Conversation with Cees Goos


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In this occasional series we record the views and personal experience of people who have specially contributed to the evolution of ideas in the Journal’s field of interest. Cees Goos is a Dutch national who worked for 15 years in senior staff positions at the World Health Organization (WHO) in Copenhagen, and who was responsible for developing a regional programme on substance abuse. He helped to set up the European Alcohol Action Plan, a seminal international public health initiative.

EARLY AWARENESS

Addiction (A): Cees, most people will know you through your work for WHO Europe. But before we get to that part of your life, perhaps you can tell us how you became involved in the field of substance use and abuse.

Cees Goos (CG): I was fortunate enough to grow up in a happy family in the countryside of Holland. At home drugs or alcohol were literally far away. Perhaps a glass of jenever (Dutch gin) for the adults at special occasions, and at the age of 16 the boys in the family were invited to join in this ritual. I recall a person visiting us every now and then, a friend of the family living in the town nearby, who held a position of some importance in what I now think was a teetotallers’ association or a treatment centre for alcoholics. To me, that was a very strange and alien world.

A: Other early awareness?

CG: The other early childhood association I have with substance abuse was the hushed rumours in the family at home every now and then when a neighbour had been dropped off at his doorstep the previous night after a drinking bout, which seemed to me equally strange. It was not until I had become a university student that I became genuinely interested in the use of alcohol and drugs. This was in the 1960s. Experimenting with drug taking, or other people using drugs, was something almost everybody had experience with.

A: So you became intrigued as to why people behaved in this way?

CG: Yes, I became intrigued about substance abuse early on, because around me I noticed some of my fellow students and friends, who were very much like me, being arrested for drug use, landing up in prison or, as it was called at the time, freaking out, and ending up on a psychiatric ward for a shorter or longer period of time. Throughout my life that question has kept me puzzling: why is it that some people get into trouble and become hooked on the substance that they are taking, while others remain in control and out of trouble? And subsequently, what is it that makes a person getting into trouble with substance abuse become a patient or a criminal?

THE INFLUENCE OF THE ENVIRONMENT

A: Why do people take drugs?

CG: What has impressed me always in this regard—but this may be the bias of my university education in social sciences—is the massive influence of the environment, the culture we live in, the examples within our own circles. Drug taking in the 1960s was part and parcel of the counter-culture, a movement that spread very rapidly throughout the western world. Somewhat later drug taking went beyond the counter-culture movement, and became a way of life for many who had no sympathy or even understanding of the anti-authoritarian counter culture.

A: What happens to freedom of choice?

CG: The almost universal use of cigarette smoking those days (and unfortunately even now still in many places) cannot be understood without duly recognizing the unavoidable, inescapable huge impact of the environment on the individual’s choices. The freedom of choice not to smoke is just a theoretical freedom in a world where everybody smokes. The freedom to say no to drugs is only a theoretical freedom in a city district where life runs on drugs. I am a believer in shaping—or if you so wish ‘manipulating’—the environment towards a better life.

‘The freedom to say no to drugs is only a theoretical freedom in a city district where life runs on drugs.’

A: It sounds as if your student days were important in stirring certain awarenesses?

CG: Fantastic young years through secondary school and university, from which I graduated in 1969. It was the time of student protests, but also of marihuana, LSD, Timothy Leary with his psychedelic experience, and so on. Influences that were so critical in this period for a professional choice. An influential book in this respect was Howard Becker’s Outsiders (Becker 1963) on deviant behaviour.

EARLY RESEARCH EXPERIENCE

A: May I ask, what was your position towards these substances?

CG: Sure, you may ask. Everybody used stuff, so I did too. I guess I was a normal child of my time in being keen to explore the world around me, including exotic places and exotic experiences. The difference perhaps was that my fascination for unorthodox or deviant behaviour—and its derailments—became the subject of my study as well. My university professor at the time, with whom I was working as an assistant, encouraged me and a fellow student to apply theories about deviant behaviour and conduct a survey on drug use among high school students, which we did. It probably was one of the first of its kind in western Europe on this scale. We had some 1500 respondents in our project and produced a report in which, among other things, we correlated interest in drug use with other behaviours.

