questions with the help of surveys.
images of particular addictions between
Separate studies on the Finnish general
clients and professionals (for example,
population (Hirschovits-Gerz & Koski-
Walters & Gilbert 2000), but the only pre-
Jännes 2010), professional (Pennonen &
vious study we found comparing popula-
Koski-Jännes 2010) and client perspec-
tion, professional and client views in the
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same study focused just on alcohol de-
trines and lay opinions about these behav-
pendence (To 2005). Since the more spe-
iours. However, the results also displayed
cific questions covered by these studies do
clear differences in the ways diverse ad-
not coincide with ours, we will not go into
dictions were perceived. For instance,
their details here.
smoking and gambling were seen as rather
Some studies have compared views on
harmless ”habits” while addiction to hard
different types of addictions. For instance,
drugs was perceived as a major personal
Orford and McCartney (1990) asked 100
and societal problem. The views on al-
lay respondents in England about their at-
cohol, cannabis and medical drugs were
titudes towards different causes and the
more diverse. Generally, unfamiliar ad-
usefulness of various treatments for exces-
dictions were regarded as more dangerous
sive smoking, drinking, eating, gambling
than familiar ones (Blomqvist 2009; Sam-
and using tranquillizers. The results in-
uelsson et al. 2009). This conclusion was
dicated that gambling was seen more like
also in line with that of Brun-Gulbrandsen
a moral weakness that was easier to con-
and Bergersen Lind (as cited in Christie &
trol and less in need of treatment than the
Bruun 1986, 83–84), who observed that
other excessive behaviours. Griffiths and
when LSD and cannabis were introduced
Duff (1993) compared 138 lay people’s be-
in Norway in the 1960s, they were as-
liefs about 17 excessive behaviours, nine
sessed as more dangerous than opiates.
of which were non-chemical activities.
The data of our study help us further
Those involving alcohol, gambling, smok-
to test the hypothesis of the reduction of
ing, inhalants, narcotics, stimulants and
fear by familiarity with a substance or be-
tranquillizers were seen as more addic-
haviour. If it holds true, the uncommon
tive than others. Most of the drug-related
addictions should generally be regarded
behaviours were seen as physiological
as more dangerous than the more com-
addictions or diseases, whereas gambling
mon ones. Furthermore, lay respondents
and smoking appeared as psychological
should regard the individual and societal
addictions or moral weaknesses. Mari-
dangerousness of hard drugs in particular
juana was regarded as some sort of outlier
as higher than do clients and even profes-
that did not belong to any group.
sionals. The group differences should be
The pilot project of Klingemann (2003)
on the perceived chances of self-change
smaller with the more common alcohol
and nicotine addictions.
from a number of addictions expanded the
comparative approach to different societal
Methods
groups and cultural contexts. Blomqvist
Questionnaires
then started a more comprehensive project
The data for this study were gathered by
on views of addiction and recovery among
questionnaires based on previous Swed-
the general population (Blomqvist 2009)
ish population and professional surveys
and professionals in Sweden (Samuels-
(Blomqvist 2009). The targeted substanc-
son et al. 2009). The results revealed that
es and behaviours covered by the Finn-
professional views on different addictions
ish survey included alcohol, heroin, am-
were largely similar to both official doc-
phetamine, cannabis, prescription drugs,
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NORDIC STUDIES ON ALCOHOL AND DRUGS
141
nicotine, gambling and Internet use. The
collected by an independent survey firm
independent variable in our analysis was
Yhdyskuntatutkimus Oy (Community Re-
the group. The dependent variables meas-
search Company). Altogether 740 subjects
ured the perceived addiction potential of
participated in the study (response rate
these substances and behaviours for the in-
37%) (Hirschovits-Gerz & Koski-Jännes
dividual, the chances of recovery and the
2010). The questionnaires to profession-
need for treatment, and the societal gravity
als were sent to a wide range of different
of addictions in relation to other societal
outpatient and inpatient treatment units
problems.
