Professor Alex Stevens
Professor Alex Stevens has worked on issues of drugs, crime and health in the voluntary sector, as an academic researcher and as an adviser to the UK government. He has published extensively on these issues, with a focus on the sociology of drugs and crime, on risk behaviours by young people, on the use of evidence in policy and on quasi-compulsory drug treatment. His published works include a book on 'Drugs, Crime and Public Health', studies of decriminalisation of drugs in Portugal, of the right to use drugs, on gangs and on the ethnography of policy making.
Professor Stevens' interest in drugs and crime dates back to his time working with UK charity Prisoners Abroad, which provides advice and information to British prisoners held in foreign prisons, and as European project manager and coordinator of the European Network of Drug and HIV/AIDS Services in Prison for Cranstoun Drugs Services.
Professor Stevens has a PhD in Social Policy from the University of Kent, an MA in Socio-Legal Studies from the University of Sheffield and a BA in French (in the School of European Studies) from the University of Sussex.
Professor Stevens’ principal research interests focus on illicit drug policies and how they affect drug use, crime and public health. He has an on-going interest in how evidence is used in making policy and in the effects of drug treatment interventions. He also works on youth crime and the reduction of youth risk behaviours and has published peer-reviewed articles and policy reports on social exclusion and youth crime.
Professor Stevens directed the 'Connections' project which promoted research and good practice in preventing drugs and related infections in European criminal justice systems. He also led the following projects:
- the development and evaluation of the RisKit project, which worked with vulnerable 14-16 year olds to reduce their risk-taking behaviours.
- QCT Europe, a European-funded, six-country research project on treatment for drug dependent offenders.
- Early Exit on early retention in treatment for the Department for Health.
Professor Stevens teaches modules on criminal justice at undergraduate level.
At postgraduate level, Professor Stevens supervises MA dissertations and PhD theses.
Professor Stevens is interested in supervising students focusing on issues of illicit drug use, drug policy, drug treatment, drugs and crime and related policies.
- President of the International Society of the Study of Drug Policy.
- Member of editorial board of Drugs: Education, Prevention and Policy
- Member of the editorial board of the British Journal of Criminology
- Associate Editor of the International Journal of Drug Policy
- Advisory Council on the Misuse of Drugs
- International Society for the Study of Drug Policy
- Society for the Study of Addiction
- British Society of Criminology
- European Society of Criminology
Videos (on YouTube)
Showing 50 of 70 total publications in the Kent Academic Repository. View all publications.
Stevens, A. (2019). Is policy ‘liberalization’ associated with higher odds of adolescent cannabis use? A re-analysis of data from 38 countries. International Journal of Drug Policy [Online] 66:94-99. Available at: https://doi.org/10.1016/j.drugpo.2019.01.013.Background: Policy makers worldwide face the choice of whether to reform cannabis
policy from the ‘full prohibition’ model. A paper by Shi, Lenzi and An (2015)
suggested that such ‘liberalization’ is significantly associated with higher odds of
adolescent cannabis use.
Aim: To test the validity and reliability of Shi et al’s conclusion that the HBSC data
show an association between policy ‘liberalization’ and increased likelihood of
adolescent cannabis use.
Methods: Replication and re-analysis of the same pooled data from three waves of
the Health Behaviour in School-aged Children (HBSC) survey (2001/2, 2005/6 and
2009/10). This replicates – as far as possible – the coding and analytical strategy of
the Shi et al article. The re-analysis makes some improvements by: excluding a
variable (‘number of siblings’) for which many cases have missing data; including
available data from the theoretically relevant case of Sweden for the latter two waves
of the HBSC survey, which Shi et al omit; and including random slopes for gender
between countries as well as random intercepts for countries in the mixed effects
model, as the predictive effect of gender on cannabis use varies across countries.
Results: Shi et al’s verbal summary of their findings is not supported by detailed
interpretation of their own numerical results. Without making the suggested
amendments, it is possible to find a statistically significant association between
policy ‘liberalization’ and higher odds of some measures of adolescent cannabis use.
But when these improvements are made, this association becomes statistically nonsignificant.
Conclusion: Using a larger and more theoretically relevant sample of the HBSC
respondents and an improved statistical model shows that the HBSC data do not
reveal a statistically significant association between policy ‘liberalization’ and higher
odds of adolescent cannabis use.
Stevens, A. (2019). ‘Being human’ and the ‘moral sidestep’ in drug policy: explaining government inaction on opioid-related deaths in the UK. Addictive Behaviors [Online] 90:444-450. Available at: https://doi.org/10.1016/j.addbeh.2018.08.036.Background: With drug-related deaths at record levels in the UK, the government faces two potential sources
of pressure to implement more effective policies. One source is the individuals and families who are most
likely to suffer from such deaths; i.e. working class people living in de-industrialised areas. The other source is
experts who argue for different policy on the basis of research evidences.
Aim: This article aims to explain why, in the face of these two potential sources of pressure, the UK
government has not implemented effective measures to reduce deaths.
Method: The article uses critical realist discourse analysis of official documents and ministerial speeches on
recent British drug policy (2016-2018). It explore this discourse through the theoretical lens of Archer’s (2000)
ideas on ‘being human’ and by drawing on Sayer’s (2005) work on the ‘moral significance of class’.
Results: Members of economically ‘residual’ groups (including working class people who use heroin) are
excluded from articulating their interests in ‘late welfare capitalism’ in a project of depersonalising ‘class
contempt’ through which politicians cast the people most likely to die as passive, ‘vulnerable’ ‘abjects’.
Conservative politicians dismiss ‘evidence-based’ ideas on the reduction of drug-related death through a
‘moral sidestep’. They defend policy on the basis of its relevance to conservative moral principles, not
effectiveness. This is consistent with the broader moral and political pursuit of partial state shrinkage which
Conservative politicians and the social groups they represent have pursued since the 1970s.
