Nils Bejerot

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Nils Bejerot (Stockholm, September 21, 1921 – November 29, 1988) was a Swedish psychiatrist and criminologist.

1 Work
2 Best known for
3 Theory of addiction
- 3.1 A different view on the War on Drugs - Nils Bejerot
4 Practical implications
5 Se also
6 External links
7 References

[edit] Work

Nils Bejerot received a medical degree from the Karolinska Institute in Stockholm, 1957. Subsequently trained as a psychiatrist at the Southern Hospital and the St. Goran Hospital in Stockholm from 1957 to 1962.

In 1963 Bejerot studied epidemiology and medical statistics at the London School of Hygiene & Tropical Medicine, on a grant from the World Health Organization.^[1]

Bejerot was consulting psychiatrist to the Stockholm Police Department from 1958 and consulting physician to the Stockholm Remand Prison from 1965. Later he became Research Fellow in drug dependence at the Swedish National Medical Research Council, and then reader in Social Medicine at the Karolinska Institute.

Bejerot became associate professor 1974 at the Karolinska Institute and received the title professor in 1979.

In 1974 he was called to testify as one of 21 scientific experts on marijuana for a subcommittee of the United States Senate on the Marihuana-hashish epidemic and its impact on United States security.^[2].^[1]

His research covered such wide areas as the epidemiology of drug abuse, the dynamics of drug dependence and the anomalies of public welfare policy. Bejerot gave an extensive number of lectures in many parts of Sweden. For 30 years he discussed in an intensive way for zero tolerance including possession and use of cannabis. He published about 600 papers and debate articles in different media and published more then 10 books about the subject.In total he had about 100000 participants on his 2 days courses^[3]. For many years he hold lectures at ‘’Polishögskolan’’ (The Swedish Police College) about drug abuse, mental problems and negotiation skill. He was teacher for almost every Swedish police officer, which gave him the epithet ‘’polisdoktorn ‘’ (The police doctor).^[4]^[5]

[edit] Best known for

He is best known for several things:

His role as a psychiatric adviser during the Norrmalmstorg robbery and coinage of the term Stockholm syndrome to refer to the way in which the hostage shows signs of loyalty to the hostage-taker.^[6]

His strong opposition against any legalization or prescription programs for narcotic drugs, He advocated for zero tolerance for illegal use and possession of illegal drugs. In the early 1980s, he became one of the "Top 10 opinion moulders" in Sweden for this. Bejerot is by UNODC and many others recognized as founder of the Swedish strategy against recreational use of drugs. His demand for zero tolerance as a drug policy was for a long time seen as extreme, but during the late 1970s occurred a change. He is without doubt the person who has meant most for changing the Swedish drug policy in a restrictive direction^[7] ^[4] something that made him a controversial person, both before and after his death. ^[8] Many people consided Bejerot as a good humanist advocating the only viable policy against narcotics. Others view this as a reactionary hindering of new treatment practices against drug abuse.^[9]

His strong opposition against the violence in comic books, which was the subject of his book, Barn, serie, samhälle (children, comics, society), published 1954, itself largely an adaptation of Fredric Wertham's book Seduction of the Innocent, also published 1954.

[edit] Theory of addiction

Bejerot attacked the symptom theory of addiction - that addictions are a symptom of other more fundamental personal or socioeconomic problems - and separated five essential factors from all of the other factors that are involved in addiction. Bejerot's point was that all of these other factors should be understood as susceptibility or risk factors. Therefore mental illness may make someone susceptible to drug experimentation and use, but it is not a causal factor. Similarly, poverty may increase susceptibility, but there is no automatic causal relationship with addiction. Many poverty-stricken communities are free of addiction epidemics, as are many people with mental illness.

Bejerot's analysis was that the presence of five factors on their own constitutes a risk that an individual will become an addict, or that a community will be affected by an epidemic of addiction:

Availability of the addictive substance

Money to acquire the substance

Time to use the substance

Example of use of the substance in the immediate environment

A permissive ideology in relation to the use of the substance. ^[10]

Bejerot advanced the hypothesis that when addiction supervenes it is no longer a symptom but a morbid condition of its own; its development will not be affected by removal of the initiating factors. Addiction has the strength and character of a natural drive: it may be considered as an artificially induced drive developed through chemical stimulation of the pleasure center.^[11].