in southern Finland where they were dis-
The addiction potential of the listed sub-
tributed to the treatment personnel. Ques-
stances and behaviours for the individual
tionnaires were also sent to the Criminal
was operationalised by two questions. The
Sanctions Agency, which distributed them
first one asked how great they saw the risk
to substance abuse workers in prisons and
of developing dependence when trying
the Probation service. Altogether 1,014
the following substances or behaviours.
questionnaires were sent out and 520 were
The second one asked to what extent ”the
returned (response rate 51%) (Pennonen &
properties of the substance or behaviour”
Koski-Jännes 2010). The clients were alco-
could serve as obstacles to the person’s re-
hol and drug abusers recruited from seven
covery efforts.
inpatient treatment and detoxification
The chances of recovery were asked as
units in southern Finland. They were per-
follows: ”How large do you rate the prob-
sonally approached by two students of so-
ability of recovery from each of the fol-
cial psychology and were offered a chance
lowing addictions with treatment/without
to fill in the questionnaire or to respond
treatment?” Views on the perceived need
to the survey questions orally (Nyyssönen
for treatment were measured by subtract-
2008). Since the client sample (n=78) was
ing the probability of recovery with treat-
an add-on to the lay and professional sam-
ment from that of without.
ples also gathered in some other partici-
The perceived societal gravity of vari-
pating countries of the IMAGES consorti-
ous addictions was assessed on a scale
um, we did not try to get a larger and more
from one to ten by responses to the ques-
representative client sample. This is why
tion: ”How serious, in your opinion, are
outpatients, for example, were not includ-
the following societal problems in Finland
ed in this study.
today?” The question was followed by a
Some words of caution should be stated
list of 15 common societal issues (see ap-
about the data of this research. The low
pendix, Table 2), six of which involved di-
response rates in the population and pro-
verse addictions.
fessional samples, the non-random nature
of the other two groups and the small
Data-gathering procedures
size of the client sample limit the gener-
The general population survey was con-
alisability of the study results. However,
ducted by sending questionnaires to a
other procedures were used to increase
random sample of 2,000 Finns between
the representativeness of the data. These
the ages of 17 and 74 years. The data were
included the use of non-response weights
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Table 1. Demographic data on the Finnish census data and the study samples %.
Variables
Sex:
Finnish general
Population
population 1)
sample 2)
Professionals
Clients
(17-74 years)
(n=740)
(n=520)
(n=78)
p3)
<.001
(n=3 848 804)
Females
50
61
76
50
≤ 30 years
24
18
20
36
31 - 50 years
37
30
55
50
> 50 years
39
53
25
14
49
56
71
85
Basic education: ≥ 12 years
42
37
66
25
<.001
Work situation:
Employed
61
52
100
5
<.001
Unemployed
6
6
0
58
33
42
0
36
Age:
Place of resi-
towns and cities with
dence:
≥50 000 inhabitants
<.001
<.001
On pension, student,
homemaker, other
1)
Tilastokeskuksen PX/WEB-tietokannat
2)
Unweighted data, 3) Welch robust test
in the population sample, the recruitment
by these variables to improve the repre-
of professionals from as representative a
sentativeness of the study results.
group of treatment institutions in Finland
The sample of professionals included
as in practice possible and the recruitment
more females since the majority of people
of clients from different kinds of inpatient
in helping professions are women with
units.
social work and health care education. As
the other groups, they lived in mostly ur-
Subjects
ban surroundings. Because of the compli-
The demographic data of the study sam-
cated organisational structure of addiction
ples and the Finnish census data on the
treatment services in Finland it is difficult
same age range are presented in Table 1.
to exactly estimate the representativeness
In comparison to the census data, females
of the professional sample. So, non-re-
and older people were overrepresented in
sponse weights could not be applied here.
the population sample. The proportion of
The client sample was the youngest, the
young males was clearly smaller, and men
most urban and the least educated group.
over 50 years were overrepresented in the
Their low level of employment was partly
sample. There were also other differences
due to their recruitment from inpatient
between the sample and the census data.
and detoxification units. Half of the clients
However, previous research has shown that
were women. Females were thus over-
mainly sex and age are the demographic
represented since only about one third of
factors that clearly correlate with views on
the clients in substance abuse treatment
addictions (Furnham & Thompson 1996;
in Finland are women (Saarelainen et al.