Stevens, A. (2018). Medical cannabis in the UK. BMJ [Online] 363:k4844. Available at: https://doi.org/10.1136/bmj.k4844.
Aldridge, J., Stevens, A. and Barratt, M. (2018). Harms, benefits and the policing of cryptomarkets: a response to commentaries. Addiction [Online]. Available at: https://doi.org/10.1111/add.14169.Commentary to: Will growth in cryptomarket drug buying increase the harms of illicit drugs?
Stevens, A. and Zampini, G. (2018). Drug policy constellations: A Habermasian approach for understanding English drug policy. International Journal of Drug Policy [Online] 57:61-71. Available at: https://doi.org/10.1016/j.drugpo.2018.03.030.Background: It is increasingly accepted that a view of policy as a rational process of fitting evidence-based means to rationally justified ends is inadequate for understanding the actual processes of drug policy making. We aim to provide a better description and explanation of recent English drug policy decisions.
Method: We develop the policy constellation concept from the work of Habermas, in dialogue with data from two contemporary debates in English policy; on decriminalisation of drug possession and on recovery in drug treatment. We collect data on these debates through long-term participant observation, stakeholder interviews (n = 15) and documentary analysis.
Results: We show the importance of social asymmetries in power in enabling structurally advantaged groups to achieve the institutionalisation of their moral preferences as well as the reproduction of their social and economic power through the deployment of policies that reflect their material interests and normative beliefs. The most influential actors in English drug policy come together in a ‘medico-penal constellation’, in which the aims and practices of public health and social control overlap. Formal decriminalisation of possession has not occurred, despite the efforts of members of a challenging constellation which supports it. Recovery was put forward as the aim of drug treatment by members of a more powerfully connected constellation. It has been absorbed into the practice of ‘recovery-oriented’ drug treatment in a way that maintains the power of public health professionals to determine the form of treatment.
Conclusion: Actors who share interests and norms come together in policy constellations. Strategic action within and between constellations creates policies that may not take the form that was intended by any individual actor. These policies do not result from purely rational deliberation, but are produced through ‘systematically distorted communication’. They enable the most structurally favoured actors to institutionalise their own normative preferences and structural positions.
Aldridge, J., Stevens, A. and Barratt, M. (2018). Harms, benefits and the policing of crytomarkets: a response to commentaries. Addiction [Online]. Available at: https://doi.org/10.1111/add.14169.
Coulton, S., Stockdale, K., Marchand, C., Hendrie, N., Billings, J., Boniface, S., Butler, S., Deluca, P., Drummond, C., Newbury-Birch, D., Pellatt-Higgins, T., Stevens, A., Sutherland, A. and Wilson, E. (2017). Pragmatic randomized controlled trial to evaluate the effectiveness and cost effectiveness of a multi-component intervention to reduce substance use and risk-taking behavior in adolescents involved in the criminal justice system: A trial protocol (RISKIT-CJS). BMC Public Health [Online] 17:2-10. Available at: http://dx.doi.org/10.1186/s12889-017-4170-6.Background
Adolescence is a critical developmental stage when young people make lifestyle choices that have the potential to impact on their current and future health and social wellbeing. The relationship between substance use and criminal activity is complex but there is clear evidence that the prevalence of problematic substance use is far higher among adolescent offenders than the general adolescent population. Adolescent offenders are a marginalized and vulnerable population who are significantly more likely to experience health and social inequalities in later life than their non-offending peers.
There is a paucity of evidence on effective interventions to address substance use and risk-taking behaviours in adolescent offender populations but it is clear that preventative or abstinence orientated interventions are not effective. RISKIT-CJS is an intervention developed in collaboration with young people taking account of the current best evidence. Feasibility and pilot studies have found the intervention addresses the needs of adolescents, is acceptable and has demonstrated potential in reducing substance use and risk-taking behavior.
The study is a mixed method, two-armed, prospective, pragmatic randomized controlled trial with individual randomisation to either treatment as usual alone or the RISKIT-CJS intervention in addition to treatment as usual. Adolescents, aged 13 to 17 years inclusive, engaged with the criminal justice system who are identified as having problematic substance use are eligible to participate. The study will be conducted across three geographical areas; South and South East England, London and North East England between March 2017 and February 2019.
The study represents an ambitious programme of work to address an area of need for a marginalized and vulnerable population.
Aldridge, J., Stevens, A. and Barratt, M. (2017). Will growth in cryptomarket drug buying increase the harms of illicit drugs?. Addiction [Online] 113:789-796. Available at: https://doi.org/10.1111/add.13899.Background and aim
Cryptomarkets—on?line, anonymous market?places for illicit goods and services that specialize mainly in drugs—account for a small but rapidly growing share of the illicit drug market in many countries. Policy responses so far are based generally on the assumption that their rise will only increase drug harms. In this contribution for debate, we question this assumption.
We provide a narrative review of the emerging literature connected to drug cryptomarkets. We use MacCoun & Reuter's formula to understand the effect of population?level increases in use on total harm as depending on the level of harm associated with each unit of use. We then consider the potential for cryptomarkets to increase or decrease the harms and benefits related to each unit of drug use, with specific attention to the quality of drugs sold and the non?drug?related harms and benefits for customers.
It is likely that cryptomarkets will increase both the amount and the range of substances that are sold. However, we argue that the effects on harms will depend upon whether cryptomarkets also increase the quality and safety of products that are sold, provide harm?reducing information to consumers and reduce transactional conflict involved in drug purchasing.
There is an emerging and rapidly growing evidence base connected to the macro and micro harms and benefits of cryptomarkets for drug users. Future researchers should use appropriately matched comparative designs to establish more firmly the differential harms and benefits of sourcing drugs both on? and off?line. While it is unlikely that the on?line drug trade can be eradicated completely, cryptomarkets will respond to regulation and enforcement in ways that have complex, and sometimes unanticipated, effects on both harms and benefits.