He compared addiction with a very deep love.

Addiction is "an emotional fixation (sentiment)acquired through learning, which intermittently or continually expresses itself in purposeful, stereotyped behavior with the character and force of a natural drive, aiming at a specific pleasure or the avoidance of a specific discomfort"

"Falling in love is a learned phenomenon and is located in the memory and not in gross physiological and vegetative reactions (although the memory functions do have their special physiological base). This is also the case with drug dependence"..."If the pleasure stimulation becomes so strong that it captivates an individual with the compulsion and force characteristic of natural drives, then there exists what I would describe as an addiction. This addiction usually--but not inevitably--is expressed in addictive behavior,that is, a specific, repetitive pleasure stimulation with lack of motivation to change this behavior, even if the individual realizes that it is extremely injurious."^[12]

And like a deep love, addiction can stop if something very special happens. Bejerot had also a theory about different types of addiction.^[13] There are a large number of overlapping and conflicting theories of addiction, see Drug addiction. Bejerot accused for example professor Alfred Lindesmith and professor Isidor Chein, know for his book The road to H, for making general conclusions in their research biased on either small atypical groups or having lacking support in their own studies.^[14]

Bejerot's view on treatment of alcoholics was in big parts, but with other words, overlapping the Alcoholics Anonymous (AA) 12-step program with the important exception that Bejerot did not see dependence of alcohol or narcotics as diseases. He saw them as an addiction ^[15], compare with his own definition of addiction.

[edit] A different view on the War on Drugs - Nils Bejerot

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Please help improve this article by adding more general information.

[edit] The addict

The founder^[16] ^[8]of the present Swedish anti drug strategy, professor Nils Bejerot (1921-1988) argued that a war against illegal drugs could not be won by focusing only on advanced technology and actions against organized crime.^[17] ^[18]. He argued that drug use and drug addiction is a learned behavior. When the person has become an addict will the development of this artificial implemented drive not be affected by removal of the initiating factors.^[19].^[12]

[edit] A restrictive policy, a variant of the gate way theory

Bejerot often compared the habit of using recreational drugs with an epidemic disease.^[20]. One commonly used method to manage an epidemic disease is to identify the carriers, isolate them and treat them under controlled circumstances. Bejerot regretted that some of the US Judges and others in the US., like professor Alfred R. Lindesmith, in the 1960s had lost confidence on restrictive drug laws and forgotten the experiences from restrictive laws in the struggle against illegal use of opium; the number of addicts declined to one tenth of its former level between 1914 (the Harrison Narcotics Tax Act) and the 1940s. He argued early that a policy with liberal drug laws and permissive ideology in relation to the use of drugs like neglecting smaller amounts for personal use, will open the doors for a much larger epidemic outbreak of recreational drugs to a level not acceptable for the government. Then the society will rebound with much more restrictive laws (compare with the War on drugs).^[18]. Zero tolerance for use of illicit drugs is a key word i the view.

[edit] The laws

The Swedish system ^[21] combines very restrictive drug laws with very few citizens per capita imprisoned compared with the US, only about a tenth (about 1 in 1400).^[22] Swedish laws concerning cannabis and other recreational drugs are arguably even more restrictive than in the US, however criminal punishment focuses more on drug dealing and less on drug addiction, which is treated as a health problem, a risk for spread to new users and a smaller crime. ^[16]. Maximum penalty for use is 6 months. Maximum penalty for drug sales is 10 years in prison^[23] (18 years in extreme cases). Drug dealing to friends is not accepted, the minimum penalty is 6 months in prison. Cannabis is not seen as a soft or harmless drug.

[edit] Detection of drug use =

A drug test by the police showing that you have used a drug (for cannabis is detection possible for several days) ^[24] is a cogent evidence of a crime. Zero tolerance for illegal drugs is an official policy. The punishment for only one single use will probably be a fine but it will also result in a report to other local authorities and probably some kind of follow up by other local authorities than the police. There is no tolerance for smaller amounts of illegal drugs for personal use.

