what is the worse thing you can get hooked on (blomqvist)

373NORDIC STUDIES ON ALCOHOL AND DRUGS VOL . 26 . 2009 . 4

Research report

A B S T R A C T

IntroductionAlthough simplistic and one-sided explana-

tions have been legion over the years, most

theorists tend today to see addiction as a

multi-factorial (bio-psycho-social) phenom-

enon. Moreover, although few endorse the

type of “vulgar constructionism” criticized

e.g. by Best (1995), many agree that addiction

is to some extent and in some sense a socially

constructed problem. Thus West (2007), for

example, contends that addiction is a social

construct with fuzzy borders, yet a condi-

tion in which many underlying pathologies

and abnormalities become manifest. Put in a

different way, even if addiction is not “just”

an invention by powerful claims makers, the

ways in which a “deviant” substance use or

behaviour is defined, how such deviances

are reacted to by society, and – thereby – the

consequences to the individual of her/his

deviance, as well as the long-term trajectory

of her/his condition, are strongly influenced

by norms and traditions that vary with time

and place (Blomqvist 1998a). This means that

addiction can be seen as an example of what

Hacking (1999) has named “interactive kinds”,

J. Blomqvist: What is the worst thing you

could get hooked on? Popular images

of addiction problems in contemporary

Sweden

AImS

To investigate potentially crucial aspects

of Swedes’ perceptions of nine different

addictions.

DATA AND mETHODS

Population survey, sent out to 2,000

adult Swedes (18–74 years), focusing on

the perceived severity of, responsibility

for, options to recover from, and

character of addiction to cigarettes,

snuff, alcohol, cannabis, amphetamine,

cocaine, heroin, medical drugs, and

gambling.

RESULTS

There are large differences in the ways

in which various addiction problems

are perceived. Whereas tobacco use,

and to some extent gambling, are

seen as relatively harmless “habits”,

not particularly easy to get hooked on

but easy to quit, the use of drugs such

as heroin, amphetamine, and cocaine

is seen as a major societal problem,

and users are seen both as “sinners”

who need to mend their ways and as

powerless “victims”. In between comes

the use and misuse of alcohol, cannabis

and medical drugs, about which

perceptions are more divided.

CONCLUSIONS

Respondents tend to downplay the

risks and dangers with addictive

habits that are common and familiar in

mainstream culture, and to dramatise

Jan Blomqvist

What is the worst thing you could get hooked on?

Popular images of addiction problems in contemporary Sweden

374 NORDIC STUDIES ON ALCOHOL AND DRUGS VOL . 26 . 2009 . 4

i.e. phenomena, the official and/or predominant definitions

of which influence the self-definition and behaviour of those

defined, thereby in turn at least partly confirming the official

or institutionalised views.

Occasionally, the significance of others’ attributions and

labelling for the origin and developmental course of various

addictions, as well as for the options of finding a path out

has attracted the attention of researchers, not seldom from a

social historical perspective (e.g. Roman & Trice 1977; Gus-

field 1981; Room 1985; Goldberg 2000). Others have found

that dominating views that stigmatise the addict may pre-

vent him/her from seeking help or lead to discrimination

of ex-problem users in work life (Kilty & Meenaghan 1977;

Dean & Rud 1984; Blomqvist 2002). There is also reason to

contend that the long-term outcome of treatment is to a large

part dependent on what happens outside the clinic door (e.g.

Moos 1994; Blomqvist & Cameron 2002).

In Sweden, the clearly varying official discourses and

policies on alcohol and narcotics are well known and well

documented (e.g. Christie & Bruun 1985; Hübner 2001), and

there are also indications that the Swedish “doxa”1 on nar-

cotic drugs, picturing these as almost inevitably dependence

generating (Bergmark & Oscarsson 1988) may decrease other

people’s inclination to offer help and support (Blomqvist

2004). People who recover from a heroin addiction seem also

to be met with greater distrust than people who recover from

an addiction to alcohol (Klingemann 1992; Blomqvist 2002).

Moreover, the historical dominance, not least in the USA,

of the “popular disease theory”, describing alcoholism as

an inexorably progressive deteriorating process (cf. Pattison

1976), has been criticised by some as being directly counter-

productive to the options of resolving an alcohol problem

(e.g. Peele 1989). Finally, increasing research has shown in

recent decades that “self-change” is by far the most common

path to recovery from most addictions (e.g. Blomqvist 1996;

Cunningham 2000; Klingemann & Sobell 2007; Blomqvist et

al. 2007). Research on the processes and influences behind

such solutions has clearly demonstrated the important role

of other peoples’ support, demands, and general attitudes in

motivating attempts to overcome an addiction, as well as in

maintaining the resolution (e.g. Blomqvist 1999; 2002; Gran-

field & Cloud 1999; Bischof et al. 2004).

the risks and dangers

with such habits that are

uncommon or “strange”.

This may have unfortunate

consequences for addicts’

options to find a path out of

their predicaments.

KEy WORDS

Addiction, images,

consequences, population

data, Sweden.

375NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 26. 2009 . 4

Although there are thus clear indications

that the “governing images” (Room 1978)

or dominant “social representations”

(Moscovici 1981; 1989) of, various addic-

tions may play a not insignificant role to

the prevalence and long-term course of

these problems, as well as to the options

of finding working strategies to counteract

them, there is no conclusive and empiri-

cally founded knowledge of how these at-

titudes and images differ between e.g.,

various addictions, various cultures, vari-

ous demographic subgroups, and various

professions. Rather, the current focus on

the perceived need to develop “evidence

based practices” tends to distract attention

from what might be called “the social con-

text of recovery”. Even if there is certainly

good reason to improve the effectiveness

and responsiveness of prevailing treat-

ment systems (e.g., Humphreys & Tucker

2002; Blomqvist et al. 2007), this is un-

fortunate, given that only a small propor-

tion of all people with addiction problems

ever come into contact with these systems

(ibid.). The study reported in this paper

has been part of an effort to improve our

knowledge about the “images of addic-

tion” underlying how people with such

problems are met by their environment,

including professionals in the addiction

treatment field, and so to lay a foundation

for the development of more realistic strat-

egies to counteract such problems.

“The social context of recovery” – aims and research questionsThe research project “The social context

of recovery – views of addiction and re-

covery in the population and in various

professional groups” has been financed by

a grant from the Swedish Research Coun-

cil (VR 2004–1831). The main objective of

this project has been to get a better under-

standing of the beliefs and assumptions

underlying how people who are trying to

overcome their addiction problems are met

by treatment professionals and significant

others. More concretely, the study endeav-

oured to ascertain what people believe

about nine different addictions or misuse

problems occurring in Sweden (addictions

to alcohol, cannabis, heroin, ampheta-

mine, cocaine, medical drugs, cigarettes,

snuff, and gambling). The main part of the

project has been a fairly extensive survey,

mailed out to a representative population

sample. In a complementary part, three

smaller surveys have been directed at three

samples of about 200 professionals each,

mainly working with addiction problems

in each of the social services, health care,

and criminal justice systems (cf. Samuels-

son et al. 2009; Christophs 2009).

The study has partly built on the in-

ternational so-called SINR study (Klin-

gemann 2003)2, and the Swiss study on

popular attitudes toward “natural recov-

ery” and about the key elements of a “self-

change friendly society” that has been

reported by Klingemann (2005; Klinge-

mann & Klingemann 2007). Although the

present study has broadened the scope of

these studies, the latter study in particular

provides valuable options for comparison

regrading perceptions of self-change. Later

studies conducted in Finland (e.g. Koski-

Jännes et al. 2009), Canada (Cunningham

2009) and Russia, using basically the same

questionnaire as the Swedish study pro-

vide further possibilities for comparisons.