A: Quite a considerable undertaking for an undergraduate. Did you have any institutional support?

CG: Hardly. It was a partly paid student job at the faculty, and we were able to use some facilities to collect and store data, but essentially it was performed by the two of us in about 6 months. We were unfortunate, in that we had promised the directors of the schools from where we recruited our respondents that we would not go public with the results without their authorization. Even though the results that we obtained were not dramatic, basically confirming only what was thought widely to be the case, most of them were afraid to have this in the newspapers, and therefore forbade us to publish anything about what we had found in their schools.

SETTING OUT ON A CAREER PATH

A: In a sense, one was not deviant using drugs at the time. How acceptable and ‘normal’ was it in student circles?

CG: Yes, I reckon I was part of a large minority of about 40% who experimented or used drugs recreationally. At the same time I witnessed many negative instances, and accidents with drugs among friends: bad trips and people ending up in jail. The risk of getting caught was much higher then. At the beginning of my professional career I worked on a project in penitentiaries for the Justice Department, and occasionally came across drug offenders, some with more or less the same background as I had had. It made me wonder, how is it that had I been lucky and they had not?

A: Was that your first official job?

CG: My first job was in the criminal justice system. For 1 year I became involved in a project aimed at improving the rehabilitation process of prisoners through investigating the lack of cooperation between community health and social services and the criminal justice system. By the way, today this is still a core problem in many countries. I was asked to look in particular at the situation of young offenders, the majority of whom were drug users, and most of them naive petty offenders. Through this job I learned about the noise and the smell in prisons, about the devastating effects that even a short stay in a prison can have on the life of the prisoner. This is not to say that we do not need prisons at all. However, the implicit double goals of a prison sentence (punishment and education), if met at all, are almost always balanced out by the detrimental effects it has on human life and its course. As an aside of this job I worked on the establishment of a local Youth Advisory Centre (JAC) to cater for the need to have better opportunities for the rehabilitation of released young offenders. Voluntary work, unpaid.

‘Through this job I learned about the noise and the smell in prisons, about the devastating effects that even a short stay in a prison can have on the life of the prisoner.’

A: I remember JACs were quite controversial in their approach?

CG: In those years, the established social and medical institutions were ill-equipped to deal with young people. I believed that the primary initiative in Amsterdam deserved a general following in the rest of the country. It taught me how difficult such an endeavour can be. At the end of the criminal justice project I decided to search for a job abroad. Via Unesco in Paris, I ended up in the Sudan, and later Egypt, as a researcher in a global evaluation of functional literacy. We were fighting illiteracy which was then, and is still, a major obstacle to development. After a few years, my interest in working in the substance abuse field pulled me back to my home country and I found a job as a scientist in the prevention department of the FZA, the national alcohol and drug agency.

A: A lasting career path this time?

CG: Yes, for about 14 years. Interestingly, I was in a team with many non-professionals, people not trained specifically in prevention, but who came from all walks of life. This is well reflected by the title of one of my reports, which sounds better in Dutch than in English: ‘Van Zorg naar Voorzorg’ (‘From care to prevention’), indicating our intention to shift the focus away from the alcoholic patient or opiate addict to a public health perspective, which was almost totally absent at the time. It turned out as a sort of health advocacy activity, trying to influence a large audience through frequent media exposure, conferences and writing books and brochures.

A: Would you say you stood at the cradle of what is now considered the typical Dutch approach?

CG: I witnessed a shift in emphasis from the medical, residential settings to more basic help in primary care, family and social work, things such as finding a suitable house. It was also a time of decriminalization of drug use, particularly marihuana. There was a whole bunch of people involved in the shaping of the Dutch approach. To mention just a few: Frits Frenkel, a criminologist at the Erasmus University, and Evert Dekker and Eddy Engelsman at the health ministry played an important role in this development. The agency I used to work for was also progressive, but in the eyes of groups such as the junkiebond (a ‘union’ of heroin addicts) was far too moderate. So one day, coming to the office we found our desks being occupied by the junkiebond.

