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Central European Journal of Public Policy Vol. 6 2 December 2012 Central European Journal of Public Policy Vol. 6 2 December 2012 pp 5683 ISSN 1802-4866 2012 Martin Nekola Licensed under Creative Commons Attribution 3.0
Nekola Pragmatists, Prohibitionists and Preventionists in Czech Drug Policy

Pragmatists, Prohibitionists and Preventionists in Czech Drug Policy

Martin Nekola1 Faculty of Social Sciences, Charles University in Prague

introduction
The establishment of the Interdepartmental Anti-Drug Commission in May 1993 and the adoption of the first three-year programme (Kalina, 1993) in August of the same year are considered as the start of official drug policy in the Czech Republic (Radimeck, 2007). Since then, the policy has undergone radical developments (Radimeck, 2004), characterised by major changes in multiple areas such as laws and regulations (e.g., the amendment of drug laws in 1998; the new Criminal Code in 2010), policy organization and financing (e.g., the status of the Interdepartmental Anti-Drug Commission and its successors; drug policy coordination at different levels of public administration), and the extent and spectrum of service providers (participation of non-governmental organizations in prevention, treatment and rehabilitation of drug users). Furthermore, addiction research and drug epidemiology have taken great steps forward (through the establishment of the National Monitoring Centre and later the Centre for Addictology) and many new actors have begun to participate in drug policy (Bullington, 2007). Understanding and explaining (or even predicting) such a public policy change is one of the most difficult exercises for policy analysts (John, 1998). The difficulty of such an exercise is determined by the complexity of the policy process, with tens of different programs at different levels and a high number of actors holding more-or-less rooted and conflicting beliefs and values (Sabatier, 1999, p.3). In the current debate, it is a generally accepted fact that the formulation of public policies is influenced not only by expertise and empirical evidence but also by other factors (see Dror, 1967; Jenkins-Smith, 1990; Sabatier & JenkinsSmith, 1999; Kingdon 1994 and others). In this respect, the important role of cognitive factors, ideas and beliefs has been debated. Such cognitive factors are constitutive for different actor groupings such as epistemic communities (Haas, 1992), professional or problem oriented networks, advocacy coalitions (Sabatier & Jenkins-Smith, 1993) and discursive coalitions (Hajer, 1995), which shape and influence policy formulation and policy outcomes. In this respect, drug policy is no exception. In spite of an apparent effort to define drug use and related problems as expert problems, drug policy constitutes an arena in which
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Abstract: The paper presents the results of an empirical survey conducted in order to identify Czech drug policy actors perspectives on illicit drug use and related problems. Q methodology was used to uncover three independent factors representing three different perspectives in a sample of 24 participants. A perspective that emphasizes pragmatism predominated in the sample of participants. It differs from the other two perspectives in lower perceived importance of the drug problem and a more sceptical view of drugs illicit status and related drug enforcement. The other two perspectives are to some extent complementary in that one rather prefers prohibition and the other puts more emphasis on prevention. Nevertheless, both agree on many general as well as specific aspects of drug policy such as the perceived importance of the problem, the active role of the government in addressing it, and the rejection of any form of illicit drug legalization or normalization. Keywords: Czech drug policy, Q methodology, perspectives, actors, pragmatists, prohibitionists, preventionists
MARTIN NEKOLA Department of Public and Social Policy, Institute for Sociological Studies, Faculty of Social Sciences, Charles University in Prague U Ke 8, Prague 5 nekola@fsv.cuni.cz

1 The preparation of this paper has been supported by Czech Science Foundation grant Nr. P404/12/0725, Policy Workers in the Czech Public Administration: Practices, Professional Values and Identity. I would like to thank my colleagues and two anonymous reviewers for their comments. Thanks also go to Eva Hejzlarov for carrying several interviews and Pamela Cotte for language editing. Last but not least, I am grateful to all the respondents who agreed with the interview.

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different interests and values clash. As demonstrated by Czech as well as international analyses of drug policy actors, conflicts about the definitions and delimitation of illicit drug-related problems and the ways to address them pose an important obstacle to formulating and implementing a pragmatic, realistic, complex and, above all, effective drug policy as well as specific prevention, treatment and repression measures (Kbler, 2001; Hartnoll, 2004; Radimeck, 2007, Tammi 2005). Divergent paradigms, interests and strategic preferences cause conflicts between rhetoric and practice, which represent one of the gravest problems of drug policies. Such conflicts can be found in the Czech Republic as well and, according to Radimeck (2007), they are responsible for the limited effectiveness of Czech drug policy. Radimeck (2004) believes that the rivalry between different professions and interest groups does not have any rational justification because all actors pursue one common final end: to minimise the potential risks and negative impacts of drug use for individuals and the society as a whole. This irrationality can be explained by identifying the different perspectivesor belief and value systemsof different actors and coalitions thereof. This article presents the results of an empirical survey conducted in 2009 to identify Czech drug policy actors attitudes to and perspectives on illicit drug use and related problems. It seeks to understand the ways individuals and groups with similar attitudes think about the subject matter, the ways they see it, and the ways their thinking about it is structured. This is associated with better understanding the opinions, attitudes and values of different actors in the policy process (Durning, 1999,p 405) or, in other words, understanding actors subjective perceptions and interpretations (Giddens, 1976). More specifically, the survey focused on a group of people who, over the past ten years, have taken an active part in the policy-making process. These included political leaders, subordinate bureaucratic officials, and the staff of organized interest groups and causes (staff of political parties, interest group representatives, citizen activists and advocacy groups etc.). The article investigates the areas of disagreement and consensus between Czech drug policy actors and outlines the possibilities for finding a shared perspective on key drug policy issues. It follows the previous work of Morvek (2007) who identified four competing rhetorical frames in policy controversy over the so-called anti-drug bill of 1998 which criminalized the possession of bigger than small amounts of illegal drugs in the Czech Republic.