Winstock, A., Eastwood, N. and Stevens, A. (2017). A new drug strategy for the UK. BMJ [Online] 358:j3643. Available at: https://doi.org/10.1136/bmj.j3643.
Ritter, A. and Stevens, A. (2017). Improving knowledge on law enforcement in drug policy. International Journal of Drug Policy [Online] 41:89-90. Available at: http://dx.doi.org/10.1016/j.drugpo.2017.02.001.
Stevens, A. and Pacula, R. (2017). Advancing knowledge on cannabis policy using evidence from North America. International Journal of Drug Policy [Online] 42:36-38. Available at: http://dx.doi.org/10.1016/j.drugpo.2017.02.004.
Rhodes, T., Stevens, A., Ritter, A. and Decorte, T. (2016). Advancing the science, methods and practices of drug policy research. The International Journal of Drug Policy [Online] 31:1-3. Available at: http://dx.doi.org/10.1016/j.drugpo.2016.04.010.The International Journal of Drug Policy (IJDP) has linked with the International Society for the Study of Drug Policy (ISSDP). The Journal and the Society have entered into a non-exclusive partnership in which ISSDP affiliates with IJDP, making IJDP its official journal. IJDP and ISSDP share a concern for advancing the science, methods and practices of drug policy research in a global context. The partnership brings together two key actors in the development and dissemination of research on global drug policies.
Stevens, A. (2016). Inequality and adolescent cannabis use: A qualitative comparative analysis of the link at national level. Drugs: Education, Prevention and Policy [Online]. Available at: http://dx.doi.org/10.3109/09687637.2015.1136266.Aim: This article explores the link between income inequality and adolescent cannabis use at the national level, in the context of other relevant social conditions, in developed countries. Methods and data: Fuzzy set qualitative comparative analysis is applied to two data sets that contain information on the national prevalence of past year cannabis use among 15 and 16 year olds, taken from the ESPAD and HBSC surveys, with supplementary data from the MtF and ASSAD surveys for the USA and Australia (n?=?97 for the ESPAD and n?=?72 for the HBSC data set). The data sets also include data on national rates of income inequality (Gini coefficient), wealth (GDP per head), welfare support (average benefit replacement rates), urbanization and labour market conditions (youth unemployment). Findings: The combination of high inequality and high urbanization forms part of configurations that are consistent with being usually sufficient to cause high-adolescent cannabis use, alongside high GDP per head in the ESPAD data set, and low welfare support in the HBSC data set. Conclusion: Social conditions, and particularly the combination of income inequality and urbanization, should be considered when studying the causation of high levels of adolescent cannabis use at the national level in developed countries.
Stevens, A. (2016). Configurations of corruption: A cross-national qualitative comparative analysis of levels of perceived corruption. International Journal of Comparative Sociology [Online] 57:183-206. Available at: http://dx.doi.org/10.1177/0020715216665663.This article advances our understanding of the potential causes of national levels of corruption. It develops a new institutionalist criminological theoretical framework. It then applies fuzzy set qualitative comparative analysis (fsQCA) to a sample of 77 countries. The outcome is perceived corruption. Potentially causal conditions are levels of democracy, human development, income inequality and two value orientations: traditional/rational-secular and survival/self-expression. The analysis supports the new institutionalist expectation that the effects of each of these conditions are configurational and dependent upon the presence or absence of other conditions, including value orientations. This can help to explain why previous findings on the independent effect of democracy on corruption have been mixed. It may also help to explain why corruption is such an intractable phenomenon in many countries.
Fleetwood, J., Radcliffe, P. and Stevens, A. (2015). Shorter sentences for drug mules: The early impact of the sentencing guidelines in England and Wales. Drugs: Education, Prevention and Policy [Online] 22:428-436. Available at: http://dx.doi.org/10.3109/09687637.2015.1011607.In February 2012, new sentencing guidelines for drug offences became effective in all courts in England and Wales. An explicit aim was to reduce the length of sentences for drug ‘mules’ and so make them more proportionate. This article examines their early impact drawing on data from the Court Proceedings Database and the Crown Court Sentencing Survey for importing/exporting a Class A drug. Overall, the guidelines have achieved their intended aim. The length of the average custodial sentence for drug trafficking fell following the introduction of the guidelines, largely due to taking defendants’ roles into account. Notably: three quarters of those in ‘lesser’ roles received sentences less than four years, representing an important change. Nonetheless, around 10% of mules received very long sentences due to the continued use of drug weight in sentencing. The new guidelines represent an internationally important innovation in drug policy reform.
Stevens, A., Fortson, R., Measham, F. and Sumnall, H. (2015). Legally flawed, scientifically problematic, potentially harmful: The UK Psychoactive Substance Bill. International Journal of Drug Policy [Online] 26:1167-1170. Available at: http://dx.doi.org/10.1016/j.drugpo.2015.10.005.This journal has often analysed legislation in the field of drug policy. Rarely has it discussed a proposed law that has such deep problems in its legal and scientific bases. The Psychoactive Substances Bill, which is currently proceeding through the UK Parliament, will (if enacted) create a ‘blanket ban’ on the production, importation, exportation and supply of all psychoactive substances for human consumption, except for those that are specifically exempted. The Bill provides for a range of civil and criminal penalties, with a maximum seven-year prison sentence.