WHO CALLING

A: But then you began to move in some more international directions?

GC: Yes. During my years in the FZA my bosses allowed me to conduct some work for the International Council on Alcohol and Addiction (ICAA), at the time the only international platform for non-governmental organizations (NGOs) collaborating in the field. Through the ICAA, I was asked by the United Nations Fund for Drug Abuse Control (UNFDAC) [now United Nations Drug Control Programme (UNDODC)] to develop and coordinate model programmes for demand reduction. It gave me a glimpse of the huge variety of what was considered to be drug demand reduction, and of the intricacies of international work. At the same time WHO asked me to make an assessment of the attention given to substance abuse in the curricula of medical schools in Europe. The conclusion of a dire state of affairs was basically already known beforehand. It was in 1986 that I was asked by John Henderson, then WHO regional adviser for mental health in Copenhagen, to develop a regional drug prevention programme, next to the already existing alcohol one. Later on, both programmes were to be joined.

A: What was your mission in Copenhagen?

CG: Henderson made me understand that the primary task was to elaborate at a regional European level an overview of the implications of alcohol and drug-taking for public health. Only a thorough overview of specified negative effects could be used for policy guidance. Quite an ambitious task, given that resources were really limited, and staff consisted of not much more than ‘half a secretary’.

A: Do you mean that you were, at that time, arguing that monitoring was essential for informed decision making, much like evidence-based policy development?

CG: Quite. That was, and is still, mainstream. However, much of the sense or power of monitoring emerges only after targets have been set. Monitoring without a framework of targets is like a prayer without end, and eventually you will be creating a churchyard full of information. So in a way this became a dual exercise, building up an information base, and at the same time developing policy targets. In the process, I guess, the target-setting has moved things more effectively than the data collection. We did not have enough power to implement large changes, but with limited resources we produced two reports which, even by current standards, are not bad at all (World Health Organization 1992).

‘Monitoring without a framework of targets is like a prayer without end, and eventually you will be creating a churchyard full of information.’

A: Would I be way off the mark in stating that the role of your Copenhagen office was a codifying one?

CG: That sounds fair. However, the codifying role, which the Regional Office had through its work on Health for All (HFA), has had a tremendous influence on public health policy-making in Europe, including substance abuse. This does tally well with the overall role of the Organization. Indeed, one of the most important tasks of WHO is to create an international consensus over health issues, how we define this and that. The foremost example of this is obviously the International Classification of Diseases (ICD), and its impact is huge: ICD is used over the entire world. In the substance abuse area I would refer to the early initiative of WHO in the 1960s to come to the standardization of epidemiological research instruments (the so-called green series) (Smart et al. 1980, 1981).

MAKING THINGS HAPPEN

A: What has been the impact of your WHO efforts?

CG: Probably something approaching a more appropriate ranking of alcohol problems and of prison health in the overall frame of public health; and in terms of projects, the European Alcohol Action Plan and the Health in Prisons Project, respectively. Both have set standards and models for member states to use as measuring rods. WHO creates models, standards. It has no authority whatsoever over what the member states do with the information provided. It is an essentially different relationship than, for instance, the European Commission and the EU-member states. On drug abuse WHO–EURO had more of a problem in finding its niche. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the Pompidou Group, the United Nations Office for Drug Control and Crime Prevention (UNDCP) and ICAA constituted organizations with often more resources than we had. In time, WHO–EURO’s attention to drug issues has consequently subsided. What we did well in this area, however, is the guidance we provided on HIV risk connected to drug use. Eastern European countries, in particular, were faced with a fast-growing HIV problem. During a visit to a town in Belarus, which was hit by the epidemic, I noticed that there was hardly any authoritative guidance to offer to local politicians in this respect. That observation led, almost as an aside, to one of the most important products I have come up with during my WHO years: an 8–10-page report named ‘Principles for preventing HIV infection among drug users’ (World Health Organization 1998). It contained some basic information and made the case for certain kinds of remedial action, such as easy access to health and social services, outreach work, needle exchanges and substitution therapy. It was translated rapidly into Russian, and was very widely disseminated.