METHODS
Q methodology was used in order to identify the perspectives of Czech drug policy actors. According to Durning (1999, p. 405), Q provides analysts with insights into different perspectives on policy issues and better understanding of the opinions, attitudes, and values that different actors in the policy process have concerning issues. The social sciences are endowed with a plenty of methods for examining and measuring peoples attitudes and beliefs. As Cross (2005) puts it, no fully effective tool to measure attitudes accurately has been devised yet. There is a long tradition of opinion measurement by survey techniques such as the Likert scale or semantic differential. In this dominant approach, the subject is perceived as a universal and bounded-rational agent and subjectivity is a scheme of autonomous choice, preference, and orientation (Robbins & Krueger, 2000). However, it has been argued that the so-called R methods a priori impose researchersconcepts and meanings and thus may misinterpret and/or omit peoples beliefs. A different approach consists of leaving questions open to respondent definition. In such a case, it is difficult to work meaningfully with the resulting wide variation of peoples conceptualizations and explore clusters of shared beliefs rigorously. According to Stephenson (1953), these approaches also remove subjects frames of reference from the inquiry and are thus inappropriate for the study of subjectivity (Robbins & Krueger, 2000). In this regard, Q methodology offers a middle road for identifying meanings, attitudes and perspectives in a subject under scrutiny (Brown, 1996) and, as such, can be considered a systematic and rigorously quantitative means for examining human subjectivity (McKeown & Thomas, 1988, p,7). This method makes it possible for participants to model their own subjectivities (i.e., their own perspectives upon an issue) and important elements of such models will remain unchanged throughout statistical analysis (Robbins & Krueger, 2000). Q methodology is used in order to explore (and to make sense of) highly complex and socially contested concepts and subject matters from the point of view of participants (Watts & Stenner, 2005). Moreover, perspectives are not defined intuitively or arbitrarily, and instead, are based on the subjective views of participants themselves (McKeown & Thomas, 1988, p.40). The following strengths of the method have been emphasized: reproducibility (Thomas & Baas, 1992; Brown, 1980) and the fact that statistical significance can be assessed on relatively small samples. Other specific qualities of Q include: integration of a data collection method (Q-sort) with a data analysis method (Q-factor analysis); and integration of quantitative and qualitative methods. This makes it possible to determine whether and to what extent the different perspectives overlap (opinion/attitude clusters) and identify individ59

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uals with similar opinions. The qualitative aspect makes it possible to identify divergent patterns of thinking. Compared to a general attitude questionnaire, Q methodology is more focused (Zraick & Boone, 1991). It is partly due to use of forced choice (see below) where respondents have to consider their attitudes more carefully and that may bring out true feelings in response (Prasad, 2001). It is also a dynamic medium through which subjectivity can be expressed actively (Stephenson, 1953). Therefore, Q is suitable whenever we want to know how people think and why they think so (rather than how many people share such a viewpoint). Both types of results are important for public policy in general and for policy analysis, more specifically. Other research or policy activities can build on Q results (e.g., compromising or advocacy based on a given attitude). In the quantitative part of Q, factor analysis is used to group/cluster participants with similar thinking (Brown, 2004). At this point, it must be stressed that unlike classical survey research, Q is not concerned with patterns across variables but, rather, patterns within and across individuals (Dryzek & Berejikian, 1993). Surveys are designed to analyze individual traits (variables) across persons and populations, e.g. how many people share conservative attitudes. Instead of this interpersonal correlation, Q is designed to analyze individuals across traits (intrapersonal correlation), e.g. what views on a certain issue there are and how these views (and individuals holding them) are interrelated. In other words, Q aims to explore the range and diversity of perspectives expressed, not the percentages of people expressing them (Kitzinger, 1987). In this manner, perspectives can be seen as units of analysis. According to Stainton Rogers (1995), Q fits those research questions which are concerned with hearing many voices, and that makes it appropriate for the purpose of the present study. How can one summarize the ways Q methodology works? A data collection technique, named Q-sort, and a data analysis technique, entitled Q-factor analysis, are the methods basic instruments. In Q-sort, a set of several tens of statements is typically assessed on a scale of given range and meaning, such as from -3 (strongly disagree) to +3 (strongly agree). In contrast to the traditional Likert scale, participants are advised to compare the different statements to each other and arrange them in a quasi-normal distribution. Thus, Q-sort results in a distribution with few statements on the margins (those the participant strongly agrees or disagrees with) and a growing number of statements towards the neutral centre of the scale. In this way, each participant creates his/her own profile (Brouwer, 1999) or model of subjective preferences with respect to the phenomenon under investigation (Peritore, 1989; Cross, 2005). See McKeown and Thomas (1988), Durning (1999), Brown (1996) and Nekola (2011) for more detailed information on Q methodology.
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Selection of statements and participants

The primary selection of statements (concourse2) was predominantly compiled from domestic sources. Given the fact that most statements were aimed at the general discourse (the study does not intend to investigate the expert discourse), statements were mainly taken from interviews with actors in five Czech press titles (Literrn noviny, Lidov noviny, Britsk listy, MF Dnes, Prvo), transcripts of radio debates on illicit drug use that were aired on BBC/ Rdio esko, the official positions of the National Drug Headquarters, the Police of the Czech Republic, strategic government documents, and articles published on the websites of politicians, activists, think tanks and drug information agencies. Such manifestations of everyday discourse were complemented by several statements from scholarly publications3 in order to cover the entire spectrum of topics relevant for drug policy. The selection and structuring of topics were based on Sabatiers concept of belief systems (Sabatier & Jenkins-Smith, 1999; Sabatier 1998) and the effort to include all the main strategies/instruments of Czech drug policy as formulated in the National Drug Policy Strategy for 20052009 (NDC, 2005). Specific statements relevant to drug policy were selected to represent both policy levels of belief systems defined in the Advocacy Coalition Framework theory (Sabatier & Jenkins-Smith, 1993; Sabatier & Jenkins-Smith, 1999), i.e., the so called policy core and secondary aspects (see Table 1). As another criterion, the selection aimed to include all four main drug policy strategies, i.e. drug enforcement/repression, prevention, treatment/social rehabilitation, and harm reduction. Special emphasis was placed on aspects related to the illicit status of drugs and, in particular, the controversial drug policy change of the late 1990s (see Morvek, 2007; Zeman, 2007) and the ongoing process of amending the Criminal Code. The final sample of statements (Q-sample) was thus selected in a structured way. It included 38 statements to reflect the full spectrum of opinions collected from the concourse. The final number of statements was determined by the number of categories and adapted in order to correspond with the distribution of choice and prevent burdening participants with too many statements to assess and sort. Some statements were slightly reformulated based
2 Concourse is defined as the flow of communicability surrounding any topic in the ordinary conversation, commentary, and discourse of everyday life (Brown, 1993). 3 Such scholarly publications included the PAD study (Zbransk, Mravk, Gajdokov & Miovsk, 2001) and the following scholarly journals: Justice Policy Review, Adiktologie, and the Central European Journal of Public Policy.