Stevens, A. and Measham, F. (2014). The ’drug policy ratchet’: Why do sanctions for new psychoactive drugs typically only go up?. Addiction [Online] 109:1226-1232. Available at: http://dx.doi.org/10.1111/add.12406.It has been much more common for drugs to be subjected to tighter rather than looser control as drugs and evidence about their effects have has emerged. We argue that there is in place a drug policy ratchet which subjects new psychoactive substances (NPS) to increasing control through the continuation of historical patterns that involve the attribution to emerging drugs of guilt by three different kinds of association: guilt by deviant association; guilt by lunatic association; and guilt by molecular association. We use our contemporary ethnographic experience of drug policy-making to show how these processes continue to be applied to policy on NPS, alongside selective, narrative use of evidence and the 'silent silencing' by absorption of the concept of evidence-based policy. We show that the drug policy ratchet cannot be justified as an example of the precautionary principle in action, as this principle is itself not rationally justified. We conclude that recognition of the drug policy ratchet and its mechanisms may help researchers and policy-makers to improve regulation of NPS.
Densley, J. and Stevens, A. (2014). ’We’ll show you gang’: The subterranean structuration of gang life in London. Criminology and Criminal Justice [Online] Online. Available at: http://dx.doi.org/10.1177/1748895814522079.This article uses data from interviews with 69 self-described members and associates of street
gangs in London to explore how young people choose their actions and construct their identities
from the material and cultural resources they find in their locales. It explores ‘drift’ as a potential
explanation of actions of gang members and finds it wanting. It suggests that Giddens’ concept
of structuration, when combined with Matza and Sykes’ notion of subterranean traditions, offers
a powerful tool for the explanation of how and why some young people in socio-economically
deprived urban areas seek association with gangs through the performance of violence.
Stevens, A., Coulton, S., O’Brien, K., Butler, S., Gladstone, B. and Tonkin, J. (2014). RisKit: The participatory development and observational evaluation of a multi-component programme for adolescent risk behaviour reduction. Drugs: Education, Prevention and Policy [Online] 21:24-34. Available at: http://dx.doi.org/10.3109/09687637.2013.787526.Aims: to develop and observationally evaluate a multi-component programme for the reduction of risk behaviours in vulnerable adolescents. Methods: the programme was theoretically informed by Catalano and Hawkins' social development model. It was developed using a combination of participatory consultation with young people and a review of evidence reviews. The resulting programme involved screening of school pupils at ages 14-16 years to identify those at risk, inviting them to attend two generic drug and alcohol awareness sessions, and then eight targeted life skills training sessions, alongside one-to-one motivational interviews and the creation of contacts with youth services. Evaluation was carried out using qualitative methods and the quantitative analysis of timeline follow-back questionnaires on drug and alcohol use at entry, exit and six-month follow-up from 226 programme participants. Findings: qualitative data showed that the programme was feasible, acceptable and positively viewed by participants, delivery staff and school staff. The professional skills of delivery staff were important in making it feasible and acceptable. Quantitative evaluation showed significant reductions in alcohol use (as measured by percentage days abstinent and drinks per drinking day). There were also reductions in illicit drug (mostly cannabis) use, although these were not statistically significant. Conclusion: the participatory development process produced a theoretically and evidence informed programme that was highly acceptable and appreciated by its target participants. This evaluation provides evidence of potential effectiveness that is worthy of further evaluation using more rigorous scientific approaches. The RisKit programme is available for use under a Creative Commons licence. Â© 2014 Informa UK Ltd. All rights reserved.
Stevens, A. and Ritter, A. (2013). How can and do empirical studies influence drug policies? Narratives and complexity in the use of evidence in policy making. Drugs: Education, Prevention and Policy [Online] 20:169-174. Available at: http://dx.doi.org/10.3109/09687637.2013.793892.Some recent contributions to debates on drug policy and the use of evidence (e.g. Henderson, 2012; Nutt, 2012) have assumed that drug policy could be improved if politicians paid more attention to scientific evidence. While not disagreeing with the broad thrust of this argument, we would like to question some of the assumptions about how evidence can and does influence policy. This was the theme of the Sixth Annual Conference of the International Society for the Study of Drug Policy (ISSDP), which was hosted by the University of Kent in Canterbury in May 2012. Papers from this conference comprise the main body of this special issue. This editorial develops some theoretical ideas concerning the policy impact of empirical research, before introducing the articles which illustrate the variety of ways that drug policy analysis can be relevant to policy making. We are specifically interested in narratives – both of and in drug policy making – and the complexity of the policy process. We argue that these render some recommendations for improving drug policy somewhat naïve. Much more attention needs to be paid to issues of problem construction, politics, ideology, power and the messy complexity of the policy process.
Stevens, A. (2012). The ethics and effectiveness of coerced treatment of people who use drugs. Human Rights and Drugs 2:7-16.In the context of international debates about ways to reduce the harms related to
the use of illicit drugs and their control, this article explores the specific issue of
coerced treatment of people who use drugs. It uses established standards of human
rights and medical ethics to judge whether it is ethical to apply either of two types
of coerced treatment (compulsory treatment and quasi-compulsory treatment,
or QCT) to any of three groups of drug users (non-problematic users, dependent
drug users and drug dependent offenders). It argues that compulsory treatment is
not ethical for any group, as it breaches the standard of informed consent. Quasicompulsory
treatment (i.e. treatment that is offered as an alternative to a punishment
that is itself ethically justified) may be ethical (under specified conditions) for drug
dependent offenders who are facing a more restrictive penal sanction, but is not
ethical for other people who use drugs. The article also briefly reviews evidence
which suggests that QCT may be as effective as voluntary treatment.
Stevens, A. and Hughes, C. (2012). A resounding success or a disastrous failure: Re-examining the interpretation of evidence on the Portuguese decriminalisation of illicit drugs. Drug and Alcohol Review [Online] 31:101-113. Available at: http://dx.doi.org/10.1111/j.1465-3362.2011.00383.x.In this Harm Reduction Digest two observers and scholars of the 2001 Portuguese drug policy reform consider divergent accounts of the reform which viewed it as a ‘resounding success’ or a ‘disastrous failure’. Acknowledging from their own experience the inherent difficulties in studying drug law reform, Caitlin Hughes and Alex Stevens take the central competing claims of the protagonists and consider them against the available data.They remind us of the way all sides of the drug policy debates call upon and alternatively use or misuse ‘evidence’ to feed into discussions of the worth, efficacy and desirability of different illicit drug policies. In doing so they provide pause for thought for those of us who operate as drug policy researchers and drug policy advocates.