A: Who is ‘we’ in this respect?

CG: One of the ‘arts and crafts’ a WHO programme manager should command is knowing the best technical people in the relevant area, and knowing how to work together with them. Good WHO products are distillates of the best technical knowledge in the field unbiased by political or commercial interests. What happens after people join WHO as staff, however well-informed they themselves may be at the start of their assignment, and the longer they stay, the less contact they have with local realities and with what is happening in the streets. One must compensate for this by building a network of experts who contribute to your work continuously.

‘Good WHO products are distillates of the best technical knowledge in the field unbiased by political or commercial interests.’

A: During your stay in Copenhagen did you yourself, in the process, lose contact with the Dutch social and political situation?

CG: Certainly, even to the extent that I felt more familiar with the situation in some other member states than in my own country. I am convinced that you have to leave your national identity behind when entering WHO. I remember only a few incidents, however, in which my Dutch background was used against me. Particularly when I did my best for the promotion of some harm-reduction practices, some opponents tried to pull my leg by pointing a finger at that ‘damned’ Dutch liberal drug policy having an advocate even in WHO.

A: What about remaining true to yourself, your own personal ideas in such a position?

CG: In the Copenhagen office one probably used to have more room in this respect than in the Geneva HQ office. I think I would have had some trouble getting the booklet on HIV prevention among drug users that we have just talked about accepted and published by the Geneva office at that time. That was in the early 1990s. Fortunately, the situation has changed considerably, and HQ plays a beautiful role now. Just look at the recent World Health Assembly (WHA) resolution on alcohol. In such a situation one has to be flexible and tactful. I always took care not to play too high a personal note, but to have other good, trustworthy people to argue in favour of it. I have to add that I have been privileged to work with outstanding public health advocates as directors, such as Jo Asvall and Ilona Kickbusch. Jo Asvall, who then was the Regional Director, made clear to Peter Anderson and me the limitations of our idea for a European alcohol action plan. He forced us to specify the degree to which the alcohol problems could and should be manipulated at the political level. We succeeded in doing precisely that, I believe, and we have to thank him.

ACTION TIME

A: You mention Peter Anderson. I associate him with the European Alcohol Action Plan. Could you let us in on how that plan came about?

CG: Ilona Kickbusch was our department director at that time. She, Peter and I were driven by the question: with alcohol use being such an important factor affecting public health, why is it so difficult to get that point across within WHO and with the member states? Peter and Ilona together did a great deal to get alcohol onto the official WHO agenda. But if I had to mention one person in particular, I would say that without Peter this action plan would never had been released.

The European Alcohol Action Plan had its roots in the Health for All (HFA) ideology, which dates back to the 1970s. The European Regional Office translated HFA into an action programme with 38 specific targets on major issues in public health to be reached by 2000. One of these targets (no. 17) was specifically about alcohol, drugs and tobacco. I think that it was quite a victory to have a separate identity for substance abuse in this framework. The European Alcohol Action Plan itself emerged later (early 1990s) as an idea after an analysis of the situation, from which it became clear that the target set for alcohol would not be reached if nothing special or specific was undertaken. Interestingly, the HFA ideology also brought along a typical problem of the involvement of non-health sectors. An essential element of the HFA ideology entailed that all actors in the field should be involved actively. In this case it meant that the alcohol action plan should also be acceptable to the alcohol industry, and to people earning a living selling drink—or even better, that they would be partners in the plan. Thus, it could happen that the telling word ‘conviviality’ could appear in the title of the very first draft. It was mainly Peter’s work to come up with a totally new concept for the plan. I now feel that the HFA premise of cooperation with all parties, including the industry, is an impossible one. At the beginning, member states were not overly enthusiastic about any action on the alcohol front. I remember two (of 51) actually sounding their scepticism out loud.