Another source of inspiration has been a

Nordic study on substance use and control

376 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 6. 2 0 0 9 . 4

policies carried out in 1995 and reported

e.g. by Hübner (2001), a study that also

provides some data for comparison.

This article presents the results from the

Swedish population survey, focusing on

differences between the nine different ad-

dictions with regard to how serious they

are judged to be as societal problems, their

perceived “addictiveness“, how easy they

are believed to be to recover from (with

and without professional or formally or-

ganised help), to what extent moral re-

sponsibility for developing and solving

the undesired condition is attributed to

the afflicted individual, and the perceived

basic character of the problem in question.

Q Method

the survey

“Addiction”, “dependence”, and “misuse”

are examples of the kind of “fat words”,

the use of which Christie & Bruun (1969)

lamented already four decades ago. It is

obvious that much of the conceptual con-

fusion from those days persists today, and

that there are a number of dimensions

and aspects that could be relevant when

it comes to the exploration of prevailing

images of various addictions. The delib-

erations that underlie the choice of study

variables for this investigation, has built

on a number of previous efforts to improve

our understanding of these issues. One ex-

ample is Mäkelä’s (1980) remark that so-

ciety’s response to any type of deviance

will be affected by the extent to which the

deviant individual is seen as doing harm

to her/himself and/or to her/his environ-

ment, and by whether effective means to

alter the deviance are believed to be avail-

able. Another has been Gusfield’s (1981)

distinction between the moral connotation

of social problems, and their cognitive sig-

nificance, and still another Brickman and

colleagues’ (1982) assertion that the issue

of moral responsibility for human prob-

lems actually involves two questions: the

question of blame (or responsibility for

causing a problem), and the question of

control (or capability and responsibility

for solving a problem). Based on these and

other considerations, the survey has tried

to capture some dimensions and aspects of

prevailing “images of addiction” that can

be assumed to be crucial to how people

with various addiction problems are met

and treated by others in practice.

Data collection

The survey was mailed out by Statistics

Sweden in 2005 to a representative popu-

lation sample of 2,000 adult Swedes (18–74 years) drawn from the official Swedish

population data base (RTB). More con-

cretely the questionnaire contained, be-

sides questions about demographic and

socio-economic circumstances, questions

asking respondents to rank the “serious-

ness” of various addictions compared to

other social problems, questions about the

perceived risk of developing an addiction

to or dependence on the substances or

activities chosen for the study, about the

perceived responsibility for developing

and resolving an addiction to these sub-

stances or activities, and questions about

the perceived chances of recovery – with

and without treatment or other formal help

– from the same addictions. In addition,

information was gathered on respondents’

own experiences – by themselves or some-

one close – of the use of or addiction to the

substances/activities in question, of treat-

ment and/or “self-change”, and of having


tried to help others with addiction prob-

lems. Finally, a number of questions were

included aimed at capturing respondents’

political – ideological orientation, trust

in various authorities, “social distance”

to people with addiction and other social

problems, personal “locus of control”, and

perceptions of major obstacles to recovery

from and desirable societal strategies to

counteract various addictions.

Response rate and potential attrition bias

Valid responses were provided by 1,098

respondents, giving a response rate of

54.6%. Although this is a low figure, it is

not uncommon for surveys like the present

one covering issues such as problem con-

sumption of alcohol and use of illegal

drugs (cf. Hague & Irgens-Jensen 1987;

Kühlhorn et al. 2000; Hübner 2001). Attri-

tion was somewhat lower among women

than men, in the oldest age group (60–74)

than among younger respondents, among

respondents who were married or cohabi-

tating than among singles, in the high-

est income groups than in lower groups,

among native-born Swedes than among

people born in other countries, and among

respondents with university education

than among respondents with lower edu-

cation. In an effort to account for sampling

and attrition bias, data were weighted,

using the mentioned variables and place

of residence (rural, urban, or metropoli-

tan) as calibration variables. All reported

analyses except sample sizes are based

on weighted data, although a number of

test analyses showed few and insignifi-

cant differences between results based on

weighted and unweighted data. In spite of

the weighting process, it must be born in

mind that the validity of the results may

to a certain extent have been jeopardized

by the low response rate. This means that

caution is needed in generalizing results

to the population level. Since problem

drinkers and users of illegal drugs can be

expected to be overrepresented among

non-respondents, and socially “undesir-

able” behaviour can generally be expected

to be underreported (e.g. Kühlhorn et al.

2000), this caveat will be particularly rel-

evant with regard to future analyses of the

connections between respondents’ images

of various addictions and their own expe-

riences with potentially dependence gen-

erating substances or activities. However,

as concerns the differences between their

images of various addictions, which is the

focus of the present paper, the results are

likely to be more reliable.

the respondent group

Table 1 describes the respondent group in

terms of some basic demographic charac-

teristics, showing e.g., an even distribution

of women and men, that just under one

third were university educated whereas

a quarter had only completed elementary

school, that one third lived in the metro-

politan area and one tenth in rural areas,

and that the great majority of the respond-

ents were native-born Swedes.

Table 2 describes respondents’ lifetime

experiences with potentially addictive

substances, which by and large seem to

mirror the Swedish “addiction scene”3

fairly well, the most common experiences

being, in order of magnitude, with drink-

ing, smoking, snuff use, and – although to

a much lesser degree – cannabis use, and

where experiences with amphetamine, co-

caine, (illegal use of) medical drugs, and,

in particular, heroin, are very limited. The


most obvious difference between respond-

ents’ reports and what is known about the

overall prevalence of the habits in ques-

tion in Sweden, is that the proportion of

present smokers and snuff users seems to

have been higher in the respondent group

than what was the case in the population

at the time when the survey was conduct-

ed, although this difference may partly be

due to differing definitions.

Table 3, finally, shows respondents’ re-

ported experiences with addiction prob-

lems, their own or those of somebody

close (family or close friend). As can be

seen, with the exception of dependence

on tobacco, few admit to having experi-

enced such problems personally. For ex-

ample, although more than nine out of

ten are previous or present drinkers, only

about six per cent, the same proportion as

those who never drank, report having been

addicted to or dependent on alcohol. The

fact that more than four out of ten admit

to being or having been dependent on to-

bacco suggests that this is seen much less

stigmatising than other addictions. At the

same time, almost two thirds of all re-

spondents report being aware of a present

or former dependence or misuse problem

in someone close. However, less than half

of these respondents report that they per-

sonally tried to help some of these people.

Table 1. Respondent characteristics

Women (N = 545) Men (N = 553) All (N = 1.098)

Characteristics n % n % n %

age 44.2 (s =15.5) 44.1 (s=14.8) 44.2 (s=15.7)

married /cohabiting 243 44 7 237 42.9 481 43.8

University education 175 32.2 147 26.5 322 29.3

only elementary education 126 23.2 148 26.7 274 25.0

living in a metropolitan area 197 36.2 163 29.5 360 32.8

living in a rural area 52 9.6 60 10.8 112 10.2

Born in sweden 467 85.7 466 84.3 933 85.0

Table 2. Personal substance use experiences (N = 1.098)a

Never used Previous use Present use

Substance n % n % n %

alcohol 65 6.0 68 6.3 948 87.7

Cigarettes 320 29.5 429 39.7 333 30.8

snuff 669 61.6 213 19.6 205 18.9

Cannabis 918 84.5 150 13.8 18 1.7

medical drugs 1029 95.1 34 3.2 19 1.8

amphetamine 1032 95.4 43 4.0 6 0.6

Cocaine 1057 97.5 18 1.7 9 0.9

Heroine 1076 99.3 5 0.5 2 0.2

a) the table shows valid answers and valid percentages


Finally, it should be mentioned that

less than five per cent of all respondents

reported personal experiences of addic-

tion treatment, whereas one quarter was

aware of a treatment episode experienced

by someone close. About four out of ten

judged these treatment experiences to

have been helpful. At the same time,

further analyses revealed that about one

fifth of the respondents claimed to have

quit what they saw as an addictive habit,

predominantly smoking or using snuff,

without treatment, and just over one third

reported similar experiences in someone

close. Data on respondents’ political-ide-

ological orientation, “social distance” to

people with addiction problems, personal

“locus of control”, trust in various authori-

ties etc. will be the object of future analy-

ses, and are not presented here.