Stevens, A. (2011). Sociological approaches to the study of drug use and policy. International Journal of Drug Policy [Online] 22:399-403. Available at: http://dx.doi.org/10.1016/j.drugpo.2011.10.003.Sociology has contributed much to the study of drug use and dependence, as
numerous reviews can attest (e.g. Adrian, 2003; Allen, 2007; Bergeron, 2009; Faupel,
Horowitz, & Weaver, 2004; Rhodes, 2009; Weinberg, 2011). However, the study of
drug policy has often been left to economists, with assistance from operational
researchers, public policy specialists, lawyers and psychologists (e.g. Boyum &
Reuter, 2005; Caulkins, Tragler, & Wallner, 2009; Donohue, Ewing, & Peloquin,
2011; Kleiman, 2009; MacCoun & Reuter, 2001). As Peter Reuter recently stated,
while economics has provided useful contributions to the analysis of the drug trade
seen as a market, economists have too often failed to question or verify the – often
grand – assumptions that they tend to bring to the study of these markets (Reuter,
Stevens, A. (2011). Recovery through contradiction?. Criminal Justice Matters [Online] 84:20-21. Available at: http://dx.doi.org/10.1080/09627251.2011.576024.With this new drug strategy, the circle has turned. It was a Conservative government
that introduced the first drug strategy, Tackling Drugs Together, in 1995. This aimed
to reduce drug related crime, protect young people and reduce health harms by
discouraging drug use. It was criticised at the time for having unrealistic, intangible
aims and for not providing the necessary funding. New Labour’s strategies introduced
increasingly specific targets and massively expanded the funding of treatment. This
new Coalition strategy has no targets and provides no new funding.
Stevens, A. (2011). Drug policy, harm and human rights: A rationalist approach. International Journal of Drug Policy [Online] 22:399-403. Available at: http://dx.doi.org/10.1016/j.drugpo.2011.02.003.Background: It has recently been argued that drug-related harms cannot be compared, so making it impossible
to choose rationally between various drug policy options. Attempts to apply international human
rights law to this area are valid, but have found it difficult to overcome the problems in applying codified
human rights to issues of drug policy.
Method: This article applies the rationalist ethical argument of Gewirth (1978) to this issue. It outlines his
argument to the ‘principle of generic consistency’ and the hierarchy of basic, nonsubtractive and additive
rights that it entails. It then applies these ideas to drug policy issues, such as whether there is a right to
use drugs, whether the rights of drug ‘addicts’ can be limited, and how different harms can be compared
in choosing between policies.
Result: There is an additive right to use drugs, but only insofar as this right does not conflict with the
basic and nonsubtractive rights of others. People whose freedom to choose whether to use drugs is
compromised by compulsion have a right to receive treatment. They retain enforceable duties not to
inflict harms on others. Policies which reduce harms to basic and nonsubtractive rights should be pursued,
even if they lead to harms to additive rights.
Conclusion: There exists a sound, rational, extra-legal basis for the discussion of drug policy and related
harms which enables commensurable discussion of drug policy options.
Stevens, A. (2011). Telling policy stories: An ethnographic study of the use of evidence in policy-making in the UK. Journal of Social Policy [Online] 40:237-256. Available at: http://dx.doi.org/10.1017/S0047279410000723.Based on participant observation in a team of British policy making civil servants carried out in
2009, this article examines the use that is made of evidence in making policy. It shows that these
civil servants displayed a high level of commitment to the use of evidence. However, their use of
evidence was hampered by the huge volume of various kinds of evidence and by the unsuitability
of much academic research in answering policy questions. Faced with this deluge of inconclusive
information, they used evidence to create persuasive policy stories. These stories were useful
both in making acceptable policies and in advancing careers. They often involved the excision of
methodological uncertainty and the use of ‘killer charts’ to boost the persuasiveness of the
narrative. In telling these stories, social inequality was ‘silently silenced’ in favour of promoting
policies which were ‘totemically’ tough. The article concludes that this selective, narrative use of
evidence is ideological in that it supports systematically asymmetrical relations of power.
Schaub, M., Stevens, A., Haug, S., Berto, D., Hunt, N., Kerschl, V., McSweeney, T., Oeuvray, K., Puppo, I., Santa Maria, A., Trinkl, B., Werdenich, W. and Uchtenhagen, A. (2011). Predictors of retention in the ’voluntary’ and ’quasi-compulsory’ treatment of substance dependence in Europe. European Addiction Research [Online] 17:97-105. Available at: http://dx.doi.org/10.1159/000322574.Background Policies and practices related to the quasi-compulsory treatment (QCT) of
substance-dependent offenders are currently implemented in many countries, despite the
absence of reliable knowledge about significant predictors of treatment retention. This study
aimed to identify such predictors in QCT and voluntary treatment.
Methods Participants were treated in one of 65 institutions in 5 European countries. They
were interviewed at intake on substance use, committed crimes, perceived pressure for
treatment, self-efficacy, stage of change, employment, and health-related variables. Binary
logistic regression models were computed to identify predictors of treatment retention at an
18-month follow-up. Moderator analyses were computed to investigate whether these
predictors vary by treatment condition (quasi-compulsory vs. voluntary).
Results A higher number of working days in the previous month was positively associated
with treatment retention, while use of heroin, crack, and multiple drugs, psychiatric problems
in the previous month, and lifetime depression were negatively associated with treatment
retention. Higher perceived medical pressure resulted in higher treatment retention rates only
for participants in QCT.
