The Treatment of Drug Addiction: The Individual Caught between Public Welfare and Private Capitalism
Laursen, Lau, Storgaard, Anette, Contemporary Drug Problems
The Danish treatment system has traditionally been public. Until a few years ago, the public system was financed and run by the counties themselves, or by private foundations with so-called operating agreements with a county. The social treatment efforts were, and still are, two-stringed to some extent, which means there is a residential treatment sector and an ambulatory sector providing various social services and offers of treatment for individuals with abuse problems.
This model, which is first sketched in broad outline here, has been changed in many ways since the last general review of the drugs situation put forward by the Danish government in May 1994. The central message in that review was the wish to give higher priority to the treatment effort, which had been given lower priority during the 1980s at the cost of the control policy apparatus. This increase in priority led to a number of changes in the social legislation and practices concerning the treatment of drug abuse in 1995-96. One of the most interesting changes was an acceptance of the use of private treatment centers, which thereby became an accepted part of the treatment system. In section 1, below, these changes are described in more detail.
This development is one of the most concise features of social policy in Denmark in the 1990s. At the same time, the socio-political discourse has been concentrated on the interplay and roles of social responsibility of the welfare state and the so-called "voluntary social work," a broad designation for all non-governmental social services and programs. These more specialized services are directed toward citizens who have difficulties feeling at home in the postmodern information society with all its demands and social mechanisms and therefore are at risk of being marginalized.
Citizens with drug misuse as a central part of their daily lives are one of the most visible and heavy groups among the socially marginalized population. A big part of voluntary social work in relation to this group therefore takes place in a multifaceted way as to structure, content and financing. One can point at a broad spectrum of initiatives that reaches from locally anchored services on the grassroots level (e.g., a shelter for citizens with social problems in a city district) to big nationwide organizations with many different services on different levels (e.g., national treatment institutions for alcoholics). The new private treatment institutions for drug addicts that grew up from the middle of the 1990s in Denmark can be placed between these two poles. By this they fit very well into the classification of nonprofit, voluntary social work as it is defined in the literature.
Smith & Lipsky (1993) distinguish among three types of nonprofit service agencies. The first type is the traditional social service agency, like the nationwide agency for treatment of alcoholics mentioned above. The second type is "the agency founded within the last twenty years, directly in response to the availability of government funds for job training, mental health, and other contemporary services. . . . Typically, these agencies do not exist as nonprofit organizations for very long prior to receiving a government contract. And in some instances the founders will reach an understanding about a contract prior to the creation of the agency" (Smith & Lipsky, 1993:39). As the third type, Smith & Lipsky mention agencies founded in response to unaddressed local community problems such as homelessness or concentration of drug users on the street level. This type matches the above-mentioned local shelters for drug users.
The entry of private treatment institutions into social laws in the middle of the 1990s and their typology match almost entirely the second category of Smith & Lipsky except perhaps in the question of for-profit versus nonprofit organizations. This development in the treatment system in Denmark forms the background for the discussion about the consequences for a political social sector in a modern welfare state when it is challenged by a private sector. …