A: The plan consisted of a population approach aimed at a 25% reduction in overall consumption, and also an attempt to target high-risk behaviours. The plan was translated into the European Charter on Alcohol, which was endorsed by most European countries. It was based on ethical principles, such as the right to impartial information, protection against negative effects of alcohol, the right to be safeguarded from pressures to drink and the right to treatment for those with harmful consumption. Why did you choose this form of presentation?

CG: The population approach, embedded in the 25% consumption reduction target, and the Charter, with its ethical principles were, as a matter of fact, complementary to each other. The idea of the Charter on Alcohol was strategic wisdom by Jo Asvall. He had unparalleled experience with reaching consensus over delicate public health issues. I think the European Charter was a masterpiece. It combines wonderfully a fundamental ethical framework for alcohol policy with tangible policy guidelines. To my knowledge, never before have the ethics of alcohol policy been defined in such a balanced way. The ethics of alcohol policy as promoted previously by the teetotallers’ movement clearly lacked balance. I dare say that, historically speaking, this lack may have hampered earlier attempts at large-scale public health-orientated alcohol policy development.

A: Trying to convince people of the severity of the alcohol problem and the good sense of the measures to be adopted seems to be the thread in your international career. In this, it may seem like swimming against the tide, with the political call for collaboration with private enterprise in the public domain becoming stronger and stronger, be it on health politics or science. What did you see of this in your work, and what is your opinion on this development?

CG: It certainly is not something which makes you popular when you advocate for protective measures in an era that is full of free market ideology. Yet I was, and I remain, sceptical about public–private collaboration when it comes to such things as food and alcohol. I think it is virtually impossible to have a real collaboration between the alcohol industry and the public health community without sizeable cost to public health. In the long term the interests of industry and its shareholders will prevail to the detriment of public health. While it may be possible to share some common goals on sub-issues, an overall public health-orientated alcohol policy which is supported by the industry sounds like a somewhat risky affair, and a rather naive dream to me. Collaboration and sponsorship may not affect independence of public health straight away, but it opens the door to a biased position. I cannot provide full proof, but I am convinced that risky terminologies such as ‘safe drinking limits’ and ‘responsible drinking behaviour’ have become widely spread and accepted due to a little help from the industry.

‘I think it is virtually impossible to have a real collaboration between the alcohol industry and the public health community without sizeable cost to public health.’

A: Parallels with tobacco?

CG: Yes, parallels with the tobacco industry spring to mind. Not long ago we still had considerable trouble finding proof for the attempts of the tobacco industry to mislead the public and politicians. I personally know of attempts by ICAP (International Center for Alcohol Policies: the Washington-based alcohol industry lobby) to influence the WHO agenda. There have been talks at a high level in the organization about possible themes of mutual interest. The obvious gain for industry lobbyists is to be able to say, ‘we have established this in close collaboration with WHO’. It would give them the highest possible level of credibility and the opportunity to improve the product and industry image. Imagine that if WHO presented a Global Alcohol Charter, like the European one, as a product of close collaboration with the industry—it would be hard for a Minister of Health in any country to then say to a multi-national drinks company: ‘no thank you for your offer of cooperation’. Luckily, after the adoption of the resolution on alcohol in the WHA in May this year we now have a much more transparent situation.

A: No communication at all between public health and industry groups?

CG: All this is not to argue that there can be no communication at all between industry and public health. As a matter of fact, I myself always insisted on having communication with the alcohol industry. Therefore, we had regular meetings with the Amsterdam Group in which we informed reciprocally on public health-related activities. I, however, never accepted their invitation to start collaboration.

A: What would be the benefit for WHO of such collaboration?

CG: There would be the obvious benefit for WHO to have an additional strong partner in the game for health—WHO, moreover, would be in a position to bring in considerable funds, and thus more power and strength. Again, there are some sub-issues on which there is common ground, and where consequently industry and the public health community in principle could join hands, targets that would not hurt the industry. Issues such as expansion of treatment options for alcoholics, or drunk driving programmes, or alcohol server training programmes, convenient to all parties would, without doubt, make sense too. But that would be about it. Everything else would be problematic. Clearly incompatible with industry interests is any control of supply, or measures aimed at reducing availability of alcoholic drinks. That also goes for promotional activities, and self-regulation of advertising is never more than a marginal affair with regard to effectiveness.