Hakkarainen & Metso 2007; Hirschovits-
2003, 40).
Gerz & Koski-Jännes 2010). The popula-
The inside perspective in excessive ap-
tion sample was, therefore, weighted only
petites was not limited only to clients:
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NORDIC STUDIES ON ALCOHOL AND DRUGS
143
two thirds (62%) of professionals and half
Since the group sizes varied and the repre-
(49%) of the population respondents also
sentativeness of the samples was not ideal,
admitted some personal experience of ad-
the significance tests are here only indica-
diction. For instance, 15% of the popula-
tive of possible group differences that have
tion respondents admitted current or pre-
to be checked by further studies.
vious alcohol dependence and 42% said
they had personal experience of nicotine
Ethics
dependence. The respective figures among
All study participants were volunteers.
professionals were 8% and 53%, and 83%
No identifying information was asked in
and 90% among clients. Experiences of
the questionnaires. The surveys were ap-
drug addiction were, however, very rare
proved by the Ethics Review Board of the
among lay (0.7%) and professional re-
A-Clinic Foundation. Every effort was
spondents (3.5%) in contrast to clients
made not to reveal any identifying infor-
(54%).
mation about any of the study respondents
One should also note that 15% of the
or treatment units involved.
population sample said that they met addicts in their work. Since the respondents’
Results
occupations were not asked, they could be
Addiction potential of various substances
anything ranging from, for example, police
and behaviours
officers, lawyers and bouncers to health
The participants were first queried how
care personnel. Because they represent a
they saw the risk of getting hooked when
small proportion and because their status
trying the listed substances or behaviours.
as addiction treatment professionals is
Figure 1 indicates that all groups regard
unclear, we will here use the terms ”lay
this risk as the highest with heroin and
respondents” or just ”ordinary people” as
the lowest with gambling and Internet use
alternatives to population respondents.
even though population and professional
respondents consider the dependence-
Data analysis
generating capacity of alcohol almost as
The data were analysed by descriptive sta-
low as that of money games and Internet
tistical methods using SPSS 17.0. Since
use. The Welch tests display highly sig-
some addictions were less known to some
nificant group differences in all substance-
respondents, the ”Cannot say” responses
related dependencies but no difference in
varied between 1–17 % by question and
behavioural addictions.
group. All these responses were here treat-
As expected, lay respondents saw the
ed as missing data. As the group sizes and
risk as significantly higher than the others
variances were unequal, the groups were
with heroin, amphetamine and cannabis,
compared by ANOVAs with Welch Robust
reflecting their lower contact with and
test. The Tamhane test was used in all the
general fear of illegal substances (Partanen
post hoc comparisons. The significance
2002; Blomqvist 2009). Clients with their
level was set to p<.01. Because of the large
wider personal addiction experiences saw
number of comparisons, Bonferroni cor-
less difference between illegal and legal
rections were applied to all the p-values.
substances. In fact, the post hoc compari-
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KOSKI-JÄNNES MFL
FIGURES
*** p < .001, * p < .05, Welch robust test
Tamhane
hoc*tests:
Heroin:
P > Pr***
andtest
P > C***; Amphetamine: P > Pr***; Cannabis: P > Pr *** and P > C***;
*** p <post
.001,
p < .05,
Welch
robust
Smoking: C > P *** and C > Pr **; Prescription drugs: Pr > P***; Alcohol: C > P *** and C > Pr ***
Tamhane post hoc tests: Heroin: P > Pr*** and P > C***; Amphetamine: P > Pr***; Cannabis: P > Pr *** and
Figure
1. Perceived
riskCof>developing
when trying different
substances
and behaviors
group
P > C***;
Smoking:
P *** anddependence
C > Pr **; Prescription
drugs: Pr
> P***; Alcohol:
C > Pby***
and C > Pr ***
(Scale: 1=none or very low risk, 4= very high risk).
sons revealed that clients saw the addic-
pendence-maintaining capacity that was
tiveness of alcohol and smoking as signifi-
examined by asking about the properties
of the substance
or behaviour
as obstaclesand
cantly
higher
than therisk
other
two groups,dependence
Figure
1. Perceived
of developing
when trying
different substances
which reflects their personal difficulties
to recovery. The response options varied
behaviors
by group (Scale:
1=none or
very low
4= very
high
fromrisk,
a very
small
to risk)
very large obstacle
with
these substances.