Q Some theoretical caveats

Besides the uncertainties caused by the

low response rate, a few words are war-

ranted about what can and what cannot

be captured by asking respondents to re-

port their attitudes to, and perceptions

of, rather complex matters by answering

survey questions with pre-coded response

alternatives. Thus, as pointed out by Hüb-

ner (2001), the basic idea that there exists a

“public opinion” that can be measured by

traditional polls to representative samples

is certainly open to debate (cf. Bourdieu

1972; Österman 1998). For example, there

is no reason to believe that all respond-

ents have the same competence in, or the

same knowledge of, the issues covered by

the survey (ibid., Hübner 2001). Further,

it is important to consider that opinions

in real life are created in interactions be-

tween individuals and groups, and are

formed in situations where taking a posi-

tion means choosing between real groups

that are in conflict (ibid.). This means that

an opinion poll carried out at one certain

point in time can only “scan the surface”,

but not give an in-depth understanding of

how opinions are mobilised, and what a

certain standpoint means to various re-

spondents (Österman 1998). In addition,

the problem posed by a poll will always

correspond to specific interests that gov-

ern the meaning of the responses (ibid.).

Respondent her/himself Somebody close Tried to help somebody a

Dependence to n % n % %

alcohol 72 6.8 519 48.6 49.4

tobacco 448 42.3 575 55.1 42.7

Cannabis 23 2.1 149 14.2 56.7

Gambling 27 2.6 128 12.3 59.2

medical drugs 31 2,9 122 11.2 57.2

narcotic drugsb 12 1.2 135 13.0 59.9

any addiction 471 42.9 723 65.9 42.2

a) Percentage of all respondents who were aware of a problem by somebody close; b) Except cannabis

Table 3. Experiences of dependence/misuse problems in oneself and/or somebody close (N = 1.098)


These interests are not likely to be shared

by all respondents, which means that it

is not unproblematic to assign the same

value and the same “meaning” to the same

response by various respondents. Finally,

attitudes and perceptions are not individ-

ual characteristics but processes, governed

by changing circumstances, actual events

and various kind of information, which in

turn means that connections captured by

opinion polls may be rather casual (Öster-

man 1998; Hübner 2001). Another general

caveat is that the wording of questions and

response alternatives may influence sur-

vey results in a significant way, especially

when the issues concerned are emotion-

ally or ideologically “loaded”, something

that can be said to be true at least about

the drug issue in Sweden (Hübner 2001).

Of special interest here may be that there is

no obvious equivalent to the concept “ad-

diction” in modern Swedish, and that the

survey therefore consistently asked about

“misuse of or dependence on” various sub-

stances and behaviours. At the same time,

“addiction”, “misuse”, and “dependence”

are all “fat words” (cf. above), and in Swe-

den the two latter could be expected to be

used more or less interchangeably, by lay

people and various “experts” alike, to sig-

nify the same broad class of phenomena

as the English term “addiction”. All in all

this means that the results presented in

this paper need to be interpreted and dis-

cussed with regard to the currents of the

“addiction scene” (see Note 3), and the dif-

fering “instutionalised responses” to and

media representations of matters like alco-

hol, narcotic drugs, tobacco and gambling

in Sweden (Hübner 2001)4. It also means

that the survey results should only be seen

as an “aerial photo” of prevailing images

of or attitudes towards various addictions

in contemporary Sweden. A fuller under-

standing of the meaning of this “aerial

photo”, warrants further analyses, explor-

ing the connections between respondents’

images of various addictions, and e.g.,

their living situation, their own experi-

ences in the field, their appreciation of the

stigma attached to various addictions, and

their political-ideological orientation. In

addition, further inquiry will be needed

into the processes by which respondents’

images of various addictions are formed.

ResultsBased on the considerations discussed in

the Methods section, the present analysis

focuses on three basic dimensions of pre-

vailing “images of addiction”: (a) the per-

ceived severity of various addictions, (b)

the attribution of moral responsibility for

various addictions, and (c) the perceived

“character” of various addictions. These

three basic dimensions have, as will be

seen, in turn be operationalised into more

specific aspects. Even if the choice of as-

pects has by necessity been somewhat ar-

bitrary, the ambition has been to focus on

what might be crucial to how people with

various addiction problems are met and

treated by others in practice.

Q Which is the “worst” addiction?

There are many ways in which the sever-

ity of an addiction problem could be de-

fined. On a societal level, severity could

refer e.g. to the prevalence of the problem,

the aggregate costs for the harm caused by

addicts, or society’s efforts to prevent the

problem and/or treat addicts. On an indi-

vidual level, severity could refer e.g. to the

stigma surrounding various addictions,


the “addictiveness” of (or the risk of get-

ting “hooked” on) a certain substance or

a certain habit, to what extent and how an

addictive habit impairs the user’s mental

and physical health and/or causes harm

to the environment, as well as to how

easy the addiction is to “cure”, and what

it takes to do so. The survey has tried to

capture at least some of these aspects, and

in the analysis the relations between dif-

ferent aspects have been explored in an

effort to further clarify the significance of

respondent’s judgements.

How dangerous are different addictions to

society?

As mentioned in the discussion on opin-

ion polls in the introduction, the fact that

there may be wide differences in the ex-

tent to which an issue concerns various re-

spondents is crucial to the interpretation of

their images of various drugs or activities.

To gain some estimation of this, respond-

ents were asked to rank fifteen such issues

on a ten-point scale with the anchor-points

“not severe at all” and “very severe”. The

general outline of this question was bor-

rowed from the Nordic survey reported

by Hübner (2001), although some issues

were added, and the wordings of some is-

sues were changed. The exact wording of

the question was (in translation): “How

serious do you think that the following

societal problems are on a scale from 1 to

10?” Table 4 shows respondents’ average

ratings of the fifteen issues mentioned in

the question.5

As can be seen, violent crimes end up

in a class of their own as the most severe

societal problem, followed by “hard”

drugs6 and environmental problems, and,

in a separate class, crimes against prop-

Rank Problem M (s)

1 violent crime 9.26 1.42

2 Drug problems (except cannabis)

8.66 1.93

3 Environmental problems 8.63 1.78

4 Property crimes (theft, burglary etc.)

8.46 1.84

5 Cannabis problems 8.15 2.32

6 Financial crimes (fraud, taxation crimes)

8.13 2.18

7 Poverty 7.99 2.27

8 Ethnic discrimination 7.89 2.35

9 Prostitution 7.61 2.60

9 alcohol problems 7.61 2.17

11 misuse of medical drugs 7.33 2.44

12 Gender inequality/gender discrimination

7.01 2.40

13 Wage differences 6.94 2.44

14 Gambling problems 6.44 2.54

15 tobacco use 5.75 2.49

note: Differences between groups of items are statisti-cally significant (paired samples t-tests of all subse-quent pairs of items; p < .05)

Table 4. Rated severity of various societal problems (scale 1 – 10; N = 1.098)

erty. Cannabis is ranked clearly below

other narcotic dugs, together with finan-

cial crimes and poverty, whereas all other

addiction problems appear at the lower

end of the ranking list. Alcohol problems,

together with prostitution, are ranked be-

low ethnic discrimination, but above the

misuse of medical drugs, and gambling

problems and tobacco use are ranked as

the two least severe concerns among the

available options, below gender discrimi-

nation and wage differences. As indicated

by the standard deviations, it also fol-

lows from the fact that “hard” drugs are

ranked close to the upper end of the scale,

that there is fairly widespread consensus


among respondents about the severity of

these drugs, whereas the opinions on the

severity of, e.g. tobacco and gambling as

societal problems are more divided. It is

possible that the “high profile” of narcotic

drugs as a societal problem should partly

be seen as an effect of the fact that the sur-

vey was mainly about addiction problems.