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Table 1 The dimensions of policy core beliefs and secondary aspects for statement selection
Policy Core Orientation on basic value priorities Identification of groups whose welfare is of greatest concern Overall seriousness of the problem Basic causes of the problem Proper distribution of authority among levels of government Priority accorded to various policy instruments Ability of society to solve the problem Participation of public v. experts v. elected officials Secondary Aspects Seriousness of specific aspects of the problem in specific locales Importance of various causal linkages in different locales/times Decisions concerning administrative rules, budgetary allocations etc. Performance of specific programs or institutions

Source: Sabatier (1998, p.112113), adapted by the author

on piloting and consultations in order to make them comprehensible for all actors. Table 2 contains the full text of all statements. The primary selection of survey participants was again based on the ACF theory which identifies key actors of the policy process not only among politicians and interest group representatives but also among experts (scholars, practitioners, and bureaucrats), journalists, judges, and activists (Sabatier & Jenkins-Smith, 1999). As was mentioned above, Q does not aim to generalize findings to any group beyond the participants themselves. In other words, the set of participants is assumed to be the entire population (Brown 2004, p.4) and no random sampling takes place. The total number of participants depends on the necessity to determine the existence of a given factor and compare it with other factors (Brown, 1980). Thus, if two to four perspectives are expected to exist (up to six in exceptional cases) and four to five persons must be found to delimit each perspective empirically, a total number of 2040 participants is usually sampled. Whether one is included in the sample depends on relevance to the research question or any particular theory. Participants are expected to formulate clear, refined or even extreme attitudes to the phenomenon in question in order to maximize the likelihood of including all relevant perspectives (Brown, 1980). The selection of particular participants was based on the study of scholarly texts on drug policy development in the Czech Republic, official government documents, and a media content analysis (newspapers, magazines, interview transcripts, official positions etc.). Subsequently, the list
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was expanded to include names that were suggested by drug policy experts during the piloting and interviewing. A total of 24 Q-sorts (interviews) were conducted, including two with highranking police officers with long-term engagement in the National Drug Headquarters, four with leaders of organizations providing services to drug users, four with researchers, and three with public administration experts. Further interviews covered four politicians (including two MPs) who took an active part in illegal drug-related policy issues, one judge of the Czech Supreme Court who participated in re-codifying the Criminal Code, three journalists, and three members of civic associations taking an active part in drug policy. The interviews and Q-sorts were conducted by means of paper cards and a software application entitled FlashQ. Each participant was advised to conduct an initial screening of the statements and sort them roughly; then from the pile of statements he/she agreed with, choose three he/she agreed with most strongly; then immediately choose five he/she agreed with less strongly (as expressed by the scale values +3 and +2, respectively). The remaining statements from the pile were automatically assigned the +1 value; only if there were too many of them, the participant was asked to continue dividing them into those he/she agreed with and those he/she found neutral. The pile of statements the participant disagreed with was sorted analogously and the participant then commented on the most agreed and disagreed statements.

RESULTS
Statistical analysis was conducted in a computer application entitled PQMethod. Factor analysis of the correlation matrix of all sorts followed the centroid method and the factors obtained were subsequently rotated by using Varimax and two manual rotations between factors 4 and 6 (by 33 degrees) and between factors 2 and 3 (by 14 degrees). Two criteria were used for selecting the resulting factors for interpretation: (1) an eigenvalue higher than one to consider the factor statistically significant and (2) at least two statistically significant sorts (factor loadings) for the given factor (see Brown, 1980; McKeown & Thomas, 1988; Watts & Stenner, 2005). In this particular case, factor loadings were significant at the 0.05 level if their values did not exceed 0.32. As an auxiliary criterion, a minimum of 10 per cent of variance explained was set. This factor analysis revealed a total of three independent factors representing three different perspectives that existed in the sample of participants. Factor A dominated strongly based on the number of sorts defining it (12) and the extent of variance explained (32%). Factor B was defined by five sorts and explained
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15% of total variance. Factor C was defined by four sorts and explained 10% of total variance. Only three sorts (participants) could not be assigned because their factor loadings were not statistically significant for either factor. The following table shows factor arrays, i.e. ideal Q-sorts around which empirically obtained sorts with significance for each factor are clustered. Table 2 Q-sort values for each factor and statement
# Statement Factor array A 1 2 3 4 5 6 7 8 9 10 11 12 13 The use of illicit drugs and related phenomena represent a serious social problem in the Czech Republic The so-called drug problem is a result of inadequate societal response to drug use (e.g., prohibition). Drug addiction is a manifestation of an individuals weak willpower. Dependent illicit drug users should be primarily treated, rather than punished. Illicit drug users pose a serious health risk to their environment (infectious diseases, accidents under drug influence). Among the causes of drug dependence, genetics are about as important as environment. Illicit drug use is an expert problem and should not be the subject of political conflicts. Major drug policy changes cannot be enacted without popular support. Evidence-based drug policy is able to maintain a socially tolerable level of drug-related problems. It is necessary to accept the fact that drugs are a natural part of human life. The government should not allow drug use to become a normal social phenomenon. A drug-free society should be the ultimate goal of the Czech Republics drug policy. Illicit drug users cause serious economic harms to the society (acquisitive crime, drug dealing). 1 0 2 3 1 0 3 0 2 3 0 3 1 B 2 2 1 2 1 0 1 1 0 0 3 1 2 C 0 2 1 2