A: The Gorbachov anti-alcohol campaign—that was a supply-side policy taken to the extreme?

CG: I remember going to Baku at that time with, among others, Robin Room for an evaluation of the Gorbachov campaign. Our conclusion was that the strict measures of that campaign did indeed have a measurable effect on consumption and damage. It also showed, however, that the administration failed in creating a consensus in politics and society, which is a prerequisite for long-lasting effects.

A: Is control of supply, restriction of availability the only type of measure that really works?

CG: No, I believe that any intervention leading to a physical and psychological environment (or the perception thereof) in which the consumption of alcohol is something rather special makes sense. Alcohol: No Ordinary Commodity (Babor et al. 2003) is a good title; but there can be little doubt that educational efforts and public campaigns, by themselves, have only limited success. I am convinced that efforts towards demand reduction can be effective; however, they need a long breath, and one needs to show that one means serious business. Good examples are the Loi Evin in France and the initiatives in Italy, just before Berlusconi became prime minister. A change in opinion, in cultural expectations and in behaviour in this respect are not overnight things. Looking at the dramatic changes in attitudes and behaviour vis-à-vis tobacco, one needs to accept a liberal time-frame of several decades. I am a believer, as you may put it, in the potential for behaviour change of large segments of society. It will take strong and sustained efforts, but it is feasible. I think, in this context, that we should not underestimate the effect of seemingly limited restrictions, such as on alcohol sold in petrol stations, or in and around football stadiums. Measures such as these can have a cumulative effect, and also have a symbolic value in the sense of creating a different environment.

A: What do you see as future developments in the field? Signs of a decreased political willingness to intervene are not really hopeful, are they?

CG: I think the picture is not so bleak. I foresee a gradual change towards more protection of the consumer and his or her environment: a perspective which implies a further decrease in availability, at least in well-defined geographical or psychological situations. I think we will see the development of alcohol-free realms of life, such as traffic, transportation, sports, schools. It is likely that, increasingly, work-places will also become alcohol-free. One may acknowledge the historical and cultural roots of drinking practices, but not at the expense of young lives being ruined or even destroyed. Free market ideology does not really match up with public health here, nor do commercial and promotional activities by the industry, which are aimed at younger generations. As the Heineken CEO said not too long ago: ‘our beer need not change, but we at Heineken need to learn to speak in a youngster’s tongue’. I do not believe that young people are asking for new products, such as alcopops, shooters, breezers and what not. This is a demand created by clever marketers.

‘One may acknowledge the historical and cultural roots of drinking practices, but not at the expense of young lives being ruined or even destroyed.’

A: Free market economy prevents selective actions against alcoholic drinks as a commodity. Do you think there are means to curb this development?

CG: There are several ways to curb this development. The first one is to be found in the very same EU regulations that shape the free market in Europe, more particularly in the Maastricht Treaty, where it is stipulated that all economic measures should be considered in the light of potential danger to public health. Citizens—and hopefully Ministers of Health and Welfare—will call increasingly for serious application of that article, and consumers are becoming increasingly keen to learn about the hazards of the products they use. In that sense, I think EU requirements for warning labels on alcohol containers, much like the ones on tobacco products, are just a matter of time. Furthermore, we should try more actively to give a voice in the public debate to all those who have suffered from some form of alcohol-related harm. Is it not strange that the suffering of millions is not heard at all in the public debate?

A: Do you, at present, see any particular European countries as doing especially well with their policies on alcohol and tobacco?

