Addiction and Recovery in Dutch Governmental and Practice-Level Drug Policy: What’s the Problem Represented to be?

• Author: Thomas F. Martinelli,Freya Vander Laenen,Gera E. Nagelhout,Dike H. van de Mheen
• DOI: http://doi.org/10.1177/00220426221087590
• Published date: 01 October 2022
• Date: 01 October 2022
• Subject Matter: Articles

Article

Journal of Drug Issues

2022, Vol. 52(4) 547–567

© The Author(s) 2022

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DOI: 10.1177/00220426221087590

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Addiction and Recovery in

Dutch Governmental and

Practice-Level Drug Policy:

What’s the Problem

Represented to be?

Thomas F. Martinelli

1,2

, Freya Vander Laenen

3

,

Gera E. Nagelhout

1,4

, and Dike H. van de Mheen

2

Abstract

Around 2009, ‘recovery’was introduced in the Netherlands as a new approach to drug addiction

and addiction services. Recovery is now featured in practice-level policy but is absent in gov-

ernmental drug policy. To investigate whether the Dutch recovery vision is coherent with

governmental drug policy, we apply Bacchi’sWhat’s the problem represented to be? approach to

analyse problematizations of ‘drug addiction’. We analysed two inf‌luential practice-level policy

documents and one governmental drug policy document. We found that governmental policy

addresses the harms and public nuisance of drug addiction, whilst practice-level policy addresses

the wellbeing of persons with addiction. Despite these different starting points, the Dutch re-

covery vision seems coherent with both problematizations. Its adoption in the Netherlands was

less subject to political debate compared to other countries. This may be a result of recovery

being driven by bottom-up efforts without government intervention, leading to constructive

ambiguity between government- and practice-level policies.

Keywords

addiction recovery, drug policy, practice-level policy, problematization, bacchi, Netherlands

1

IVO Research Institute, The Hague, The Netherlands

2

Tranzo Scientif‌ic Centre for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Tilburg,

The Netherlands

3

Department of Criminology, Penal Law and Social Law, Faculty of Law andCriminology, Ghent University, Ghent, Belgium

4

Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands

Corresponding Author:

Thomas F. Martinelli, IVO Research Institute, Koningin Julianaplein 10, Den Haag, The Hague 2595AA, Netherlands.

Email: martinelli@ivo.nl

Introduction

Drug policy in the Netherlands is historically controversial. The essence of this reputation can be

traced back to the late 1960s, when Dutch drug policy deviated from international standards and

framed drugs more as a public health and social issue, instead of a criminal (justice) issue (Grund

& Breeksema, 2018). Consequently, most of Dutch drug policy became the responsibility of the

Ministry of Health. Dutch strategies for addiction services, harm reduction and prevention of

marginalization and stigmatization of drug users ref‌lect this health focus. In the late 1970s and

early 80s, for example, a shift in the Netherlands occurred, when traditional drug treatment

services were criticized by user organizations, left-wing political parties and progressive treatmen t

professionals for their abstinence-only focus and poor results (Tops, 2006). The Netherlands

became the f‌irst place in the world to have government-approved needle exchange and supervised

injecting facilities and has had drug-testing available as early as 1992, as part of an early warning

program combining surveillance and harm reduction (Ritter & Cameron, 2005;Spruit, 2001;

Tops, 2006). Another famous example is the so-called tolerance policy (‘gedoogbeleid’in Dutch)

allowing the possession and sale of a limited amount of cannabis products in ‘coffee shops’, which

was initiated to protect cannabis users from engaging with more harmful substances, by separating

the cannabis (soft drug) market from the hard drug market (Blok, 2011;van Laar & van Ooyen-

Houben, 2009).

1

In the late 80s, however, Dutch drug policy changed direction and got in-

creasingly repressive, as law enforcement programs were initiated to reduce drug-related publi c

nuisance, aimed at people who use drugs (Mol & Trautmann, 1991).

2

The current Dutch drug policy is primarily based on a white paper from 1995 (Nota ‘Het

Nederlandse drugbeleid: continu¨

ıteit en verandering’–Drugbeleid, 1995) and has since only been

complemented with specif‌ic subjects, mostly around law enforcement (van Laar & van Ooyen-

Houben, 2009). In the following years, much of the (mental) health sector was privatized

(Zorgverzekeringswet, 2006) and Dutch drug addiction services could evolve almost indepen-

dently from governmental drug policy. As such, they are now independent organizations that are

f‌inanced through health insurance.

3

The 15 largest addiction service providers are aff‌iliated with

the branch organization ‘The Dutch Mental Health Sector’(‘De Nederlandse GGZ’). Conse-

quently, we can distinguish two types of policy that address drug addiction in the Netherlands: one

drafted by the Dutch national government, in the form of drug policy (including both public health

and law enforcement perspectives), and the other drafted by the Dutch mental health and spe-

cialised addiction sector, representing the practice-level policy of addiction services (see Figure

1).Dutch governmental drug policy consists of a whitepaper and a myriad of ‘letters to par-

liament’, whilst practice-level addiction policy consists of a few key vision and mission docu-

ments and guidelines from the national branch organization. Although both types of policies

address drug addiction, they start from fundamentally different premises about the problem of

drug addiction. So far, no studies have compared these two types of policies.

Around 2009, the concept of recovery was introduced in the Netherlands as a new approach to

deal with addiction. This new concept, which originated in the United States (US) is also gaining

interest in other parts of the world, challenges existing addiction service approaches, and is often

described as a paradigm shift (Davidson & White, 2007). Brief‌ly, it is described as a shift from a

clinical disorder-oriented approach, characterized by a focus on symptoms of addiction (and

symptom reduction), towards a person-centred and broader wellbeing-oriented approach, through

learning from lived experience (White, 2007). Typically, a clinician is more concerned with

remission of symptoms and outcomes of addiction treatment, whilst a person who experiences

addiction may be more concerned with things as loneliness, stigma or identity, and the process of

getting better (Davidson & Roe, 2007). Whilst a def‌inition of recovery is still debated, it is

increasingly agreed upon that recovery is a process that can take place in various ways, depending

548 Journal of Drug Issues 52(4)