Statement

Factor array A B 2 C 2

14

A part of the budget that is currently allocated to drug law enforcement in the Czech Republic should be transferred to other activities (prevention, treatment, social rehabilitation, harm reduction). The Czech Republics drug policy should primarily aim at the socalled problem drug use (i.e., injection and/or long-term or regular use of heroin and methamphetamine). The Police should remove drug users from of public spaces. Early detection of drug-related petty crime helps prevent serious crime (robberies, murders, organised crime). Society can reduce drug-related risks and harms by facilitating responsible drug use. Prohibition of drug possession helps detect drug dependence in its early stages. Strong sentences for drug crimes (production, distribution etc.) ultimately help decrease the number of illicit drug users. Primary prevention should build on the fundamental position that any drugs are harmful. Primary prevention should emphasise minimising the possible risks related to drug use. Involvement of drug users in a criminal environment may cause higher social harm than the use of illicit drugs itself. A decision to enter treatment must come from the drug user him/ herself. Medically supervised administration of a substitute drug or the original drug is an efficient way of reducing drug crime. Harm reduction promotes drug use. Legalization of the sales of hitherto illicit drugs would increase their consumption. The illicit status of some drugs means that they also cannot be used for their positive effects Drug users primarily harm themselves. Illicit drug use undermines the values our society is built on. From the perspective of social cost, it is not effective to enforce the penal prohibition of illicit drug possession for personal use.

15

16 17 18 19 20

2 1 1 2 3 1 1 0 1 2 3 1 1 1 2 2

1 1 2 1 0 3 0 0 1 0 1 1 1 2 2 3

1 0 0 1 1 3 1 0 1 1 2 2 1 1 0 0

2 21 3 22 1 23 3 24 1 25 2 26 0 1 2 27 28 29 30 31

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Statement

Factor array A B 2 3 C 1 2

32 33

Regions should have the competence to determine sanctions against drug possession. The demoralizing effect of drug criminalization on our young generations attitude to laws is a greater evil than all drug-related risks taken together. Harm reduction only perpetuates dependence in those who have not found the courage for long-term treatment. The distribution of financial resources and management of preventive programs must be conducted at the level of local administration as much as possible. Prevention must be the main focus of drug policy. By legalizing illicit drugs, the government could save many resources that could be devoted to fighting real crime. The health risks related to illicit drug use are largely determined by the drugs illicit status.

1 0

34 35

2 0

1 0

1 0

36 37 38

2 0 1

3 3 2

3 3 3

Source: Own calculations Note: Variance = 2.842; standard deviation = 1.686

Even the table itself makes it possible to infer on the characteristics of individual factors or, in other words, the perspectives of drug policy actors. However, in order to distinguish between and interpret the different factors more precisely, one must look at the levels of difference between statements (zscores), which help us identify the distinguishing statements for each factor. Based on z-scores, the following three factors representing Czech drug policy workers perspectives were identified.

Factor A Pragmatic Professionals

Based on the level of agreement, Factor A is best characterised by the following statements: It is necessary to accept the fact that drugs are a natural part of human life (+3; 2.13)4, Dependent illicit drug users should be primarily treated, rather than punished (+3; 1.39), and Illicit drug use is an expert prob-

4 The first number in brackets gives the statements position on the factor array scale for the given factor; the second number gives the statements z-score. The higher the number the more agreement (+) or disagreement (-) exists among participants.

lem and should not be the subject of political conflicts (+3; 1.34). Actors sharing the perspective represented by Factor A agreed with those statements the strongest, while actors sharing Factors B and C tended to disagree with them.5 This was similar for the statements, From the perspective of social cost, it is not effective to enforce the penal prohibition of illicit drug possession for personal use, Medically supervised administration of a substitute drug or the original drug is an efficient way of reducing drug crime and The Czech Republics drug policy should primarily aim at the so-called problem drug use (i.e., injection and/or long-term or regular use of heroin and methamphetamine). All those statements can be interpreted as expressing a pragmatic perspective on illicit drug use and some fundamental assumptions about the ways drug-related problems should be addressed. As a key aspect of this perspective, the idea that drugs are a natural part of human life is accepted (Participants no. 5, 9 and 15), i.e., in all historic times and all societies there have been individuals using drugs irrespective of their licit/illicit status and the negative effects that can be associated with use. While such perspective does not necessarily approve of drug use itself, it states that a repression-oriented war on drugs cannot be won or even makes the problem worse. In the words of participant no. 9, unless we accept [drugs as a natural part of human life], we will spend unreasonable amounts of energy that could be spent in a better way. The pragmatists often mentioned the functions drugs can have for individuals and the society. Thus, not only the negative effects of use that are most frequently mentioned in popular media and scholarly publications alike, but also the positive functions motivating people to begin using drugs in the first place were mentioned. Drugs are one of the ways of changing the state of consciousness which is a natural human need (Participant no. 4). This is closely related to the view that some drugs illicit status creates a false impression that they are not a natural part of life (Participant no. 17). Instead of trying to wipe drugs out of the society, one should provide people with sufficient information (Participants no. 5 and 23). In line with their pragmatic perspective on drug use, participants strictly rejected the statement, A drug-free society should be the ultimate goal of the Czech Republics drug policy (3; 1.84). They found the goal unrealistic, unattainable, and one that decreases the credibility and feasibility of a (pragmatic) drug policy.
5 Except statement no. 4 where all three perspectives were more-or-less united on prioritizing treatment over punishment.