[edit] Voluntary and mandatory treatment

The follow up is very important, for ex. by the local Social services board^[25]. Suspected addicts are offered some kind of free drug treatment program, a right supported by law ^[25]. For citizens with repeated offences or young users it can be mandatory to cooperate.^[26] The system can be seen as a cousin to drug courts in the USA.^[27] The system with follow up of other authorities than the police has a long tradition with roots in the temperance movement in the beginning of of 20th century. Support to families and parents and cooperation with different voluntary organizations is important.^[21]

[edit] Prisons with treatment

50% of the prisoners have used illegal drugs at least once the year before the crime, serving for drug offenses is common but their number is a lot lower than in US. Sweden has no three strike law. Many prisons have drug free departments^[28] and drug treatment program inspired by cognitive therapy. Upon suspicion, prisoners is requested to take a drug test. There are also random drug tests.^[22] Since addiction is a learned behavior is training to a drug free life possible even if relapses happens. The first phase in this treatment is to make the addict free from drugs for ex in a drug free department with frequent drug test. Then can the real treatment/training for a drug free life start. Since addiction is a very strong artificial drive can the treatment/training for a drug free life take years.

[edit] Interfere at a very early stage

Bejerot states that the habit of using drugs often is introduced by friends or people well known to drug user^[29]. He and many others states that it is effective to interfere at an early stage before the citizen has become an addict of any kind of drug or alcohol or introduced more people in the habit of using drugs; this will also lower the general crime level.

[edit] Effect

The United Nations Office on Drugs and Crime reports that Sweden has one of the lowest drug usage rates in the Western world, and attributes this to a drug policy that invests heavily in prevention and treatment, as well as strict law enforcement ^[16]^[30]

[edit] Practical implications

The practical implications were: (i) to increase prevention and treatment activities as well as to criminalize not only drug trafficking but also drug use, (ii) to target cannabis use as the first drug in the chain towards drug abuse (based on the ‘gateway’/‘stepping stone’ hypotheses), any use of cannabis is today an offense in Sweden, and (iii) to create a national consensus on drug policies across party lines, supported by civil society pressure groups. ^[16]

Bejerot also argued that drug policy had to target the drug user, since the drug user was the irreplaceable element in the drug chain while drug dealers could be easily replaced in the event of being arrested. In addition, he saw the need for a broad popular support to be achieved through a broad political agreement and massive information campaigns, leading to something like a popular uprising against drug epidemics.^[16]

Bejerot often compared spread of recreational use of drugs with spread of epidemic diseases^[31]. One commonly used method to manage an epidemic disease is to identify the carriers, isolate them and treat them under controlled circumstances. Bejerot argued for the same principles in anti drug laws with restrictive drug laws and zero tolerance for possession or use. This shall however not be interpreted as an anti drug policy in the Bejerot style in the long run is equal to many citizens imprisoned. Sweden has per capita very few people imprisoned for drug offenses compared with the US, only about one tenth. He should probably liked drug courts in the US ^[32] if the treatment includes frequent drug test. He supported a change in the Swedish drug law in 1979 that gives a Swedish court similar possibilities.

Bejerot wrote that some of the US. Judges and others in the US. in the 1960s had forgotten the successful experiences from the struggle against illegal use of opium^[31]; the number of addicts declined to on tenth of its former level between 1914 (the Harrison Narcotics Tax Act) and the 1940s. He argued that a policy with liberal drug laws, like neglecting smaller amounts of illegal drugs for personal use, will open the doors for a much larger epidemic outbreak of recreational drugs to a level not acceptable for the government.^[31] Then the society will rebound with much more restrictive laws (compare with the War on drugs). “A country can afford liberal narcotics laws as long as it has no widespread epidemic use of narcotics”^[31]

Another typical term in Bejerot's text is enabling. The term is imported from the Alcoholics Anonymous movement. Enabling comes from poor thinking about the consequences as a response to manipulations by the addict. The addict person often tries to escape from the down side of the drug, consequences that can work as a brake on the drug abuse. Persons who are close to the drug user often become a co-addict even if they are not using the drug themselves. The term enabling was also used by Bejerot in criticism of harm reduction programs that helped the addict to feel secure in his drug abuse but not demanded that that the addict should stop with use of the drug. He claimed these programs for being inefficient or increasing the total number of addicts.

[edit] Se also

[edit] External links

http://www.nilsbejerot.se/om.htm - written by admirers, including full text of many of his books
http://www.rns.se/swedish-addiction.asp Nils Bejerot: The Swedish Addiction Epidemic in global perspective

[edit] References

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