Retreat or Entrenchment? Drug Policies in the Nordic Countries at a Crossroads

The drug policies of the Nordic countries have been relatively strict. Since this seems to contradict the internationally recognized liberal criminal policy in general, analyses have been devoted to try to understand this gap. Why doesn’t the “Scandinavian exceptionalism” apply to the drug policies? The new question in relation to drug policy is, however, if and how the Nordic countries will adapt to a situation when several countries all over the world are questioning ‘the war on drugs’ and orienting themselves in the direction of decriminalization and legalization. An analysis of a possible change in drug policies must be undertaken against the background of the existing policies. There are both similarities and differences between the five countries. A common feature is a stress on the demand side through both treatment and punishments directed against the user and abuser. Differences are shown in degrees of toughness in drug policies with Sweden strongest stressing a zero-tolerance stand and Denmark being the most liberal in the Nordic context. The strong welfare state ideology of all the countries is important for understanding the obstacles to a more liberal and permissive drug policy. The welfare state is an interventionist state. To not do anything about what is considered to be a problem both for the individual and the society is just not an option. In most of the countries the traditions from the temperance movements also have influenced the drug policies through the stepping-stone or gateway theory, not making a distinction between soft and hard drugs. At the same time, a number of facts and processes work in the direction of change. The drug policies of the countries have not delivered, including high numbers of drug-related deaths. The debate has opened up in just a short period of time. Many of the political youth parties demand decriminalisation of use of drugs and so have some public authorities. Human rights arguments are increasingly being put forward as a critique of police interventions. A tendency for politicians to meet the critique seems to be to separate the marginal abuser from the recreational user. The first one should be given treatment and care according to welfare state ideology. The second one, however, could be punished since the user in line with neo-liberal theory can choose and by the use contributes to the drug trade and even the killings in poor suburbs. The Nordic countries stand at a crossroads, but what new roads will be taken is far from clear.

Common Neural Mechanisms of Palatable Food Intake and Drug Abuse: Knowledge Obtained with Animal Models

Eating is necessary for survival, but it is also one of the great pleasures enjoyed by human beings. Research to date shows that palatable food can be rewarding in a similar way to drugs of abuse, indicating considerable comorbidity between eating disorders and substance-use disorders. Analysis of the common characteristics of both types of disorder has led to a new wave of studies proposing a Gateway Theory of food as a vulnerability factor that modulates the development of drug addiction. The homeostatic and hedonic mechanisms of feeding overlap with some of the mechanisms implicated in drug abuse and their interaction plays a crucial role in the development of drug addiction. Studies in animal models have shown how palatable food sensitizes the reward circuit and makes individuals more sensitive to other substances of abuse, such as cocaine or alcohol. However, when palatable food is administered continuously as a model of obesity, the consequences are different, and studies provide controversial data. In the present review, we will cover the main homeostatic and hedonic mechanisms that regulate palatable food intake behavior and will explain, using animal models, how different types of diet and their intake patterns have direct consequences on the rewarding effects of psychostimulants and ethanol.

The association of waterpipe tobacco smoking with later initiation of cigarette smoking: a systematic review and meta-analysis exploring the gateway theory

IntroductionThere is a concern that waterpipe tobacco smoking (WTS) can lead to the later initiation of cigarette smoking, a concept referred to as the ‘gateway theory’. The objective of the study was to systematically review the literature for the association of WTS with later initiation of cigarette smoking.MethodsWe searched Medline, Embase and ISI Web of Science in April 2018 without using any language or date restrictions. We selected eligible studies, abstracted data and assessed the risk of bias using a duplicate and independent approach. We meta-analysed the ORs across eligible studies using the inverse variance method and the random-effects model. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation methodology.ResultsWe included eight papers reporting on six eligible prospective cohort studies with a total of 21 224 participants, belonging to the adolescent and young adult age categories. The pooled adjusted OR for the association between ever waterpipe user (compared with never waterpipe user) at baseline, with ‘cigarette smoking initiation’ (ever cigarette use) was 2.54 (95% CI 1.60 to 4.02) at 6 months to 3 years follow-up (moderate certainty evidence). The pooled adjusted OR for the association between ever waterpipe user (compared with never waterpipe user) at baseline, with ‘current cigarette smoking’ (past 30-day cigarette use) was 2.04 (95% CI 1.32 to 3.15) at 1–2 years follow-up (moderate certainty evidence). The pooled adjusted OR for the association between past 30-day waterpipe user (compared with never waterpipe user) at baseline, with current cigarette smoking (past 30-day cigarette use) 2.46 (95% CI 1.73 to 3.49) at 6 months to 1 year follow-up (high certainty evidence).ConclusionOur findings indicate that WTS is associated with more than doubling of the odds of later initiation of cigarette smoking, supporting the gateway theory. Strengthening WTS policies is a priority and further research is needed on the development and evaluation of appropriate clinical and public health interventions.