So, familiarity
with
the substances did not reduce clients’ risk
(see Figure 2 in the appendix). Instead
assessments here. Treatment providers
of separate items for amphetamine and
mostly seemed to mediate between clients
heroin, this question included a combined
and lay respondents but in the case of al-
item on ”hard drugs”.
cohol, gambling and Internet addictions,
The groups agreed on the greatest power
their concern for the risk of dependence
of hard drugs to prevent recovery, whereas
was the lowest, even though with no sig-
gambling and Internet use were also here
nificant difference from that of general
seen as the least powerful hooks as such.
population respondents.
The views on alcohol reflected high con-
The risk question addressed the per-
sensus. Beliefs about prescription drugs,
ceived dependence-generating capacity of
cannabis, smoking and Internet use were
the listed substances and behaviours. An-
more heterogeneous. Lay respondents saw
other side of addiction potential is its de-
the properties of cannabis as a larger obUnauthenticated
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NORDIC STUDIES ON ALCOHOL AND DRUGS
145
*** p < .001, ** p < .01, Welch robust test
Tamhane post hoc tests: Cannabis: Pr > P***; Prescription drugs: P > Pr*** and P > C**; Gambling: P > Pr***
*** p < .001, ** p < .01, Welch robust test
Figure 3. Perceived chances of recovery without treatment by group (Scale: 1= none or very low chances, 5=
very high chances).
Tamhane
post hoc tests: Cannabis: Pr > P***; Prescription drugs: P > Pr*** and P > C**; Gambling: P > Pr***
stacle to recovery than did professionals
the questions posed above, but it may also
and clients, which supports the fear of less
involve such intervening factors as the
well-known substances in this group. Pro-
person’s social networks, life situation and
fessionals then again believed more than
health. Figure 3 shows that heroin and am-
phetamine
are seenby
by group
all as the
most 1=
dif-none
lay respondents
in thechances
obstaclesoftorecovery
change without
Figure
3. Perceived
treatment
(Scale:
caused by legal substances and behav-
ficult to quit on one’s own while smoking
iours.
An interesting
between
low
chances,
5= very difference
high chances)
and behavioural addictions are believed
clients and professionals was that clients
to be rather easy to resolve without treat-
emphasised the dependence-generating
ment. Clients believe less than do lay re-
aspect of smoking and prescription drugs,
spondents in self-change from all the legal,
while professionals were more concerned
addictions although the differences do not
about their dependence-maintaining pow-
reach significance due to the small size of
er.
the client sample. Their personal familiarity with all these addictions and their
Chances of recovery and need for treat-
current status as patients probably explain
ment
their reduced optimism about self-change.
The next question on the chances of recov-
Then again, professionals believe signifi-
ery without treatment partly overlaps with
cantly more than the others in self-change
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or very
*** = p<.001, ** = p<.01, Welch robust test.
Tamhane post hoc tests: Cannabis: P > Pr***, Prescription drugs: Pr > P***, Gambling: Pr > P***, Internet: Pr > P***.
*** = p<.001, ** = p<.01, Welch robust test.
Figure 4. Perceived need for treatment by group (Scale: -4 - +4).
Tamhane post hoc tests: Cannabis: P > Pr***, Prescription drugs: Pr > P***, Gambling: Pr > P***, Internet:
Pr > P***.
from cannabis dependence and conversely
ment, the chances of recovery without
less than ordinary people in resolving pre-
treatment were subtracted from those with
scription drug and gambling addictions
treatment (see Figure 4). All groups agree
without treatment. With the exception of
on the clear need to treat ”hard drug” and
smoking, the group trends reflect the risk
alcohol addictions and no or just minor
curves in the reverse order.
need for treatment in nicotine addiction.
