National-level drug policy and young people's illicit drug use: A multilevel analysis of the European Union

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Abstract

Introduction

Recent research has called upon investigators to exploit cross-national differences to uncover the cultural and structural factors influencing drug use. While the individual-level correlates are well-established, little is known about the association between cross-national variation in drug policies and young people's substance use. This study examines, net of individual-level predictors, the association between national-level drug policy and use of an illicit drug other than cannabis.

Methods

The study uses Eurobarometer repeated cross-sectional surveys in 2002 and 2004 of adolescents aged 15–24 drawn in multistage, random probability samples proportional to population size and density within regions of their country (N = 15,191). Participants completed self-reported measures of last month drug use, attitudes toward drugs, school and work participation, and demographics. Gathered from several international bodies, national-level policy measures include drug offense levels, possession decriminalization, and presence and usage of harm reduction strategies.

Results

Hierarchical logistic regression models demonstrate that, while controlling for important individual-level predictors, in countries where there is no restriction on possession of drugs for personal use, the odds of drug use in the last month are 79% lower (p < 0.05). On the other hand, higher usage of treatment and drug substitution are associated with higher levels of drug use. These results are robust to several alternate specifications.

Conclusions

Among the strongest and most consistent findings, eliminating punishments for possession for personal use is not associated with higher drug use. The results indicate that researchers should take national-level context into account in individual-level studies of drug use.

Introduction

Despite recent evidence of cross-national differences in substance use rates and calls to exploit cross-national differences to uncover the cultural and structural factors influencing drug use (Teesson et al., 2006, Degenhardt et al., 2008), most examinations of predictors of use are confined within a single national context, neglecting a critical source of variation that may explain differences in use (Ghandour et al., 2012). National-level drug policy, however, provides a specific context for substance use (Vuolo, 2012). Fields such as sociology have a long tradition of examining contextual effects. According to organizational institutionalism, across- and within-nation variation in policy and behavior is a product of institutionalized cultural frames (Meyer et al., 1997). Institutional structure, such as cultural models and discourse, diffusely influence national and regional actors. Resultant loosely coupled changes in law, policies, attitudes, and values engender an uneven drift towards improvement on a particular outcome (Schofer and Hironaka, 2005). These cultural frames provide a lens through which individual actors understand the world and act within it, shaping the social behaviors and practices that are deemed legitimate, or even thinkable (Bourdieu, 1972, Swidler, 1986). This line of research has shown that national-level context drives individual-level behaviors such as civic engagement (Schofer and Fourcade-Gourinchas, 2001), blood-giving (Healy, 2000), environmentalism (Schofer and Hironaka, 2005), and religiosity (Kelley and De Graaf, 1997). Though connecting national context to related behaviors, this literature has rarely examined policies that were explicitly created to affect behavior. For such policies, the role of cultural diffusion is even more salient, as was recently shown for tobacco policy and youth cigarette use (Vuolo, 2012). Following this approach, this study examines whether national-level drug policies diffuse in a way that is associated with behavior, or whether such policies are too distal.

Both legal (Ewick and Silbey, 1998) and health (Bird and Rieker, 2008) policy create institutionalized cultural frames that influence behavior. The drug policy literature provides reasons to believe such policies may provide frames for behavior. The dominant strategy at all levels of government towards illegal drugs has been antidrug legislation and law enforcement (MacCoun and Reuter, 2001). In the limited locations adopting decriminalization, drug use does not increase, unless a substance becomes commercialized (MacCoun and Reuter, 2001, Reinarman et al., 2004). Nonetheless, for decades, common rhetoric has implied that removing penalties will result in increased use and harm to society and send an improper message of tolerance of drug use (Goldstein and Kalant, 1990, Hall, 2001). For health-related policy, while evidence shows reductions in use and harm for current users in the presence of methadone maintenance (Kleber, 2008), syringe exchanges (Des Jarlais et al., 2009), and treatment more generally, little is known about how the presence of such programs are related to young people's drug use in the general population, which is an important effect to explore if one assumes policy provides cultural frames.