However, this interpretation is contradict-

ed by the fact that alcohol problems, the

misuse medical drugs, gambling problems

and tobacco all turn up at the end of the

list. As claimed above, another dimension

that may be important for the interpreta-

tion of respondents’ images of different

addictions is their personal acquaintance

with various substances and activities.

Albeit these relations will be the object

of future, separate analyses, this suggests

that the low ranking of tobacco use as a so-

cietal problem should be seen in the light

of the fact that tobacco dependence seems

to be surrounded by less stigma than other

addictions (cf. above). In addition, since

respondents were explicitly asked to rank

the severity of the fifteen issues as societal

problems, it is also important to consider

the way in which such problems are of-

ficially defined and handled, which may

influence people’s attitudes towards espe-

cially such issues with which they have

little personal experience. Thus, respond-

ents’ ratings of the severity of narcotic

drugs should most likely to a large extent

be seen as reflections of the strong official

stance in Sweden against any use of these

drugs, and the fact that objections to this

policy have been more or less banned in

the media (cf. Note 1).

Although the two studies are not totally

comparable, it is also fairly obvious that

opinions have not changed much since

1995, when the study reported by Hübner

(2001) was carried out. Thus, drug prob-

lems ranked next to violent crimes in the

previous study, too7, whereas both alcohol

problems and smoking ranked relatively

low8. The most obvious difference seems

to be that prostitution, which ranked low-

est among men and third lowest among

women in 1995, has “moved up the scale”,

which may be due to the relatively large

media attention during the past decade to

the issue of “trafficking” and to the change

in the legislation in this area in 1998, that

made buying sex a crime. In addition,

cannnabis, which was not distinguished

from other narcotic drugs in the previous

survey, may in reality have moved down-

ward on the severity scale. One might per-

haps also have expected that the changes

in alcohol policy that followed Sweden’s

accession to the EU in 1995, and the sub-

sequent, rapid and large increase in con-

sumption (e.g. Leifman 2004; Boman et

al. 2007) should have reflected in alcohol

problems moving “up the scale”. That this

is not the case may partly be explained by

most respondents making a clear distinc-

tion between “normal drinking” and “al-

cohol problems”, partly by the fact that

the recent increase in drinking seems, un-

like the simultaneous increase in Finland,

so far to have had fewer negative conse-

quences than might have been expected

(e.g. Norström & Ramstedt 2006).

Perceived severity of various addictions at

the individual level

Another crucial aspect of the “dangerous-

ness” of various substances or activities

concerns the risk for individual users of

“getting hooked”. To get a grasp of this

aspect respondents were asked, using a


four-point scale9 to rate the perceived risk

of developing a dependence or misuse if

experimenting with each of the nine sub-

stances or activities included in the study.

As touched upon in the introduction, one

of the reasons for setting the study up was

the experience that people’s success in try-

ing to recover from various addictions is

influenced not least by whether they are

met with trust and support or with dis-

trust and repudiation by others – family

and friends as well as professionals. Thus,

respondents’ “change optimism” in this

sense can be claimed to constitute another

crucial aspect of the perceived severity at

the individual level of a certain addiction.

To asses this, respondents were asked to

rate the perceived probability for recovery

from various addictions – with and with-

out the help of professional or formally or-

ganised treatment – including mutual help

groups such as AA, NA etc. These prob-

abilities were rated on a five-point scale,

ranging from “no or very little probability”

to “very high probability”. Table 5 shows

the ranks and mean ratings for the risk of

getting hooked on, and the overall options

of recovery from, the nine addictions in

questions. For all addictions, except snuff,

the overall options of recovery meant the

rated probability of finding a path out with

treatment (see further below).

As can be seen, there is, by and large,

an inverse relation between respondents’

views on which addictions it is easiest

to “get into” and “get out of”. Thus, the

“hard” drugs (heroin, amphetamine, and

cocaine) are not only seen as a large so-

cietal problem, but also as highly addic-

tive and very difficult to quit. At the other

end of the scale, drinking, gambling, and

snuff are seen as much less dependence

generating, and as relatively easy to quit,

should an addiction develop. Cannabis

and medical drugs are allotted middle

ranks in all these respects, whereas ciga-

Table 5. Overall perceived risk of becoming addicted and overall “change optimism” (scales 1–5; N = 1.098)

Perceived risk Change optimism

Problem with Rank m (s) Problem Rank m (s)

Heroin 1 4,26 (0,97) Heroin 9 3,52 (1,16)

Cocaine 2 4,17 (0,97) Cocaine 8 3,57 (1,13)

amphetamine 3 3,99 (1,00) amphetamine 7 3,67 (1,04)

Cannabis 4 3,64 (1,09) Cannabis 6 3,83 (0,98)

Cigarettes 5 3,18 (1,14) medical drugs 5 3,84 (0,96)

medical drugs 6 2,96 (1,07) Gambling 4 3,90 (0,92)

snuff 7 2,78 (1,06) Cigarettes 3 3,98 (1,01)

Gambling 8 2,65 (1,02) alcohol 2 3,98 (0,88)

alcohol 9 2,59 (0,98) snuff 1 4,02 (1,00)

mean 3,36 (0,72) mean 3,82 (0,70)

note: Regarding responsibility for causing the problem, differences between subsequent pairs of problems are significant except for cigarettes – gambling, cannabis – amphetamine, and cocaine – heroin – alcohol (paired samples t-tests, p < .05); regarding responsibility for solving the problem, all differences between all subsequent pairs of problems are significant.


rettes are rated as moderately addictive,

although smoking is judged as fairly easy

to quit. The small standard deviations also

indicate that there is relatively good agree-

ment between respondents both concern-

ing the high risk of getting “hooked” on

the “hard” drugs and the fairly low risk

of getting “hooked” on alcohol and gam-

bling. Concerning rated options on finding

a path out of the addiction, standard devi-

ations indicate fairly good agreement that

it is relatively easy to successfully treat

drinking and to some extent gambling

problems, whereas opinions seem to be

more divided regarding the same options

when it comes to “hard” narcotic drugs.

Harm to whom? Perceived severity at the

societal and individual levels compared.

How is the perceived dependence-gener-

ating capacity of various substances/be-

haviours related to how serious they are

judged to be as societal problems? To shed

light on this relation, the two ratings10 have

been brought together in Figure 1.

As shown in the figure, the perceived

“dangerousness” at the societal and indi-

vidual levels seem to converge regarding

“hard” narcotic drugs and to some ex-

tent cannabis, in the sense that these ad-

dictions are judged to be the most severe

ones on both levels. However, gambling,

and the misuse of medical drugs and al-

cohol are all seen as more severe societal

problems than tobacco use, although the

latter is judged to be stronger dependence

generating. Whereas respondents’ ratings

of the “addictive potential” of various sub-

stances and activities seems to fit fairly

well with what at least some researchers

have claimed (cf. West 2007), the ratings

of their severity to society fit rather poorly

with what is known about e.g. the preva-

lence and aggregate costs to society of vari-

ous such problems in Sweden (cf. Note

3). This strengthens the assumption that

these ratings to a large part represent the

official stance on and the prevailing media

image of these problems, and that there is

a strong relation between the perceived

12

3

4

5

6

7

8

9

10

Tobacco Gambling Medical drugs

Alcohol Cannabis

Individual risk to get hooked„

Severity to society

Other narc.drugs

„

Figure 1. Severity at the societal and individual level (standardized ratings, 1–10)


“strangeness” of various problems and the

extent to which they are seen as dangers to

society (cf. above; Christie & Bruun 1985).