CG: In Europe, two countries used to have a promising policy on alcohol and tobacco: France and Sweden. Although the changes occur a little at a time the change is towards uniform norms, for example the 0.03% blood alcohol concentration (BAC) limit in transportation. To secure this, however, a constant effort is necessary. I also believe that grass-root initiatives, such as Mothers Against Drunk Driving (MADD) in the United States, can have an effect. People will stand up and say: ‘have we been well-informed, did you mislead us, did you give sufficient information on the negative effects?’.

A: Give us, please, the formal listing of your WHO positions.

CG: I joined WHO–EURO as a staff member in 1986, first as a psychoactive drugs scientist; I became a regional adviser on substance abuse a few years later, served as acting director for health promotion and disease prevention intermittently for a period of almost 4 years, was also simultaneously coordinator for health in prisons for 5 years, and retired in 2001. The scope of my responsibilities varied obviously with the posts, but the core responsibilities through the years remained: development, planning, implementation and monitoring and evaluation of a regional programme on substance abuse aiming at strengthening the response in member states towards substance abuse.

ETERNAL RECURRENCE

A: At the end of this interview, would you like to add anything we missed along the way?

CG: I have been struck time and again by the power that addiction has over people. Sad to see, but also fascinating. We know it from so many famous novels and movies. I have also seen people close to me lose control over their lives. Evert Dekker, for example, who used to work quite high up at the Ministry of Health, in Holland, a top civil servant, who at the end of his career developed a very serious drinking problem and who had the courage to come out in public. He has published his experiences (Dekker 1998). Quite intriguing. Typically, he was one of the many people who became stuck between the lines of psychiatric care and detoxification and the addiction services. It is remarkable that the problem of psychiatric comorbidity has taken such a long time to transpire and to receive the attention it is now gradually gaining.

A: Did you ever use tobacco?

CG: I became addicted to tobacco in the real sense, smoking even while driving a motor cycle. In that situation it had to be a pipe, of course, so I managed to keep on smoking while driving. I quit a long time ago when I discovered I was wheezing at the top of the stairs, gasping for air. Now I run for pleasure and feel good with that. I doubt whether running will develop into a real dependency. However, I feel sympathetic to people struggling with a dependence, walking that thin line between use and abuse. Industry tells us that users are free and individually responsible, that they should and can cope without any support from so-called public health-orientated restrictive measures. That message is a fiction.

‘Industry tells us that users are free and individually responsible, that they should and can cope without any support from so-called public health-orientated restrictive measures. That message is a fiction.’

A: Any book or report which has specially influenced your thinking?

CG: What influenced me greatly at the time was the Purple Book (Bruun et al. 1975), a real eye-opener. It was the scientific backing of ideas on prevention and policy which were hard to sell, certainly at the time. I feel that the tradition set by that book paved the way for us to manage two large European ministerial conferences on a public health subject which, hitherto, was very much under-rated. It really is extraordinary to gain this huge attention and support and it is one of the things, I think, the regional office in Copenhagen can be truly proud of.

A: Retired from WHO, a private consultant, busy as ever, what is your current project?

CG:‘Ill weeds grow apace’, is I think the English version of a Dutch saying. There are a number of issues on which I am still working, either as a consultant or as a volunteer. Thus, I am still involved in promoting health in prisons, drug abuse policy making, AIDS among drug users and alcohol policy. With the establishment of the European Working Group on Treatment of Alcohol Dependence a couple of years ago, it looks as if the circle has almost closed. This group is basically a European network advocating treatment and exploiting the huge experience available in Europe. But to end this interview, I want to mention the names of some colleagues for whose collaboration I have over the years been specially grateful, besides those already mentioned: Griffith Edwards, Ambros Uchtenhagen, Rob van Amerongen, Klaas Brijder, Pavel Bem, Jan Walburg, Arnold Trebach, Martin Mitcheson, Jo Casselman, Rudi Mader, Franklin Apfel, Ove Petersson, Archer and Eva Tongue, Antoni Gual, Teresa Robledo de Dios, Emanuele Scafato and as a matter of fact the whole group of national counterparts of the European Alcohol Action Plan.

A: That ends the interview with Cees Goos, with him in his own modest style giving credit to others.

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