Figure 4. Perceived need for treatment by group (Scale: -4 - +4)
The results on the chances of recovery
Moreover, ordinary people see no utility
with treatment displayed a relatively high
for treatment in net addictions and only
overall trust in treatment services. All the
marginal need to treat gambling problems.
group means varied between 3.3 and 4.0
In contrast to lay respondents, profession-
on a scale from 1 to 5. Expectedly, profes-
als see significantly more need for treat-
sionals had the highest confidence in the
ment in prescription drug, gambling and
effectiveness of treatment. Their mean
net addictions but like clients, less need to
level of trust in all addictions was 3.81,
treat cannabis addiction.
whereas among lay respondents it was
3.64. Client trust in the power of treatment
Addictions as societal problems
was the lowest (3.54), even though it was
The study participants were also asked to
still rather close to the other groups.
assess the gravity of various addictions as
To assess the perceived need for treat-
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NORDIC STUDIES ON ALCOHOL AND DRUGS
147
*** = p<.001, ** = p<.01, Welch robust test
Tamhane post hoc tests: Alcohol: Pr > P ***; C > P*, Hard drugs: Pr > P* & C > P*, Prescription drugs: Pr > P *** & C >
P***; Gambling: Pr > P **.
*** = p<.001, ** = p<.01, Welch robust test
Figure 5. Perceived societal severity of various addiction problems by group (Scale: 1= not at all serious, 10=ex-
tremely serious).
Tamhane
post hoc tests: Alcohol: Pr > P ***; C > P*, Hard drugs: Pr > P* & C > P*, Prescription drugs: Pr > P
*** & C > P***; Gambling: Pr > P **.
cietal issues, the group means of the six
the groups, since the average of all items
addiction problems varied significantly in
among population respondents (6.52) was
other than cannabis and nicotine addic-
lower than that of professionals (6.79) and
tions. Figure 5 indicates that all groups rate
significantly lower than that of clients
alcohol problems the most serious of the
(7.05). Because of this scale discrepancy,
addiction problems and gambling the least
we also compared the rank order of the
serious (net addiction was not included in
items by group (Table 2 in the appendix).
this list). The post hoc tests show that or-
When the order of severity in relation to all
dinary people consider alcohol, hard and
the 15 problems was taken into account,
prescription drug problems significantly
all groups placed alcohol and hard drugs
less serious for society than do profession-
among the top three societal problems. All
als. Client views are here closer to those of
groups also placed smoking in the 10th
professionals, but their difference with lay
place and gambling among the three least
respondents reached significance only in
important problems. The major disagree-
the case of prescription drugs.
ments involved, again, cannabis and pre-
Figure 5. Perceived societal severity of various addiction problems by group (Scale: 1= not
at all serious, 10=extremely serious)
However, the mean values for each
scription drugs. The rank order of canna-
item were not totally comparable between
bis was 7 by population, 9 by professional
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and 11 by client respondents whereas the
than the actual damage done by these sub-
rank order of medical drug abuse was 11
stances (Blomqvist 2009). Then again, the
by population, 5 by professional and 6 by
low concern about excessive gambling and
client respondents. The results on the per-
Internet use could be explained by their
ceived societal gravity of alcohol problems
wide unproblematic use in the population
did not seem to be reduced by familiarity,
(Aho & Turja 2007). In this situation, their
since most people in Finland and particu-
nature as a possible source of dependence
larly clients and treatment professionals
has not been recognised, which may ef-
are quite familiar with alcohol problems.
fectively prevent provision of help to in-
This did not, however, affect their views
dividuals who actually suffer from these
on the dangerousness of these problems
problems, as observed also elsewhere (Or-
for society.
ford & McCartney 1990).