Conclusion Predictors of substance abuse treatment retention are quite similar across both
the quasi-compulsory and voluntary treatments. Perceived medical pressure is of higher
relevance than the often-believed legal pressure for treatment retention in QCT.
Stevens, A. and Hughes, C. (2010). What can we learn from the Portuguese decriminalization of illicit drugs?. British Journal of Criminology [Online] 50:999-1022. Available at: http://dx.doi.org/10.1093/bjc/azq038.The issue of decriminalizing illicit drugs is hotly debated, but is rarely subject to evidence-based
analysis. This paper examines the case of Portugal, a nation that decriminalized the use and possession
of all illicit drugs on 1 July 2001. Drawing upon independent evaluations and interviews
conducted with 13 key stakeholders in 2007 and 2009, it critically analyses the criminal justice and
health impacts against trends from neighbouring Spain and Italy. It concludes that contrary to
predictions, the Portuguese decriminalization did not lead to major increases in drug use. Indeed,
evidence indicates reductions in problematic use, drug-related harms and criminal justice
overcrowding. The article discusses these developments in the context of drug law debates and
criminological discussions on late modern governance.
Schaub, M., Stevens, A., Berto, D., Hunt, N., Kerschl, V., McSweeney, T., Oeuvray, K., Puppo, I., Santa Maria, A., Trinkl, B., Werdenich, W. and Uchtenhagen, A. (2010). Comparing outcomes of ‘voluntary’ and ‘quasi-compulsory’ treatment of substance dependence in Europe. European Addiction Research [Online] 16:53-60. Available at: http://dx.doi.org/10.1159/000265938.Aim: This study evaluates quasi-compulsory drug treatment
(QCT) arrangements for substance-dependent offenders receiving
treatment instead of imprisonment in comparison to
voluntary treatment within five European countries. Methods:
Participants were interviewed with the European Addiction
Severity Index, the ASI-crime module, questions on
perception of pressure and self-efficacy, and the Readinessto-
Change Questionnaire at treatment entry and after 6, 12,
and 18 months. Results: Reductions in substance use and
crime as well as improvements in health and social integration
were observed in QCT and voluntary treatment groups.
After controlling for various factors, subjects in the QCT and
the comparison group showed similar reductions in substance use and crime over time. Study retention was comparable
in both groups. Conclusion: QCT is as effective as voluntary
treatment provided in the same services in reducing
substance use and crime.
Stevens, A., Radcliffe, P., Hunt, N. and Sanders, M. (2008). Early Exit: Estimating and explaining early exit from drug treatment. Harm Reduction Journal [Online] 5:1-14. Available at: http://dx.doi.org/10.1186/1477-7517-5-13.Background: Early exit (drop-out) from drug treatment can mean that drug users do not derive the full benefits that treatment potentially offers. Additionally, it may mean that scarce treatment resources are used inefficiently. Understanding the factors that lead to early exit from treatment should enable services to operate more effectively and better reduce drug related harm. To date,
few studies have focused on drop-out during the initial, engagement phase of treatment. This paper describes a mixed method study of early exit from English drug treatment services.
Methods: Quantitative data (n = 2,624) was derived from three English drug action team areas; two metropolitan and one provincial. Hierarchical linear modelling (HLM) was used to investigate predictors of early-exit while controlling for differences between agencies. Qualitative interviews were conducted with 53 ex-clients and 16 members of staff from 10 agencies in these areas to
explore their perspectives on early exit, its determinants and, how services could be improved.
Results: Almost a quarter of the quantitative sample (24.5%) dropped out between assessment and 30 days in treatment. Predictors of early exit were: being younger; being homeless; and not being a current injector. Age and injection status were both consistently associated with exit between assessment and treatment entry. Those who were not in substitution treatment were significantly more likely to leave treatment at this stage. There were substantial variations between agencies, which point to the importance of system factors. Qualitative analysis identified several potential ways to improve services. Perceived problems included: opening hours; the service
setting; under-utilisation of motivational enhancement techniques; lack of clarity about expectations; lengthy, repetitive assessment procedures; constrained treatment choices; low initial dosing of opioid substitution treatment; and the routine requirement of supervised consumption of methadone.
Conclusion: Early exit diminishes the contribution that treatment may make to the reduction of drug related harm. This paper identifies characteristics of people most likely to drop out of treatment prematurely in English drug treatment services and highlights a range of possibilities for improving services.
McSweeney, T., Stevens, A., Hunt, N. and Turnbull, P. (2008). Drug testing and court review hearings: uses and limitations. Probation Journal [Online] 55:39-54. Available at: http://dx.doi.org/10.1177/0264550507085678.The ability of the UK criminal justice system to divert drug-dependent offenders into treatment has been enhanced during recent years. Despite the rapid expansion of such coercive measures, research findings to date are equivocal
about their impact. This article draws on qualitative data from in-depth interviews with professionals and those mandated to treatment by the courts to assess the
uses and limitations of two defining features of court-ordered drug treatment in Britain and elsewhere – drug testing and court review hearings – as a means of
promoting and monitoring compliance with the conditions of these disposals.