Change optimism and confidence in

treatment

As already noted, respondents were asked

to rate the probability for recovery from the

nine addictions both without professional or

formally organised help (“self-change”) and

with such help. Based on these rankings,

Figure 2 shows the perceived probability

for “self-change”, and what treatment is as-

sumed to be able to add in finding a solution.

As can be seen, the perceived options

to quit without professional or formally

organised help are high concerning tobac-

co use and to some extent gambling, and

lowest concerning “hard” narcotic drugs

of which few Swedes have personal expe-

rience (cf. Note 3 and Table 3). A closer

analysis reveals that only eleven percent

of the respondents believe that a heroin

addict has any chance at all of finding a

resolution on her/his own, whereas the

same proportion for snuff use is close to

seventy-five per cent. With the exception

of tobacco use, the figure also indicates

that Sweden is rather far from being the

type of “self-change friendly society” that

for example Klingemann (2005; Klinge-

mann & Klingemann 2007) has argued for.

Rather, respondents’ views of the options

for self-change seem far more pessimistic

than topical research about the prevalence

for such solutions can be claimed to give

grounds for (Klingemann & Sobell 2007;

Blomqvist et al. 2007). In fact, if the scale

used in the figure should be transformed

to a percentage scale, it would mean that,

besides tobacco dependence, the rated

probability for self-change would vary be-

tween about twenty (heroin addiction) and

slightly below fifty per cent (gambling).

This should be put in the perspective of

topical research, indicating that the large

majority of recoveries from dependence

not only on alcohol, but also on most nar-

cotic drugs, take place outside the treat-

ment system (e.g. Blomqvist 2009).

On the other hand, the figure also indi-

cates that this pessimism is to a large ex-

tent compensated for by a strong general

confidence in the effectiveness of addic-

Snuff Cigarettes Gambling Alcohol Cannabis Cocaine Heroin1

2

3

4

5With treatmentSelf-change

Amphe-tamine

Medical drugs

Figure 2. Change optimism with and without treatment (scales 1–5)


tion treatment, where type of addiction

does not seem to matter much. Thus,

whereas the probability for a successful

outcome of treatment of alcohol prob-

lems, using the transformed scale, would

be set at about seventy-five per cent, the

corresponding probability for treatment

for amphetamine misuse would be set at

almost seventy per cent. The figure also

shows that the relative importance of ex-

pert help, i.e. the difference between the

rated probabilities for recovery with and

without treatment, is consequently judged

to be larger for the “hard” drugs (heroin,

amphetamine, and cocaine) than for e.g.,

addiction to alcohol and cannabis11, and to

be more ore less non-existent for depend-

ence on tobacco (and even negative for

snuff). By and large, this may be said to

reflect the current situation in the addic-

tion field in Sweden, where more energy

and, in relative terms, more resources are

spent on treating a rather limited number

of drug addicts, than on treating a much

larger number of problem drinkers and al-

cohol misusers (cf. Blomqvist 2002; Mel-

berg 2006), and where treatment of smok-

ers and snuff users is rare12.

It is not self-evident how to interpret re-

spondents’ high confidence in addiction

treatment. Potentially, it could be seen

as an indication of a generalised strong

trust in (or at least nostalgia concerning)

the benevolent welfare state (cf. Rothstein

1994) and/or as mirroring the promises of

increasingly “effective cures” (mainly of a

medical kind) that are recurrently report-

ed by the media (cf. Note 4). Whereas no

final conclusions can be drawn from the

fact that studies in Finland (Koski-Jännes

et al. 2009) and Canada (Cunningham

2009) show a similar strong trust in addic-

tion treatment, further comparisons with

studies in countries with less developed

welfare ambitions may resolve this issue

with time. The fact that both Canadian and

Swiss respondents (Cunningham 2009;

Klingemann & Klingemann 2007) are

clearly more optimistic about the options

for self-change from problematic cannabis

use than Finns (Koski-Jännes et al. 2009)

and Swedes, and the fact that Finns rate

alcohol as a much larger societal problem

than Swedes13, certainly shows that views

and attitudes differ between countries and

contexts. In sum, however, respondents’

ratings on the severity, “addictiveness”,

and options to “get out of” various addic-

tions, rather clearly suggest that the less

common and familiar – to the common

citizen or in mainstream culture – a habit

or a substance is, the “worse” – in most

aspects – it is judged to be.

Q Who is responsible? The moral aspect

As mentioned, drawing on the work of

Brickman et al. (1982) respondents were

also asked to what extent they ascribed

the responsibility for causing, as well as

for solving the nine addiction problems to

the single individual. The answers to these

two questions are displayed in Table 6.

As shown by the high means in the first

column of the table, addiction problems

seem largely to be seen as the individual’s

own fault. At the same time, there is a

tendency that the more severe an issue is

rated to be as a societal problem (cf. Ta-

ble 4), the less likely the individual suf-

ferer is to be blamed for having caused the

problem. However, there seems to be two

exceptions to this. Thus, the group of ad-

dicts who are to the greatest extent seen

as “victims” are those addicted to medical


drugs. In addition, problem drinkers are

on the average blamed less for their condi-

tion than are users of at least cannabis and

amphetamine. A possible explanation is,

in the first case, that the misuse of medi-

cal drugs is seen to have been “created” by

doctors or by the health care system who

should therefore also take responsibility,

whereas in the other case the results might

be a reflection of repeated claims – from

different parties with differing agendas14 –

that alcoholism is a “disease”.

As regards the responsibility for solving

an addiction problem, respondents seem

to put even greater pressure on the single

individual, a fact that could at the same

time and in some sense be said to refute

the assumption of a widespread disease

notion of addiction. Since this question

asked whether the responsibility for solv-

ing a problem should rest primarily with

the individual or society, it should be

pointed out that the high means do not

necessarily imply that the majority view is

that society is not obliged to offer help, but

rather that the main responsibility for solv-

ing the problem lies with the individual

client or patient, whether she or he is in

treatment or not. Thus the majority stance

should probably be interpreted according

to the common view that you cannot help

someone to quit an addiction, unless she

or he really wants to do so. The rankings

of various addictions are again, with the

partial exception of the misuse of medical

drugs, clearly related to their perceived

“dangerousness” as social problems, mak-

ing the individual the more responsible

for the solution the less severe and/or the

less risky a certain substance use or activ-

ity is considered to be. However, the main

impression from the data shown in Table 6

is that the blame for developing an addic-

tion, as well as the responsibility for find-

ing a path out is to a large extent attributed

to the single individual.