Group disagreements involved mainly
Discussion
cannabis and prescription drugs. Profes-
General observations about group views
sionals de-emphasised the harmfulness of
This study addressed the perceived dan-
cannabis possibly because they compared
gerousness of various addictions to the
it with hard drugs that are often injected
individual and society. The aim was to
in Finland. Another reason could be that
compare the views on these issues be-
drug abusers, too, usually seek help pri-
tween Finnish general population, pro-
marily for their amphetamine and opiate
fessionals and clients in treatment. The
dependences even though they are also ad-
overall results showed that the group dif-
dicted to cannabis (Forsell et al. 2010, 53).
ferences, even if significant, were mostly
Lay respondents displayed higher concern
of degree rather than of kind. Furnham and
about cannabis, which could be attribut-
Thompson (1996) as well as Samuelsson
able to its illegality and suspected func-
et al. (2009) also found that lay and expert
tion as a gateway to hard drugs, or because
views are not so far from each other as of-
they are worried about its physiological
ten expected. What is even more notable is
effects. At the same time, lay respondents
that clients with much lower educational,
were less worried about prescription drug
work and marital status, and with more de-
dependence, which may reflect its lower
pendence experiences, thought about most
visibility in society and the common trust
addictions largely in the same ways as the
in anything officially classified as a medi-
other two groups. So, possible concerns
cation. In any case, more information and
about their clearly diverging subcultural
societal discussion about cannabis and
views on these issues are not warranted.
prescription drug dependence would help
All groups displayed high concern for
create more consistent recommendations,
hard drugs and low concern for behav-
treatment interventions and prevention
ioural addictions. The consensus about
policies for these problems.
hard drugs as the most dangerous cat-
egory for the individual seems to reflect
Searching for explanations
the highly negative media portrayal of
Generally, lay respondents assessed the
drug users and the illegality of drugs more
individual risks of illegal drugs as higher
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NORDIC STUDIES ON ALCOHOL AND DRUGS
149
than clients and professionals in line with
their identity position as the recipients of
the hypothesis that unfamiliar things are
treatment was reflected in clients’ high be-
more feared than familiar ones (Mosco-
lief in the dependence risk of smoking and
vici 1984; Blomqvist 2009). However, this
drinking as well as in their low belief in
hypothesis was not supported by clients
the chances of recovery from these addic-
of whom the great majority had personal
tions.
experience with nicotine, alcohol and pre-
In assessing the societal gravity of vari-
scription drug dependences but who still
ous addictions, all groups regarded alcohol
assessed these substances as more addic-
problems as the most serious, hard drugs
tive than did the other groups. So, even
as the second most serious and gambling
familiar substances and behaviours may be
as the least serious of the dependence is-
seen as more dangerous when their more
sues on the list of 15 societal problems.
serious consequences are revealed. Being
The opinions on cannabis and prescrip-
currently in treatment for related problems
tion drug abuse varied more. The societal
may also have increased clients’ risk aware-
gravity of cannabis use was upgraded by
ness. On the other hand, more than half of
ordinary people and downgraded by cli-
the clients had also been addicted to drugs
ents and professionals, whereas the oppo-
but they assessed the dependence risk there
site was true of prescription drug abuse.
as lower than the other groups. Either they
Nutt et al. (2010) have recently ranked
were inconsistent or they just saw less dif-
drugs on the basis of their objective criteria
ference in the addiction potential of illegal
of harmfulness. Heroin, crack and crystal
and legal substances than the others.
meth were assessed as the most danger-
All groups agreed that smoking, gam-
ous for the individual; alcohol, heroin and
bling and net addictions are relatively
crack as the most harmful for those around
easy to solve without treatment. Similar
them. It is difficult to say how well the re-
results have been observed also in the
sults of this British study apply to Finland,
UK and Sweden (see Orford & McCartney
but Finns drink about as much as people
1990; Blomqvist 2009). To what extent is
in the UK (Global Status Report on Alco-
this related to the belief that only aware-
hol and Health 2011), and binge drinking is
ness-reducing chemical substances can
common in both countries. Yet the level of
produce ”real addictions”, while the other
drug use is clearly lower in Finland (World
excessive appetites are just bad habits that
Drug Report 2010). Our results support the
can and should be changed at will? If this
view that lay people in Finland are quite
is the case, it is no wonder that there has
well-informed and aware of the societal
been rather little organised help for people
costs of excessive drinking but are less
with these problems in our society.
aware of the risk of alcohol dependence for
The trust in treatment was generally high
as observed also in Sweden (Blomqvist
the individual. This reflects their optimistic bias of personal risks (Arnett 2000).