Radcliffe, P. and Stevens, A. (2008). Are drug treatment services only for ’thieving junkie scumbags’? Drug users and the management of stigmatised identities. Social Science and Medicine [Online] 67:1065-1073. Available at: http://dx.doi.org/10.1016/j.socscimed.2008.06.004.This article uses qualitative interviews with 53 problematic drug users who had dropped out of treatment in England, UK to explore how they describe the stigmatisation of drug users and drug services. It discusses the construction of the category of the junkie through its association with un-controlled heroin use and criminality. It shows how some drug users carefully manage information about their discreditable identities by excluding themselves from this category, while acknowledging its validity for other drug users. The junkie
identity was generally seen as shameful and therefore to be avoided, although it holds attractions for some drug users. For many of the interviewees, entry to treatment risked exposing their own activities as shaming, as they saw treatment as being a place that was populated by junkies and where it becomes more difficult to manage discreditable information. The treatment regime, e.g. the routine of supervised consumption of methadone,was itself seen by some as stigmatising and was also seen as hindering progress to the desired ‘normal’ life of conventional employment. Participation in the community of users of both drugs and drug services was perceived as potentially damaging to the prospects of recovery. This emphasises the importance of social capital, including links to people and opportunities outside the drug market. It also highlights the danger that using the criminal
justice system to concentrate prolific offenders in treatment may have the perverse effects of excluding other people who have drug problems and of prolonging the performance of the junkie identity within treatment services. It is concluded that treatment agencies
should address these issues, including through the provision of more drug services in mainstream settings, in order to ensure that drug services are not seen to be suitable only for one particularly stigmatised category of drug user.
Reuter, P. and Stevens, A. (2008). Assessing UK Drug Policy from a Crime Control Perspective. Criminology and Criminal Justice [Online] 8:461-482. Available at: http://dx.doi.org/10.1177/1748895808096473.Over the entire last quarter of the 20th century the British drug problem worsened, despite the implementation of a variety of approaches and commitment of substantial criminal justice and other resources. The link between chronic use of expensive drugs and property crime makes this experience important for understanding trends in crime
and justice in Britain. The worsening of the problem can be seen in the growing number of new heroin users each year over almost the entire period 1975–2000, on top of which was layered, starting in the late 1990s, the first major outbreak of chronic cocaine use. This was not the common pattern in Western Europe over that time and by
2000 the UK had Western Europe’s most serious drug problem.
The response initially took the form of increasing enforcement against drug markets; in just the decade 1994–2005 the number of prison cell years handed out in annual sentences has tripled. Even with this expansion we estimate that the annual probability of incarceration for a class A drug dealer is only approximately 6 per cent.
Since 2000 there has also been a massive increase in treatment resources linked to the criminal justice system. The number of treatment assessments in recent years has been as large as 58 per cent of the number of persons estimated to be problematic users of Class A drugs. The government believes that drug policy has contributed to
the decline in crime in the UK since 2000. Using what is known about treatment outcomes, we argue that despite impressive evidence of effect on individual level offending, the effect of treatment expansion in reducing overall crime rates is likely to have been limited.
Stevens, A. (2011). Drugs, Crime and Public Health: The Political Economy of Drug Policy. [Online]. London: Routledge-Cavendish. Available at: http://www.routledge.com/books/details/9780415491044/.Drugs, Crime and Public Health provides an accessible but critical discussion of recent policy on illicit drugs. Using a comparative approach - centred on the UK, but with insights and complementary data gathered from the USA and other countries - it discusses theoretical perspectives and provides new empirical evidence which challenges prevalent ways of thinking about illicit drugs. It argues that problematic drug use can only be understood in the social context in which it takes place, a context which it shares with other problems of crime and public health. The book demonstrates the social and spatial overlap of these problems, examining the focus of contemporary drug policy on crime reduction. This focus, Alex Stevens contends, has made it less, rather than more, likely that long-term solutions will be produced for drugs, crime and health inequalities. And he concludes, through examining competing visions for the future of drug policy, with an argument for social solutions to these social problems.
Stevens, A. (2017). Principles, pragmatism and prohibition: explaining continuity and change in British drug policy. In: Liebling, A., Maruna, S. and McAra, L. eds. Oxford Handbook of Criminology. Oxford, UK: Oxford University Press.
Stevens, A. (2015). An integrated approach to the treatment of drug dependence – The English experience. In: el-Guebaly, N., CarrÃ , G. and Galanter, M. eds. Textbook of Addiction Treatment: International Perspectives. Milan: Springer.
Stevens, A. (2010). Evidence and Policy - Crime and Public Health in UK Drug Policy(Chapter 10). In: Yates, R. and Malloch, M. S. eds. Tackling Addiction: Pathways to Recovery. London: Jessica Kingsley Publishers, pp. 156-174. Available at: http://www.jkp.com/catalogue/book/9781849050173.
Stevens, A. (2010). Treatment sentences for drug users: contexts, mechanisms and outcomes. In: Hucklesby, A. and Wincup, E. eds. Drug Interventions in Criminal Justice. Open University Press. Available at: http://www.mcgraw-hill.co.uk/html/0335235808.html.
Stevens, A., StÃ¶ver, H. and Brentari, C. (2010). Criminal justice approaches to harm reduction in Europe (Chapter 14). In: Rhodes, T. and Hedrich, D. eds. Harm Reduction: Evidence, Impacts and Challenges. Spain: European Monitoring Centre on Drugs and Drug Addiction. Available at: http://dx.doi.org/10.2810/29497.
Stevens, A. (2009). Trends in youth offending in Europe. In: Junger-Tas, J. and Dunkel, F. eds. Reforming Juvenile Justice. New York: Springer-Verlag, pp. 1-18.
Radcliffe, P. and Stevens, A. (2009). Early Exit: Estimating and Explaining Early Exit from Drug Treatment. In: MacGregor, S. ed. Responding to Drug Misuse. Taylor & Francis Ltd.