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Furthermore, such a society would deprive its people of the positive effects drugs may have, because the society needs drugs and the society would not develop if there were no rebels (Participants 7 and 23, respectively). It is also a hypocritical goal of a society without prohibited drugs (Participant no. 5, highlighted by the author) in which the legal status of drugs is determined by morality and the interests of mainstream society. In line with this attitude, the statement Illicit drug use undermines the values our society is built on was met with strongly negative reactions (2; 1.53). The critical opinions about this statement mainly questioned the assumption that there are any such values or found any such values unclear. Unfortunately, our society is not based on any values, hence drugs have nothing to undermine. Unfortunately (Participant no. 24)

stead of rational solutions, and politicians attempt to win votes through simple promises such as drug-free society) (Participants no. 5 and 15, respectively). Nevertheless, while some voices refused to give politicians and other non-experts an important role in addressing drug-related problems (see also statement by participant no. 21 below), politics as such was not absolutely rejected (and therefore, no colonization of drug issues by the expert community was suggested). Instead, participants tended to submit the policy sphere to the expert sphere, whereby the role of politicians should be to adopt and win popular support for expert-driven (i.e., rational and evidence-based) solutions. The role of politicians is to be matter-of-factly and to explain (Participant no. 15) and they are supposed to use their leadership for educating the general public, rather than making populist politics (Participant no. 5).6

This statement provided a good illustration for the value background of existing conflicts within drug policy. In the public discourse, this statement usually refers to traditional (Christian, conservative) values and the lack of compatibility thereof with drug use; and most participants interpreted the statement as such. However, some pointed out that their dis/agreement with the statement depended on the kind of values they found fundamental. For instance, if consumerism is the value of today, it is certainly not undermined [by drug use] (Participant no. 5). Similarly, the value of individual freedom was not found to be undermined by drug use. Illicit drug use is absolutely in line with the values this society is based on (such as creativity). It is at least fifty-fifty What undermines those values is the related crime (overpriced illicit drugs etc.). (Participant no. 17)

In line with what was said above, the proponents of this perspective can be expected to express a high level of trust in science and, in turn, evidence-based drug policy.7 This aspect was expressed by the statement, Evidence-based drug policy is able to maintain a socially tolerable level of drug-related problems which agrees with Factor A (+2) but fails to be a distinguishing statement because actors taking other perspectives more or less agreed with it as well.

Since drug use is, almost entirely, an expert problem, [only] expertise can keep the problem within some boundaries. (Participant no. 21)

Factor B Proactive Prohibitionists

Therefore, while pragmatists refused the above statement, they were aware that drug use can be associated with nonconformist lifestyles that undermine the values of mainstream society and provoke negative reactions. As another dimension of this perspectiveand in close association with their pragmatismparticipants emphasised an expert nature of the drug problem. While this was expressed explicitly by the statement, Illicit drug use is an expert problem and should not be the subject of political conflicts (+3; 1.34), other statements strongly distinguished this factor as well. Actors sharing this perspective criticized politicians for stealing the drug issue from professionals and making it a political issue. Such an (ab)use of the drug problem for political purposes is characterised by irrationality (no rational arguments are used in political conflicts) and populism (emotions become part of it, in68

Factor B stands largely in opposition to Factor A and thus this perspective is somewhat the reverse of that of the previous one. The following statements distinguish Factor B by the level of dis/agreement: The government should not allow drug use to become a normal social phenomenon (+3; 1.7) and From the perspective of social cost, it is not effective to enforce the penal prohibition of illicit drug possession for personal use (3; 1.81). In sharp contrast to the other two factors, Factor B emphasizes an proactive role of the government in fighting illicit drugs because they undermine the fundamental values of the society (+2; 1.19) and their use represents a serious social problem (+2; 1.09).
6 Typically for this perspective and in contrast to the other two perspectives, the general public was not viewed as an important actor whose support must be won in order to enact major drug policy changes (statement no. 8). Given the expert and highly complex nature of the problem, the general public was found unlikely to fully understand it, especially if politicians failed to play the role of opinion leaders and explain drug issues clearly to the general public. 7 In the words of participant no. 9, I could not do my job [as a researcher] if I did not believe this.

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The use of illicit drugs causes great problems to the entire society. It is a social-pathological phenomenon the government must respond to, not only due to our international commitments. (Participant no. 19) Drug abuse undermines the principles of the Christian-Jewish civilization, the family, and our relationship with children. (Participant no. 11)

From this perspective, the government actually does not have a choice but pursue an active fight against illicit drugs because, first, it is paid to create a safe living environment (Participant no. 11) and, second, it is bound by relevant laws (Participants no. 6 and 19). This, however, does not necessarily mean that a drug-free society should be the main goal of drug policy. While this goal received majority support (+1; 0.68), it did not become a defining feature of this perspective. In order to better understand the perspective behind Factor B, one must answer the key question, what should the governments active fight against illicit drugs look like? Unambiguously, it should have both prohibitive and repressive character, as demonstrated by participants positive ratings of measures oriented on supply reduction and law enforcement as well as their negative ratings of statements questioning effectiveness of prohibition or offering different approaches. Thus, in contrast to the other two perspectives, participants found the fight against petty drug crime and the prohibition of illicit drug possession to be effective (statements 17, 19 and 31), were sceptical about substitution treatment and possible utilization of illicit drugs positive effects (statements 25 and 28, respectively) and strictly refused to debate increasing budgets for prevention and treatment to the expense of law enforcement (statements 18 and 14, respectively). Assuming a high social importance of the problem, they also did not agree with drug policy orientation on problem users, as they are currently defined. In this context, the criminalization of illicit drug possession appeared as a key measure that was supposed to help reduce both supply (by cutting down the distribution of drugs) and demand (by limiting drug use).

As in the case of the role of government and other aspects of the problem of illicit drug use, criminalization of possession was perceived as a matter of principle that relies on a clear, undisputable logic. The fact that some drugs are illegal made it necessary to sanction their production, distribution as well as possession, because every user is a potential dealer (Participant no. 13).8 By questioning this principle, one would open door to law relativization, thus helping drug dealers. An open question remains, whether the attitudes of prohibitionists to illicit drug use would change if drugs were legalized. One might hypothesize that their attitudes would shift towards greater tolerance, at least in the case of drugs like marijuana or ecstasy.

Factor C Ambiguous Preventionists

Factor C is to some extent complementary to Factor B, which is demonstrated by a high correlation coefficient between the two factors (0.61).9 Both perspectives build on the assumption that illicit drugs represent a problem and the society should take an active approach to addressing it.