2009). It was especially high among professionals reflecting their need to defend
Study limitations and conclusions
their particular identity position as treat-
As stated in the Methods section, the gen-
ment providers. A similar need to defend
eralisability of the results of this study is to
150
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some extent restricted by the low response
possible differences in the images of the
rate in the population sample. While non-
individual and societal harmfulness of
response weights were used to make the
various addictions between different ac-
results more representative, this does not
tors in the field and to test the hypoth-
solve all the problems caused by the low
esis concerning familiarity as a source of
response rate. The results of our survey
”downplaying the risks and dangers of
were, however, rather similar to other
addictive habits” (Blomqvist 2009). The
Finnish surveys on the use of psychoac-
results of our study did not consistently
tive substances with higher response rates
support this hypothesis. Even though hard
(for example, Hakkarainen & Metso 2007),
drugs were generally feared more than
which increased confidence in the results
smoking, gambling or use of Internet, per-
of this survey. One should nevertheless
sonal familiarity with and the salience of
note that the subjects who respond to sur-
the negative consequences caused by ex-
veys on psychoactive substances are prob-
cessive involvement in various addictive
ably more often those who have some con-
behaviours also seems to upgrade their
tact with substance-related issues. Those
perceived harmfulness.
with no contact may find the questions either hard to answer or irrelevant from their
perspective. Other limitations were the
lack of random samples of the other two
groups. Furthermore, the client group only
consisted of substance-abusing clients in
inpatient treatment, so they cannot be
Declaration of Interest The first two authors have
received some funding from the Finnish Alcohol
Retail monopoly Alko for teaching addiction treatment research at the University of Tampere.
generalised to outpatients or addicted individuals in the general populations. Another limitation was the small size of the
client sample, which allowed only robust
differences to the other groups to reach significance. This group was included in the
comparison to illuminate the client side of
the study questions.
Such data limitations were not, however, fatal because the main point of this
study was not so much to provide exact
measures of similarities and differences
between these stakeholder groups. The
point was rather to raise the question of
Anja Koski-Jännes, professor
School of Social Sciences and Humanities
University of Tampere, Finland
E-mail: [email protected]
Tanja Hirschovits-Gerz, researcher
University of Tampere, Finland
E-mail: [email protected]
Marjo Pennonen, researcher
University of Tampere, Finland
E-mail: [email protected]
Milla Nyyssönen, researcher
E-mail: [email protected]
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NORDIC STUDIES ON ALCOHOL AND DRUGS
151
(Fig 2 & Table 2)
APPENDIX
*** p < .001, ** p < .01, Welch robust test. P = Population, Pr = professionals, C = clients.
***
p < .001, ** p < .01, Welch robust test
Tamhane post hoc tests: Cannabis: P > Pr*** and P > C**; Smoking: Pr > P***; Prescription drugs: Pr > P***; Internet:
Pr > P***; Gambling: Pr > P***.
Tamhane post hoc tests: Cannabis: P > Pr*** and P > C**; Smoking: Pr > P***; Prescription drugs: Pr > P***;
Internet:
> P***;properties
Gambling:
Prsubstance
> P***. / behavior as an obstacle to recovery by group
Figure 2.Pr
Perceived
of the
(Scale: 1=very small obstacle, 4 =very large obstacle).
Table 2. Ranked seriousness of societal problems by population, professional and client
respondents. Scale: 1= the most serious – 15= the least serious.
Population
Professionals
Clients
Property crimes
5
8
9
Use of cannabis
7
9
11
Use of hard drugs
3
2
3
Figure
Perceived properties of the2 substance / behavior1 as an obstacle for
Alcohol 2.
problems
1 recovery by
group
(Scale:damage
1=very small obstacle, 44 =very large obstacle)
Environmental
4
4
Lacking gender equality
13
15
14
Smoking
10
10
10
Violent crimes
1
3
2
Large wage differences
9
7
7
Prostitution
14
13
15
Poverty
7
6
5
15
14
13
Ethnic discrimination
12
12
12
Misuse of prescribed drugs
11
15
6
Financial crimes
6
11
8
Mean 1)
6.52
Gambling
1)
6.79
7.05
p < .001, Welch Robust test
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