Conference or workshop item
Stevens, A. (2019). The ‘ontological politics of drug policy’: a critical realist approach. In: 13th Annual Conference of the International Society for the Study of Drug Policy.This paper explores the question of what we can consider to be real in drug policy. It examines two common approaches in drug policy analysis (and criminology more broadly); radical constructionist critique and successionist data science. It shows how researchers using both approaches have produced valuable findings, but also demonstrates the theoretical incoherence of their ontological assumptions, based on their shared ‘flat ontology’. The radical constructionist detachment of knowledge from an independently existing reality – seen in some qualitative studies - is shown to be unsustainably self-defeating. As acknowledged by Annemarie Mol, it is analytically ‘paralyzing’. This leads to two common inconsistencies in radical constructionist studies; crypto-empiricism and ersatz epistemic egalitarianism. The Humean successionist approach of econometric data science is also shown to be unsustainable and unable to provide explanations of identified patterns in data. Four consequent, limiting characteristics of this type of research are discussed: causal inference at a distance, monofinality, limited causal imagination, and overly confident causal claims. The paper goes on to describe and exemplify a critical realist ontology for drug policy analysis based on Roy Bhakra’s 'Realist Theory of Science'. The ‘depth ontology’ of this approach enables more deeply explanatory, methodologically eclectic and democratically inclusive analysis of drug policy development and effects.
Stevens, A. (2017). Effective drug policies: international experiences. In: Proceeding of the National Drug Conference, Hong Kong.
Stevens, A. (2008). Crossing Frontiers: International Developments in the Treatment of Drug Dependence. [Online]. Stevens, A. ed. Brighton: Pavilion Publishing and Media. Available at: http://www.pavpub.com/crossing-frontiers/.Crossing Frontiers encourages readers to think about different international approaches to the treatment of drug users to inform their own understanding (and application) of practice in the UK. The text encourages providing a range of services, including newer approaches, which respond to the needs of users as unique individuals, empowering and supporting them to 'break the barriers' created by their drug use thus improving their lives.
Stevens, A. (2013). Modernising Drug Law Enforcement: Applying Harm Reduction Principles to the Policing of Retail Drug Markets. International Drug Policy Consortium. Available at: http://dl.dropboxusercontent.com/u/64663568/library/MDLE-report_3_applying-harm-reduction-to-policing-of-retail-markets.pdf.Key Points:
• The level of harm is more important than the size of the market.
• Visible, open air drug markets tend to be more harmful per unit of use than hidden, closed
• Policing tactics that are not experienced by the community as being fair, lawful and effective
will harm police legitimacy and community relations.
• Some enforcement-led approaches, including short-term crackdowns and large scale stop
and search, are unlikely to produce sustainable reductions in drug sales. They may increase
levels of violence and health harms and reduce police legitimacy.
• It is rarely possible to eliminate retail drug markets, but well designed and implemented
policing tactics can force the drug market to take less harmful forms.
• Applying harm reduction principles to drug policing may boost police legitimacy as well as
• Focused deterrence and ‘pulling levers’ may reduce both harm and crime, but this depends
on the context and on careful implementation and evaluation.
Armenta, A., Bell, R., Carlin, E., Eastwood, N., Fordham, A., Harris, G., Luck, H., de Castro e Silva, A., Nougier, M., Saucier, R., Stevens, A., Trace, M. and Youngers, C. (2010). IDPC Drug Policy Guide. International Drug Policy Consortium (IDPC). Available at: http://idpc.net/policy-advocacy/idpc-drug-policy-guide-html.The International Drug Policy Consortium (IDPC) is a global network of non-governmental organisations (NGOs) and professional networks that specialises in issues related to the production and use of controlled drugs. We aim to promote objective and open debate on the effectiveness, direction and content of drug policies at national and international level, and support evidence-based policies that are effective in reducing drug-related harms. We produce occasional briefing papers, disseminate the reports of our member organisations about particular drug-related matters, and offer expert consultancy services to policy-makers and officials worldwide. IDPC members have a wide range of experience and expertise in the analysis of drug problems and policies, and contribute to national and international policy debates.
This drug policy guide was compiled in 2009 through research and consultation with our network of experts. It aims to provide our regional and national partners with a resource that they can use to conduct reviews of the national drug policies and programmes in their areas, and engage with policy-makers to work towards policy and programme improvements. The guide will be updated annually to reflect changes in global evidence and experience.
Margo, J. and Stevens, A. (2008). Make Me a Criminal: Preventing Youth Crime. ippr - Institute for Public Policy Research.
Wilson, L. and Stevens, A. (2008). Understanding Drug Markets and How to Influence Them. Beckley Foundation. Available at: http://beckleyfoundation.org/wp-content/uploads/2016/04/BF_Report_14.pdf.This paper provides a review for policy makers of what is known about the economic structure of illicit drug markets and the business operations of high level dealers operating within it. It is based on interviews with imprisoned drug traffickers and dealers in UK prisons carried out by Matrix Knowledge Group, and also owes a substantial debt to the valuable work done in this field by Peter Reuter, Jonathan Caulkins and Frederick Desroches, amongst others. The paper does not review the harms caused by law enforcement, some of which have been looked at in previous reports. It assumes that the structure of drug markets influences the primary harms arising from drug use (e.g. excess mortality and disease), the violence that is related to drug markets and the opportunity costs of people spending time and money on illicit substances. Some of these harms might be reduced by introducing alternative arrangements for the international regulation of psychoactive substances. These alternative arrangements are not reviewed here. Rather, the aim is to provide policy makers with information on drug markets as a basis for focussing enforcement resources, and devising more effective policies, to reduce the damage done by the trade in illicit drugs.
Research report (external)
Iversen, L., Stevens, A. and Dale-Perera, A. (2016). Reducing Opioid-Related Deaths in the UK. [Online]. Advisory Council on the Misuse of Drugs. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/576560/ACMD-Drug-Related-Deaths-Report-161212.pdf.This independent report by the Advisory Council on the Misuse of Drugs investigates the increase of drug-related deaths in the UK.
It looks at:
- patterns and trends in opioid-related deaths
- causes and drivers of trends in opioid-related deaths
- policy and treatment responses to prevent opioid-related deaths
Stevens, A. (2008). Drug-Crime Connections. Contemporary Sociology: A Journal of Reviews 37:590-591.