Even with evidence of cross-national variation, most research on adolescent substance use has examined the individual-level of variation, producing a well-established, high quality body of research. According to Bachman et al. (2002), the social bonds of school and work are important predictors of substance use for adolescents. Illicit drug use is higher for non-college bound students and remains high following high school (Bachman et al., 1997). During high school, excessive work can lead to increased substance use (Resnick et al., 1997, McMorris and Uggen, 2000). Following high school, those who are neither students nor employed have higher consumption (Schulenberg et al., 2000). Beyond bonds, perceiving a substance as risky results in lower use (Bachman et al., 1998, Bachman et al., 1990). The consumption of peers and parents is also central, with such use increasing the likelihood of one's own use (Bauman and Ennett, 1996, Li et al., 2002, Ennett et al., 2006). Finally, demographics also distinguish users, with males (European Monitoring Center for Drugs and Drug Addiction, 2006), older adolescents (Bachman et al., 2002), and residents of particular neighborhoods (Sampson et al., 2002) more likely to use drugs.

It remains important to consider contextual influences on adolescent drug use (Teesson et al., 2006, Degenhardt et al., 2008, Ghandour et al., 2012), particularly the influence of drug policy. While drug policy is often the focus of research, such research has rarely accounted for cross-national policy variation in examinations of the predictors of individual-level use. Thus, the goal of this article is twofold. First, the article examines the extent to which individual-level drug use is better predicted taking into account policy context. In other words, if significant variation exists cross-nationally, do policy differences explain this variation? Second, the article explores to what extent certain policies are associated with individual-level use, using the above studies as a guide for potentially important predictors. The variation across nations in both the qualitative presence of certain policies and their utilization provide the opportunity to examine these often overlooked contextual influences at the individual-level among adolescents.

Section snippets

Individual-level sample

The individual-level data come from Eurostat, the European Commission's statistics branch, collected by their Eurobarometer survey. Two near identical in-person surveys, conducted in the appropriate national language, were administered with new cross-sections of 15–24-year olds in 2002 (T. Christensen, 2003) and 2004 (European Communities, 2004). Applying an identical sampling technique across nations, households were drawn in multistage, random probability samples proportional to population

Descriptive findings

As shown in Table 2, the rate of last month drug use among those aged 15–24 across all countries and both years is 2.8%. Fig. 1, however, shows considerable variation across country and year. Ireland had the highest rate of use in both years, while seeing an increase from 2002 (5.0%) to 2004 (7.6%). In both years, Greece exhibits the lowest use. Although most countries saw a change, the direction is inconsistent. The Netherlands and Austria remained fairly stable. Despite its overall rarity,

Discussion

This paper sought to answer recent calls to exploit cross-national differences to uncover the cultural and structural factors influencing drug use (Teesson et al., 2006). Organizational institutionalism (Meyer et al., 1997) justifies an examination of the national-level cultural scripts that guide behavior. The cross-national variation in drug policy provides an area ripe for such an examination. Among young people in the European Union, this analysis demonstrates that drug policy is associated

Role of funding source

This work was supported by a University of Minnesota Graduate School Doctoral Dissertation Fellowship and the University of Minnesota Department of Sociology Director of Graduate Studies Discretionary Award. The University of Minnesota Graduate School and the University of Minnesota Department of Sociology Director of Graduate Studies had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper

Contributor

Mike Vuolo conducted all aspects of the manuscript.

Conflict of interest

No conflict declared.

Acknowledgements

The author gratefully acknowledges Brian Kelly, Chris Uggen, Joachim Savelsberg, Liz Boyle, and Sandy Weisberg, as well as Associate Editor Jan Copeland and the anonymous reviewers, for their time and feedback on the various versions of this and related papers, and also thanks Ty Miller and Sierra Lange for invaluable research assistance.

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