Table 6. Degree to which the individual is deemed responsible for causing and solving the problem (scale 1– 4; N = 1.098)

Causing Solving

Problem with Rank M (s) Problem with Rank M (s)

snuff 1 3,33 (0,76) snuff 1 3,64 (0,58)

Cigarettes 2 3.27 (0,76) Cigarettes 2 3,60 (0,62)

Gambling 3 3,25 (0,77) Gambling 3 3,22 (0,74)

Cannabis 4 2,91 (0,84) alcohol 4 3,09 (0,63)

amphetamine 5 2,90 (0,88) Cannabis 5 3,01 (0,72)

Cocaine 6 2,89 (0,89) amphetamine 6 2,91 (0,77)

Heroin 7 2,87 (0,90) Cocaine 7 2,86 (0,81)

alcohol 8 2,87 (0,75) Heroin 8 2,84 (0,82)

medical drugs 9 2,54 (0,87) medical drugs 9 2,77 (0,83)

mean 2,97 (0,61) mean 3,11 (0,56)

note: Regarding responsibility for causing the problem, differences between subsequent pairs of problems are significant except for cigarettes – gambling, cannabis – amphetamine, and cocaine – heroin – alcohol (paired samples t-tests, p < .05); regarding responsibility for solving the problem, all differences between all subsequent pairs of problems are significant.


Q What kind of problems?

Although the choice of dimensions and

aspects in trying to capture the prevail-

ing popular images of various addictions,

has – as already mentioned – by neces-

sity been somewhat arbitrary, the analyses

presented so far could be claimed to have

given a reasonably coherent and meaning-

ful result. There are, however, still some

aspects that might be added to provide a

more comprehensive understanding of the

ways in which the percieved characters

of various addictions diverge. One means

for such an understanding would be to ex-

plore how respondents’ perceptions of the

severity of various addictions are connect-

ed to each other, and to their perceptions

of the severity of other social problems (cf.

Hübner 2001). To this end, a factor analy-

sis was conducted, using the data shown

in Table 4. As can be seen in Table 7, a

four-factor solution in this analysis result-

ed in a set of quite distinctive dimensions,

explaining a fairly large proportion of the

total variance.

The first factor can clearly be interpret-

ed to represent an addiction or misuse

problems factor with high loadings for

the “traditional” addictions, as well as for

gambling and to some extent prostitution.

The second factor can be interpreted as a

“social/political” factor, with high load-

ings for issues that concern social and eco-

nomic justice, gender and ethnic discrimi-

nation, and environmental protection.

The third factor stands out as a relatively

distinctive “crime factor” with high load-

ings for all of the, rather different types of,

crimes that were included in the question.

Finally, the analysis discerns “tobacco

Variables: Rotated factor matrix

Cannabis problems . 812 .059 .382 .065

other drug problems . 786 .124 .398 .032

misuse of medical drugs . 686 .415 .203 .203

Gambling problems . 639 .414 .015 .367

alcohol problems . 605 .151 .240 .417

Ethnic discrimination . 195 .762 .155 .123

Poverty . 280 .762 .243 .031

Environmental damage .098 .580 .354 .257

Gender inequality/discrimination -.037 .575 .144 .065

Prostitution .524 .572 .144 .065

large wage differences .009 .562 ..206 .539

violence crimes .303 .268 .741 -.018

Property crimes .395 .011 .739 .201

Financial crimes .250 .353 .502 .086

tobacco use .337 .068 .086 .824

Eigenvalue 6.90 1.48 1.01 .86

Explained variance b 46.01 % 9.89 % 6. 75 % 5.71 %

a) varimax rotation; b) total explained variance: 68. 4 %

Table 7. Factor analysis of ratings of various societal problems. Principal componentsa


use”, as an own – but as also indicated in

Table 4, not particularly important – di-

mension in Swedes’ apprehension of so-

cial problems.

It can be noted that a similar analy-

sis conducted on data from the above-

mentioned Nordic survey (Hübner 2001),

yielded three dimensions, represent-

ing a “moral”, a “social/political”, and a

“crime” factor, where smoking problems

were grouped together with alcoholism,

drug abuse, and prostitution in the first

factor. The main difference is thus that to-

bacco use here appears as a separate fac-

tor, something that may to some extent be

due to the fact that the two studies used

partly different items and different word-

ings (cf. above)15. In sum, this analysis can

be claimed to suggest that the public dis-

course on addiction problems in Sweden

is largely separated from the political dis-

course, and that a distinction is also made,

even if the border is somewhat blurred,

between “addictions proper” (most clearly

represented by heroin and other “hard”

drugs) and “bad habits” (most clearly rep-

resented by snuff use and smoking).

Another way of trying to summarise the

perceived “character” of various addic-

tions would be to apply to them the four

“models of helping and coping”, deline-

ated by Brickman’s and colleagues (1982).

As already mentioned, these authors claim

that the attribution of moral responsibility

for human and/or social problems involves

not one but two basic dimensions, namely

the question of blame (“who caused he

problem”) and control (“who is capable of

and responsible for solving the problem”).

By combining these two dimensions, they

arrive at what they refer to as four “mod-

els” of how a certain problem could and

should be handled. According to the

“moral model” people are held responsi-

ble for creating a problem as well as capa-

ble of and responsible for solving it, which

means that help essentially takes the form

of punishments and rewards. According to

the “treatment model” (or perhaps rather

the “expert model”) on the other hand,

problems are seen as caused by forces

beyond the subject’s own control, and as

curable only by professional experts. By

and large these two models correspond

to the “badness-illness” dichotomy that

has often been used to illustrate different

ways of looking at addiction problems (cf.

Mäkelä 1980). To this common figure of

thought, the authors add the “enlighten-

ment model”, according to which people

are blamed for having caused their prob-

lems, but are at the same time seen as inca-

pable of solving them. As a consequence,

the subject’s best hope for a solution lies

in submitting to a higher moral authority

that can help her or him to overcome their

destructive impulses. Since this author-

ity could obviously be both of a spiritual

and a profane character, “fostering” might

in fact be a better name for this model (cf.

Blomqvist 1998b16). Finally, in the “com-

pensatory model”, people are seen as

subjected to certain handicaps or obsta-

cles imposed on them by the situation or

by nature but as basically capable of and

responsible for managing their own lives.

Accordingly, they may be entitled to cer-

tain help, given on their own terms, and

aimed at empowering them to solve their

own problems and manage their own lives

on the same terms as other citizens.

Previous research suggests that the dis-

tinctions suggested by Brickman et al.

(1982) may be more fruitful when applied


in e.g., overarching socio-historical analy-

ses (cf. Blomqvist 1998b), than in clinical

contexts (e.g. West & Power 1995), and it is

not self-evident how the four models could

and should be operationalised, using the

survey questions. One option would be to

dichotomize the two questions on respon-

sibility for causing and solving various

problems, the answers to which are shown

in Table 3. However, as indicated by the

same table, that would obviously mean

that a large majority of the respondents

would be claimed to apply the “moral”

model to all addictions, a result that does

neither stand out as particularly meaning-

ful nor as particularly informative in the

present context. Further, as already indi-

cated, the wording of the question on re-

sponsibility for solving various problems

was not ideal, asking respondents to rate

to what extent this responsibility should

be put on the individual or on society. Fi-

nally, the “control” dimension in the work

of Brickman et al. (1982) seems on closer

scrutiny to be at least as much about the

capacity to solve a problem as about the

responsibility for doing so. Therefore, the

rated responsibility for developing various

addictions has here been combined with

the rated options for “self-change” from

the same problems17. The resulting distri-

bution of preferred “models for helping

and coping” over the nine addictions is

shown in Figure 3.