The possession and use of illicit drugs are interrelated. Use is not criminalized in the Czech Republic but it is certainly an element we attempt to influence through drug policy. The illicit status of drugs does not exist for its own sake it is supposed to prevent use. Without the criminalization of possession, the society would be unable to fulfil the primary goal of drug policy. Moreover, use often leads to illegal acts (harm to others). (Participant no. 6)

However, instead of the social importance of the drug problem (0.07) this perspective emphasises the health risks drug users pose to their environment (+1.03) and the economic harms associated with drug use and drug crime (+0.91). Emphasis is placed upon prevention as the main focus of drug policy (+2.23) and primary prevention should build on the basic assumption that any drugs are harmful (+1.40). For these statements we must stress that while they have relatively high z-scores for Factor C, they are not defining for it in a statistically significant way. In other words, the statements are characteristic for this perspective but do not distinguish it statistically significantly from the other perspectives. This is caused by a great proximity between Factors B and C as
8 It must be emphasized that this opinion was explicitly mentioned by one participant only. Thus, it cannot be taken as shared by all participants within this perspective. However, Police representatives often mentioned it in the media (primarily, but not exclusively, in relation to drugs other than cannabis). 9 At the same time, both factors represent perspectives that are different from Factor A. In terms of correlation coefficients, Factor A is more distant from Factor B (0.23) and less so from Factor C (0.03).

We cannot accept that nothing is happening. The societal response is not inadequate because drugs are, unfortunately, a part of the society. Drug use is a problem because addicts live among us, steal from us, etc. The problem would definitely not disappear if it was not tackled. (Participant no. 2)

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well as a certain inconsistency of Factor C itself.. The attitudes of actors taking this perspective failed to be clearly defined, and appeared ambiguous, with few defining sorts (4 participants).10 On one hand, Factor C proponents strictly rejected legalization because it would lead to higher drug consumption (+0.84) and fail to make resources available for fighting other crime (1.83), rejected substitution treatment (1.00), and expressed general pro-repression attitudes (pushing users out of public spaces, questioning the effects of the illicit status on health risk, questioning the demoralizing effects of criminalization etc.). Every policy should have a goal and a drug-free society certainly is the highest goal. We must not take a defeatist approach. (Participant no. 1)

On the other hand, the proponents preferred prevention11, treating users from punishing them (+1.27) and an evidence-based drug policy (+0.60), and even strongly supported transferring financial resources from repression to other drug policy activities (+1.35). This can be ascribed to the underlying belief that prevention is better than repression (Participant no. 16), while any attempts to normalize or even legalize drugs are undesirable; drug policy and the society as a whole cannot do without repression. Compared to the above two perspectives, Factor C also emphasized the role of the general public in enacting drug policy changes. However, the envisaged role consisted in a one-way communication from experts and politicians to the general public, which must accept the different measures and must be willing to accept them (Participant no. 20). From my perspective, we must reach a consensus between the executive power and experts and then communicate such a consensus to the general public. Otherwise, it would not be accepted by the general public. (Participant no. 16)

Apparently, this perspective strongly emphasizes drug policy acceptance, rather than participation in drug policy formulation. Along with Factor B, this perspective refuses to view illicit drug use as a purely expert problem and accentuates the political dimension of policy formulation and implementation. It is exactly politicians and bureaucrats who should mediate the relationship between experts and the general public by advocating for certain solutions and explaining the reasons behind them. One must note that the pragmatic professionals were mostly afraid of this because they found that politicians tend to abuse drug issues for manipulating the public. Because of this, pragmatic professionals strived to keep illicit drug issues within the boundaries of an expert issue, rather than make it a political issue (see above).

CONSENSUS AND disagreement AMONG PERSPECTIVES

The use of drugs, and especially illicit ones, is associated with a number of controversies, differences, and disagreements. Those can occur at different levels of generalization (from value differences to disputes over specific measures or organizations) and at different forums expert (journals, conferences etc.), political (parliamentary debates, political party programmes etc.), religious, and other. It is one of the goals of this article to identify the areas of consensus and disagreement between the perspectives of Czech drug policy workers. Areas of consensus and disagreement between actors were identified through a combined deductive and inductive approach. Based on a literature review, controversial issues of drug policy in general (i.e., not only in the Czech Republic) were determined and a large part of those issues was relayed to actors in the form of statements for rating. Based on a literature review, the following controversial drug policy issues were included: legal regulation of prohibited drugs and law enforcement, court-mandated drug treatment, harm reduction and responsible drug use. Issues that appeared too specific and could be subsumed under more general themes12 as well as controversies surrounding specific drugs (such as the marijuana gateway theory) were excluded because the survey aimed at formulating statements pertaining to illicit drugs as a whole. Given the procedure for selecting statements and the general nature of the original set of statements, one may expect to identify further areas of tension between the three empirically identified perspectives, on one hand, and some
12 Examples include ecstasy testing at rave parties (a harm reduction measure) or school drug testing (generally part of the repressive repertoire).

10 Such inconsistency can be illustrated by the fact that each of the four participants took a different position on statement no. 1. The importance of the illicit drug problem was given ratings across the scale (+3, +1, 0 and 3). 11 However, once again, their support for prevention revealed inconsistent attitudes because they agreed with more-or-less contradictory concepts of primary prevention. On one hand, they believed that primary prevention should be based on the principle that any drugs are harmful; on the other hand, it should emphasize the minimisation of drug-related risks. While such a combination of approaches can be difficult to fulfil at the conceptual level, it is probably realized in the practice of preventive programs.