An Examination of the Importance of Strain in the Cannabis Gateway Effect

Gateway theory has been the source of much debate in both the research literature and public policy. Support for gateway sequencing has been mixed, especially in research that has considered the role of criminological variables in the etiology of substance use. For example, limited prior research has observed as important in gateway sequencing the effects of severe stressors. Data from the National Longitudinal Study of Adolescent to Adult Health are utilized to test gateway theory and examine whether severe stressors affect the relationship between frequency of cannabis use and later use of other illicit drugs (OIDs). Findings suggest that while frequency of cannabis use does increase the likelihood of later use of OIDs, this relationship may be the result of the common cause of experiencing severe stress. Implications of the findings are discussed.

Alcohol misuse and gateway theory: a longitudinal study among adolescents in Switzerland

Objective: Adolescence is a transitory and exploratory stage during which risky behaviors such as substance use take place. This study aims to assess the characteristics and predictive risk factors of alcohol misuse among adolescents. Methods: A sample of 621 youths was followed from ages 14 to 16 years in Switzerland between spring 2012 (T0) and spring 2014 (T1). Participants were divided into two groups according to their alcohol misuse evolution: those who increased it (Misusers) and those who decreased or never experimented it (Non-misusers). The final sample consisted of 574 adolescents. At T0, participants reported demographic data, substance use data and emotional well-being. A multivariate regression was performed to assess the explanatory variables of alcohol misuse at T1 using Non-misusers as the reference category. Results: Alcohol misuse in the previous month increased dramatically from 2.4% (T0) to 29.2% (T1). At the bivariate level, alcohol misuse was associated with residence, use of alcohol, tobacco and cannabis. Compared to Non-misusers, Misusers were significantly more likely to live in a rural area (aOR: 1.75 [1.1:2.8]), use cannabis (aOR: 3.2 [1.0:9.8]) and have consumed alcohol (aOR: 2.65 [1.6:4.3]) at T0. Conclusion: Alcohol misuse increases dramatically with age. However, the only demographic difference between groups was that young adolescents living in rural areas were more likely to misuse alcohol. Moreover, having consumed alcohol without drunkenness and using cannabis at age 14 years predicted alcohol misuse at age 16 years. This finding is in line with the reverse gateway theory, where cannabis use precedes the use of legal substances.

The Gateway Hypothesis, Common Liability to Addictions or the Route of Administration Model? A Modelling Process Linking the Three Theories

Background: The aim of this study was to describe the transitions between tobacco (T), cannabis (C) and other illicit drugs (OIDs) initiations, to simultaneously explore several substance use theories: gateway theory (GT), common liability model (CLM) and route of administration model (RAM). Methods: Data from 2 French nationwide surveys conducted in 2005 and 2010 were used (16,421 subjects aged 18-34). Using reported ages at initiations, we reconstituted a retrospective cohort describing all initiation sequences between T, C and OID. Transition probabilities between the substances were computed using a Markov multi-state model that also tested the effect of 2 latent variables (item response theory scores reflecting propensity for early onset and further substance use) on all transitions. Results: T initiation was associated with increased likelihood of subsequent C initiation, but the reverse relationship was also observed. While the most likely initiation sequence among subjects who initiated the 3 groups of substances was the ‘gateway' sequence T → C → OID, this pattern was not associated with substance use propensity more than alternative sequences. Early use propensity was associated with the ‘gateway' sequence but also with some alternative ones beginning with T, C or OID. Conclusion: If the gateway sequence appears as the most likely pattern, in line with GT, the effects of early onset and substance use propensities were also observed for some alternative sequences, which is more in line with CLM. RAM could explain reciprocal interactions observed between T and C. This suggests shared influences of individual (personality traits) and environmental (substance availability, peer influence) characteristics.