When interpreting this figure, it should

first be noted that with the operationali-

sation used, it follows from respondents’

ratings of the individual as largely respon-

sible for acquiring an addiction (Table

6), that the “moral” and “enlightenment/

fostering” models are overall more com-

monly endorsed than the “compensatory”

and “treatment/expert” models. This said,

it should be noted that respondents seem

to apply different models for different ad-

dictive substances or activities. At one end

of the scale, tobacco use (snuff and ciga-

rettes), and to some extent gambling, are

predominantly seen as “moral concerns”

or “bad habits”, in the sense that both

starting and terminating these activities

is predominantly seen as the individual’s

0

10

20

30

40

50

60

70

80% Moral Enligtenment

Snuff Cigarettes Gambling Alcohol Cannabis Cocaine HeroinAmphe-tamine

Medical drugs

Treatment Compensatory

Figure 3. Preferred model of “helping and coping” with various problems (%)


own business. At the other end of the scale

is the use of “hard” drugs (heroin, cocaine,

and amphetamine), where opinions are

more divided, but where the “enlighten-

ment” and “treatment” models, both im-

plying that the individual needs external

help to overcome her/his predicament,

and that the addict should be seen either

as a “sinner” or a “crook” who needs help

to mend his/her ways, or a powerless “vic-

tim” who needs expert treatment, clearly

predominate. In a “middle group” are ad-

dictions to alcohol, cannabis and medi-

cal drugs, where opinions are even more

spread, but where the “compensatory”

model gets more “votes” than it gets with

regard to the “hard” narcotic drugs.

The fact that tobacco dependence stands

out from the other addictions as being al-

most exclusively seen through the eyes of

the “moral model”, is in line both with the

fact that this seems to be a fairly common

and mundane experience (Table 3), as well

as with the fact that tobacco use is ranked

low as a societal problem (Table 4), and

is singled out as an “own” dimension in

the factor analysis (Table 7). In addition,

it suggests that respondents’ assessments

of the severity and character of tobacco

use pay little attention to matters such as

mortality, morbidity, and harm to others.

Together, these data rather suggest that

smoking and snuff use, in spite of recur-

rent campaigns pointing to tobacco as a

large public health problem, are predomi-

nantly seen as “private” as opposed to

either moral or political concerns in con-

temporary Sweden.

The figure also indicates that legal sub-

stances or activities are to a greater extent

seen as moral matters than are illegal sub-

stances – cannabis being a partial excep-

tion here. The fact that the enlightenment

or “fostering” model is the one most en-

dorsed by respondents concerning both al-

cohol and narcotic drugs may partly have

to do with the growing popularity of, and

media attention to, AA, NA and other mu-

tual help groups (cf. Note 4), partly with

the fact that coercion has always been –

and is probably been seen by most – as an

integral part of society’s efforts to counter

addiction problems. The relative unpopu-

larity of the “treatment (or expert) model”,

in spite of respondents’ strong confidence

in the treatment system (see Figure 2), can

perhaps be seen in the same light.

In sum, the results presented above may

be claimed to hint that respondents down-

play the severity of and risks with hab-

its and conditions with which they have

some – direct or indirect – personal experi-

ence and/or which are seen as part of main-

stream culture, whereas problems that are

more uncommon or “alien” are perceived

as more severe or dangerous. In addition,

the former problems seem to be regarded as

more “private” and to a larger extent as the

individual’s own business, whereas users

of “hard” drugs in particular are seen as be-

ing both a threat to society and as victims of

powers stronger than themselves.

DiscussionThis article presented analyses of data

from a survey aimed at capturing prevail-

ing popular images of nine different ad-

dictions in contemporary Sweden. The

results show that these images vary greatly

between different addictions, and in a fair-

ly consistent way. These differences seem

to have little to do with known facts about

either the prevalence of different addic-

tion problems, their harmful and hazard-


ous effects on user’s health and wellbeing,

or their “costs” to society in the form of

premature deaths, health care expendi-

ture, lost years in work life, or potential

harm to others. Rather, the popular images

of various addictions seem to a large extent

to reflect beliefs of a rather “ingrown” and

stereotypical character. This is true above

all as concerns respondents’ images of

the “hard” narcotic drugs (amphetamine,

cocaine, and heroin), which are clearly

in line with the basic conceptions which

have been used to justify Sweden’s tradi-

tionally very restrictive drug policy, de-

picting narcotic drugs as extremely dan-

gerous and poisonous, with the capacity

to quickly enslave every user, and almost

impossible to quit (cf. Bergmark & Oscars-

son 1988), a picture that has also recur-

rently been reproduced by the media (cf.

Hübner 2001). At the other end of the con-

tinuum are the images of some relatively

mundane and familiar “habits” – smoking,

using snuff, and to some extent gambling

– the dangers and addictive character of

which seem rather to be played down by

the respondents. In between come addic-

tions to alcohol, cannabis, and medical

drugs, about the severity and character of

which there seems to be less consensus in

popular thinking, perhaps due to the fact

that rather divergent views on these issues

have come to light repeatedly over the

years, also in the media (cf. Hübner 2001;

Blomqvist 2004).

The fact that respondents largely at-

tribute the responsibility for the devel-

opment of addictive problems, as well as

the responsibility for solving them to the

individual, may seem surprising, not least

considering the fact that survey answers

reflect a generally strong confidence in

the addiction treatment system and its po-

tential benefits. One possible explanation

may be that “treatment” of these problems

is not mainly thought about in terms of,

“expert” or “professional”, specific inter-

ventions, but as much – in line with what

the media tend to pay attention to in this

area – in terms of AA, NA or other mutual

help groups, backing up people who have

made a decision to quit, and/or in terms of

coercive care, exerting external control to

make them do so.

Since “self-change” is today known to

be the most common path out of many ad-

dictions (e.g., Klingemann & Sobell 2007),

and since supportive and encouraging, al-

though not undemanding, social networks

have been found to be crucial in such proc-

esses (e.g., Blomqvist 1999; 2002), it can

be deemed unfortunate that so few of the

respondents endorse what Brickman et al.

(1982) term the “compensatory model”,

which guarantees the individual the nec-

essary support, but without putting blame

on her/him for their distressing condition,

and without expressing scepticism or dis-

trust. This is the more regrettable given

that only a minority of the respondents

who had reportedly experienced an addic-

tion problem in someone close, actually

had offered any personal help.

It is also tempting to dwell on the fact

that dependence on smoking and snuff in

particular are more often seen as “bad hab-

its” than as “real addictions” or “diseas-

es”, and to relate this to the fact that smok-

ing has decreased substantially in Swe-

den during the past two decades, largely

due to “rational” reactions to measures

such as information on health risks, price

policy and, in particular, rendering smok-

ing more difficult and more expensive.


Since earlier studies have shown that the

adoption of a “disease notion” of alcohol

problems may in certain respects function

as a self-fulfilling prophecy, one might

wonder whether a de-stigmatisation and

wider acceptance of a view of substance

use problems as a “central activity” in the

subject’s way of life (Fingarette 1988) or as

“lifestyles leading to predicaments” (Drew

1989), might not increase addicts’ options

of cutting loose from their addiction (cf.

Blomqvist 1998a; Blomqvist & Cameron

2002). This may also have a bearing on the

present new wave of “bio-medicalisation”

of addiction problems, proclaiming these

problems to be “diseases of the brain” (see,

e.g. www.hjarnfonden.se), a tendency that

may thus in a longer run not necessarily

prove to be particularly productive to ad-

dicts’ options for finding a path out.

However, it needs to be pointed out that

there are a number of study limitations

that imply that these conclusions should

be regarded as tentative. First, the relative-

ly low response rate means that generalisa-

tions need to be made with caution, even

if attrition bias does not seem to be a major

problem. Secondly, as has already been

pointed out, a survey of this kind can only

“scan the surface” when it comes to peo-

ples’ conceptions and beliefs about vari-

ous addictions. For example, the way in

which this study was been conducted has

not left room for more nuanced statements

from the respondents, e.g. to the effect that

the perceived risk of becoming addicted or

options for self-change may vary not only

with type of addiction, but also with vari-

ables such as age, gender, socio-economic

status, and social context.