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issues may prove uncontroversial despite original expectations, on the other hand. The following text deals with the question whether and to what extent those issues were also controversial within the empirically identified perspectives of Czech drug policy actors; and whether there were other conflict issues as well. The results of Q-factor analysis revealed that the gravest disagreements related to the more general issues of core drug policy. Most importantly, the proponents of the different perspectives disagreed in their views of drugs as such and their role in the society. The deepest conflicts surrounded the statements that It is necessary to accept the fact that drugs are a natural part of human life and Illicit drug use undermines the values our society is built on. This value conflict further encompassed divergent views of the main goal drug policy should pursue, i.e. whether it should aim at a drug-free society. While pragmatists absolutely rejected this goal as unrealistic (or even undesirable), most prohibitionists and preventionists more or less supported it. Similarly, the latter two perspectives do not tend to view the societal reaction to drug use as inadequate, with unintended consequences in creating drug-related problems (pragmatists did not have a clear stance on this). However, the preference for a drug-free society did not necessarily lead to rejection of harm reduction approaches (as suggested by, e.g., Kalina, 2003, p.19). Instead, all three perspectives were surprisingly united in rejecting the statements that harm reduction promotes drug use or only perpetuates dependence in those who have not found the courage for long-term treatment. Thus, attitudes to HR did not differentiate among actors like they had in the past and like actors themselves assumed during interviews. All evidence suggests that HR has gradually become a more-or-less accepted part of a balanced approach to drug policy. Nevertheless, HR was not accepted fully and unconditionally. Rather, actors seemed to give positive ratings to the results of some less controversial programmes such as needle exchange, about which they were better informed, thus resisting the ideological arguments about drug promotion. Nevertheless, measures such as prescription of substitute drugs (or even the original drugs of choice) continued to be viewed as controversial ways of treatment and crime reduction. Not even all HR proponents agreed on its effectiveness. At the level of specific measures, the greatest controversy has been waged for more than ten years around the issue of criminalizing illicit drug possession (see Morvek, 2007). Unsurprisingly, prohibitionists were among the strongest proponents of criminalization, preventionists took a rather neutral stance and pragmatic professionals were among the most defined critics (many participants from the latter category had collaborated on the PAD study
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(Zbransk et al., 2001) which evaluated possession criminalization as ineffective from the perspective of social cost). Another sharp difference surrounded the orientation of primary prevention: both prohibitionists and preventionists wanted the state to send a clear message to young people that any drugs are harmful. This attitude was in line with the more general belief that drugs are not a natural part of society and, as such, must be fought against. A similarly sharp conflict between perspectives surrounded the statement that the health risks related to illicit drug use are largely caused by their illicit status. While pragmatists were open to this possibility, prohibitionists and, in particular, preventionists were strictly against it, adding that such discussions opened the door to normalization or legalization efforts and went against their general belief that the illicit status of drugs is desirable and effective. Nevertheless, pragmatists found themselves in a surprising agreement with preventionists on the opinion that the money spent on repression should be diverted to other activities; a closer look reveals clearly that while pragmatists preferred to strengthen harm reduction, preventionists wanted instead to invest the money in prevention. Prohibitionists were the disagreed with these opinions. Were there any issues that the participants agreed on? The analysis revealed that the only statement eliciting strong and similar opinions in all participants was that Dependent illicit drug users should be primarily treated, rather than punished. This attitude was based on the shared premise that addiction is a disease, and therefore, treatment works better than punishment. Most proponents of the prohibitionist perspective also found the treatment of addicts to be necessary, yet without questioning the necessity and utility of punishment. The latter caveat was related to the above-mentioned principle that if something is illegal than violations must be punished as well as the assumption that the threat of sanctions can make petty offenders (primarily users) cooperate with prosecutors against drug producers, traffickers and dealers. Follow-up interviews revealed that most prohibitionists (except a few who called for a criminalization of drug use per se) agreed with the criminalization of illicit drug possession, while pragmatists wanted to criminalize largescale production and distribution only (especially in the case of the so-called hard drugs). Apart from the above-mentioned attitude to harm reduction, an emphasis on prevention emerged as another area of strong consensus. A pronounced preference of prevention as the main focus of drug policy represented a common denominator for prohibitionists and preventionists, while pragmatists took a more ambiguous attitude. Thus, even the proponents of the prohibitionist perspective called for prevention as something repression can never do
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without. Pragmatists more reserved attitude to prevention was probably associated with the ways (especially primary) prevention has been realized in the Czech Republic and certain doubts about its effectiveness or, more generally, about the potential drug policy has in this direction. Pragmatists did not agree with the other two perspectives on the view that primary prevention should be based on the principle that any drugs are harmful. They rejected this attitude because no one is going to trust it (Participant no. 15) and it is precisely trust that prevention should rely on. The proponents of the any-drug-is-harmful thesis are often criticized for trying to build primary prevention on scare tactics. This was not confirmed by the attitudes of prohibitionists or preventionists; they rather spoke in terms of dissemination of information or dialogue: Repression only chases the consequences. [Prevention should] prepare the person for their first contact with drugs. An adequate form of primary prevention is necessary, not just scare tactics (such as the campaign You Will Pay for Not Thinking). (Participant no. 11)

CONCLUSIONS
While every Czech drug policy actor assumes a specific set of opinions, Q methodology made it possible to identify three main perspectives. Each of these perspectives represents a comprehensive and unique set of views on illicit drug use and related problems that was shared by a certain number of survey participants. The perspective emphasizing pragmatism and professionalism dominated among survey participants.13 Compared to the other two perspectives, it differed in (1) lower importance ascribed to the problem and (2) a sceptical view of the illicit status of drugs and related law enforcement. This was manifested in the explicit rejection of illicit drug possession criminalization and other measures oriented on supply reduction as well as a strong emphasis on substitution, decriminalization14 or even responsible drug use. The sceptical view of prohibition arose out of the perceived low effectiveness of different measures in mitigating drug-related problems and, more generally, a different perception of the problems importance. Within this perspective, drug use in the Czech Republic and related phenomena were not considered as serious social, economic, or health problems (compared to other problems). Thus, policy workers sharing this perspective defined drug use as a predominantly individual problem, without significant social consequences, and one that only concerns certain drugs and modes of application. Accordingly, a drug policy orientation on the so-called problem drug use was preferred, focusing on a relatively narrow group of users and their individual health (or family, work etc.) related problems.15 For the pragmatic-professional perspective, drug policy should build upon the pillars of prevention, orientation on problem drug users, harm reduction, and substitution as effective ways of treating dependent drug users as well as reducing drug crime.
13 Given the sampling procedure, results cannot be generalized to the entire population of actors. Thus, no conclusions about the distribution of the different perspectives within the population can be reached. However, available information about the history and current situation of drug policy and legislation (e.g., Radimeck, 2007; Morvek, 2007, as well as other publicly available sources such as transcripts of the proceedings of the Czech Parliaments lower chamber, strategic documents, or mass media content) suggest that this perspective dominates Czech drug policy as a whole. 14 None of the empirically identified perspectives was clearly in favour of legalization, although the proponents of this perspective spoke most frequently in favour of different forms of legalization (from decriminalization to the normalization of lower-risk drugs to a complete legalization of possession, production and sales of most hitherto illicit substances). 15 In this respect, Morvek (2008) argued that the introduction of this concept in Czech drug policy enabled experts to somewhat play down problems pertaining to other drugs (and in particular, marijuana), thus contributing to their decriminalization.

This however begs the question, what exactly an adequate form of primary prevention entails and how serious the rejection of scare tactics is (by reference to a media campaign built on scary examples of road accidents inspired by the UK campaign Think!). In the last two statements, actors formulated a shared (this time, negative) attitude with respect to a possible competence of regional governments to regulate sanctions against drug possession, and addiction as a manifestation of weak willpower. In the first case, actors rejected the option of adapting prohibition and law enforcement to specific regional conditions for several reasons. First, they pointed out that nationally applicable norms were necessary. Second, they held little trust for the regional governments ability to realize a desirable (for the given actor) drug policy. Third, regions with milder sanctions might become victims of their own benevolence. In the second case, actors were more-or-less united on the view that addiction is a disease and a complex phenomenon that is determined by multiple factors. In contrast, some actors pointed to the fact that some addicted people must have a very strong willpower if they are able to break out of addiction; or that strong willpower is suggested by their striving for knowledge. Thus, the myth that people addicted to illicit drugs have weak willpower was refused by all three perspectives and actors realized the consequences of such an attitude.
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The other two perspectives were to some extent complementary in that one rather preferred prohibition and the other placed more emphasis on prevention. Nevertheless, both agreed on many general as well as specific aspects of drug policy such as the higher perceived importance of the problem, the active role of the government in addressing it, and the rejection of any form of legalization or normalization etc. The following table summarizes the attitudes of the different perspectives towards selected aspects of the problem. Table 3 Attitudes of the three perspectives towards different aspects of the drug problem
Issues Perspectives Pragmatists Fundamental drug-related value orientations Drugs as a natural and functional part of social life (pragmatism) Users (in particular, problem drug users) Low to medium Prohibitionists Legal compliance; drugs seen as social pathology undermining societys values Society as a whole High Preventionists Drugs are bad

Issues

Perspectives Pragmatists Prohibitionists Preventionists Experts should explain to the general public Drug related crime; economic harms Health risks; economic harms

Participation by the general public, experts and elected representatives Seriousness of specific aspects of the problem in specific locales Importance of various causal linkages in different locales/times

Expert problem; politicians should explain (lead) Problem drug use

Criminalization of drug possession does not help detect drug dependence; strong sentences do not decrease demand (and number of users) Different levels of legalization (possession, lowerrisk drugs)

Illicit status does not influence health risk; criminalization does not demoralize

Little role of genetics in addiction; illicit status does not influence health risk; criminalization does not demoralize; legalization would increase use Strengthen prevention; prevent legalization (maintain status quo) Positive ratings of prevention

Most-at-risk groups Overall importance of the problem Underlying causes

Young people, society as a whole Medium Drug addiction as a complex of different causes; inadequate societal reaction does not create the problem Centralized

Decisions concerning administrative rules, budgetary allocations etc.

Prevent legalization; do not divert finances from repression Positive ratings of repression, rather negative ratings of HR and treatment

Drug addiction as a Drug addiction as a complex of different complex of different causes; inadequate causes societal reaction does not create the problem Centralized Centralized

Performance of Positive ratings specific programs or of HR (and institutions substitution), rather negative ratings of repression
Source: Author

Distribution of power between government levels Preferred policy tools

Limitations
HR, prevention, focus on problem drug use Repression; possession prohibition; prevention High; active government involvement Prevention; repression; possession prohibition Medium

Ability of the society Relative; evidenceto solve the problem based drug policy focusing on specific groups

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Concerning the limitations of this study in particular and methodological approach in general, some authors have criticized Q for its non-random sampling method and small sample sizes. However, this demonstrates a lack of understanding of the methods purpose: it aims to identify all possible perspectives within a sphere of interest, rather than make inferences about a general population (see Methods section above). Practical experience shows that the set of perspectives becomes saturated quickly with growing samples, and raising the numbers of participants (above several dozen) fails to reveal new views upon the issue under investigation. Nevertheless, it must be admitted that since
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the number of participants in this study was at the lower margin of the usual range, the existence of further perspectives shared by multiple drug policy actors cannot be ruled out. Furthermore, one might argue that Q methodology can be used on a representative sample of the target population, and indeed, a few surveys of this kind have been done (e.g., Hill, 1992 or Anderson, Avery, Pederson et al., 1997). However, as Danielson (2009, p.223) pointed out, Q-directed investigation on large samples (typically in public opinion surveys with hundreds of participants) faces numerous logistical and technical obstacles. In that case, it appears more favourable to combine Q with more traditional methods: operationalize the perspectives found through Q and identify their distribution in the population through a representative survey. Thus, the present study can be understood as a possible first step in investigating drug policy actors perspectives in the Czech Republic or even other countries. Another limiting factor may lie in the fact that a pre-selected set of statements were administered to participants for assessment on a scale. Inappropriate selection of statements would prevent participants from truly modelling their own perspectives. As Cross (2005) stated, People can tell a story only if they have the appropriate statements with which to tell it. (p.212) In order to avoid inappropriate selection of statements and biased observation of actors perspectives, theory-based structured selection and subsequent piloting took place. The survey itself somewhat confirmed the correctness of the selection because only a few participants protested certain statements and all participants managed to complete their Q-sorts.

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