To overcome these limitations, more

research will be needed. Further analysis

of the data from the study presented here

will focus on how respondents’ percep-

tions of various addictions relate to their

personal addiction experiences, to socio-

demographic factors such as age, gender,

ethnic background, educational level, and

family situation, and to wider political-

ideological inclinations and attitudes, as

well as to the stigma surrounding various

addictions. In addition, the issues under

study in the present survey will be ex-

plored in further investigations, using

qualitative methods, in an attempt to cap-

ture more subtle aspects of prevailing con-

ceptions of addiction and how these con-

ceptions have been formed. To get a better

grasp of how the “images of addiction”

are influenced by various kinds of per-

sonal addiction experiences, such studies

should include not only lay people and

professionals, but also persons with past

and present addiction problems (cf. Koski-

Jännes et al. 2009). Finally, and consider-

ing that similar research is ongoing in sev-

eral countries, cross-cultural comparisons

in this area offer, as already disussed, an

interesting option.

Jan Blomqvist, ProfessorCentre for social Research on alcohol and Drugs, soRaD stockholm UniversitysE-106 91 stockholm, swedenE-mail: [email protected]


NOTES

1) Bergmark & Oscarsson (1988) use this term to refer to a set of undisputed, and alleged-ly undisputable, themes that they claim to provide the unreflected basis for any debate on and public action targeting the drug problem in Sweden. According to Hübner (2001) this “doxa” has, by and large, also been adopted by the media, thereby leaving little room in the public debate for oppo-nents to the official Swedish drug policy, based on zero tolerance.

2) Societal Images of Natural Recovery. This study explored the confidence in “self-change” from different addictions, based on 30 “key informants” (representing addiction professionals as well as “lay therapists” and “common people”) in nine large cities in seven different countries. The Swedish part of this study, reported by Andersson et al. (2004), was led by the present author. The results pointed to considerable differences between various addictions, but also between settings, and between professionals and lay people.

3) Regarding alcohol, less than 5 per cent of the adult Swedish population are today lifetime abstainers (Blomqvist et al. 2007), whereas slightly more than 10 per cent could at the time of the survey be charac-terised as “frequent binge drinkers” (Selin 2004). With regard to tobacco use, the proportion of daily smokers in Sweden decreased from 36 per cent of the men and 29 per cent of the women in 1980, to 14 per cent of the men and 19 per cent of the women in 2004, and has decreased further since (Lundquist 2007). At the same time snuff use has increased, partly as a substitute for smoking, and 23 per cent of the men and 4 per cent of the women were daily users during 2004 (ibid.). As concerns narcotic drugs, Sweden’s extremely restric-tive policy in this area, making any use of narcotics classified substances a punishable crime, has been fairly successful in keeping youthful, recreational use on a low scale (Olsson 2009). For example, lifetime use of any narcotic substance among nine-graders has during the past decades fluctuated bet-

ween six and ten per cent (Leifman 2008). However, seen in a European perspective, Swedish drug policy seems to have been less successful in keeping down “heavy” drug abuse and drug-related mortality in particular (ibid.). Still, the use and misuse of narcotic drugs is uncommon in Sweden, as shown by the fact that, since the turn of the millennium, past year prevalence of cannabis use has been estimated to less than 2.5 per cent, and the use of other narcotic drugs to less than 1.5 per cent (ibid.) As for the misuse of medical drugs, there are no reliable reports on illegal use of drugs sold on prescription (which is probably not very common), albeit that the Swedish National Association for Helping Misusers of Pharmaceutics (RFHL), claim that a quarter of a million Swedes are dependent on (illegal or legally prescribed) such drugs. Finally, Jonsson et al. (2000) found that one and a half per cent of the population over 15 years were present problem gamblers, and that as many were former problem gamblers. The highest prevalence was found among the youngest men (ibid.).

4) By and large, Sweden has long spent more per-capita resources in care and treatment of alcohol and drug problems than most comparable countries. The main responsi-bility for this care lies with the municipal Social Services, and has to a large extent been focussed on social and psychosocial rehabilitation, although treatment for alco-hol problems has largely been more “thera-peutic” in character, and treatment for drug problems more aimed at re-socialisation (Blomqvist 2004). However, in recent years, the quest for “evidence-based practice” that has accompanied various attempts to make the public sector more rational and more cost-effective, has also given way for an increasing “bio-medicalisation” (cf. Blomqvist et al. 2009). This has become evident not least in the official rhetoric and in the media, where more attention seems at present to be paid to “promising” phar-macological treatments and to “disease-based” mutual help groups such as AA and


NA, than to traditional psychosocial care. In recent decades, with increased interna-tionalisation and increased Internet access, new forms of gambling have appeared and have become an integral part of the entertainment industry, including TV. At the same time, gambling problems have re-ceived increasing attention, and a number of separate treatment facilities for such pro-blems have been established. There are also a few specialised facilities for persons who misuse medical drugs, although those enga-ged in these matters often claim this to be a “hidden” problem, more or less neglected by both the prescribing doctors and the media. Finally, smoking has been officially discussed largely as a health issue, and as an economic burden to society, but seldom in terms of an individual “disease”. Ac-cordingly, the official strategy in this area – which has been fairly successful (see Note 3) – has largely consisted in a combination of health information (pamphlets, warning labels etc.), and campaigns and measures aimed at rendering smoking more difficult. Regarding snuff use, there has been some debate concerning potential health risks, but by and large, snuff has not been a big issue neither to the authorities nor in the media.

5) Although not necessarily statistically cor-rect in all aspects, paired t-test was consis-tently applied to all ratings to test whether the mean rating of a certain problem was statistically different from its next lower or higher counterpart.

6) It should be noted thought that the official drug discourse in Sweden does not make this distinction between e.g. cannabis and “harder” drugs

7) In this study, “crimes against the person” (murder, rape a.s.o.) ranked highest before “family violence” and “drug abuse”.

8) In places seven and nine out of ten respec-tively.

9) Transformed in the analysis, for the sake of comparability, to a five-pont scale.

10) It should be observed that severity on the societal level was, except for alcohol, gambling, medical drugs, and cannabis, only rated for “tobacco” and “other narco-

tic drugs” (than cannabis). Therefore, the individual risk to develop tobacco depen-dence has been calculated as the mean risk for cigarettes and snuff, and the risk to get “hooked” on other narcotic drugs (“hard drugs”) as the mean risk for amphetamine, cocaine, and heroin.

11) Although paired t-tests showed these dif-ferences to be statistically significant for all these addcitions (p < .05).

12) Except for the use of substitutes such as nicotine pills, chewing gums or plasters (or, for that part, substituting cigarettes for snuff ). It should also be noted there is an increasing commercial launching of such means.

13) This may at least partly be explained by the Finnish “experiment” with lower taxes on liquor to counter increased private im-port, that lead to a rapid increase in alcohol mortality and alcohol related harm during the years before the Finnish survey was conducted in 2007.

14) Whether the assumptions about metabolic or other physiological aetiological factors of the popular disease model of the 1940s (cf. Pattison 1976), AA: s concept of “spiritual disease”, or topical claims of all kinds of addictions as “brain diseases”.

15) In addition it can be noted that in a three-factor solution using the present data, “hard” drugs and cannabis got grouped together with all types of crime in a “moral-legal” factor, the “social/political” factor looked much the same as in the four-factor solution, and tobacco got grouped together with alcohol and gambling in what could be seen as a “bad habits” factor.

16) In this article, ”guilty” vs. “victim”, and “capable” vs. “incapable” are distinguis-hed as the two basic dimensions of the Brickman et al. model, and “discipline” or “fosterage” and “conversion” are discus-sed as the implications in practice of the “enlightenment” model.

17) Responsibility entirely or mostly on the individual vs. entirely or mostly on circumstances; and no or relatively low vs. moderate to very high probability for “self-change”.


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