Addiction research centres and the nurturing of creativity: Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Sweden
Kerstin Stenius, SoRAD, Stockholm University, 10691 Stockholm, Sweden. E-mail: firstname.lastname@example.org
The Centre for Social Research on Alcohol and Drugs (SoRAD) was established as a national research centre and department within the Faculty of Social Science at Stockholm University in 1997, following a Government Report and with the aim to strengthen social alcohol and drug research. Initially, core funding came from the Swedish Council for Working Life and Social Research and from the Ministry of Health and Social Affairs for several long-term projects. Today, SoRAD, with 25 senior and junior researchers, has core funding from the university but most of its funding comes from external national and international grants. Research is organized under three themes: consumption, problems and norms, alcohol and drug policy and societal reactions, treatment and recovery processes. SoRADs scientific approach, multi-disciplinarity, a mix of qualitative and quantitative methods and international comparisons was established by the centre's first leader, Robin Room. Regular internal seminars are held and young researchers are encouraged to attend scientific meetings and take part in collaborative projects. SoRAD researchers produce government-funded monthly statistics on alcohol consumption and purchase, and take part in various national government committees, but SoRADs research has no clear political or bureaucratic constraints. One of the future challenges for SoRAD will be the proposed system for university grants allocation, where applied social science will have difficulties competing with basic biomedical research if decisions are based on publication and citation measures.
THE EVOLUTION OF SORAD
The Centre for Social Research on Alcohol and Drugs (SoRAD) was formally established in 1997 as an interdisciplinary research centre and department within the Faculty of Social Sciences at Stockholm University. SoRAD became active in spring 1999, when professor Robin Room took up his position as its first Director.
The Centre was set up following the recommendation of a government report on social and behavioural alcohol research , which was published in the same year that Sweden joined the European Union (EU), an act that seemed to threaten the future of the restrictive Swedish alcohol policy. Already prior to the Centre, Sweden had conducted a substantial amount of social research on alcohol and illicit drugs, but research was decentralized, sporadic, with no career possibilities and increasingly in the shadow of biomedical research. The 1995 report pointed to the need to strengthen and coordinate efforts in social research related to alcohol with a national institute for social research, similar to those in Norway and Finland. The establishment of SoRAD as a national centre not only marked the political administration's emphasis on scientifically, evidence-based policies, but demonstrated simultaneously the view that credible research is best performed within independent scientific bodies.
The recruitment of Robin Room, with his uniquely broad competence and international contacts, and political support in the form of funding from the Ministry of Social Affairs and Health (see below) was crucial for the swift development and early success of the Centre. The first staff of SoRAD emanated from the Department of Sociology, with Professor Eckart Kühlhorn, and from the Department of Criminology, with Dr Börje Olsson, later a Professor and now SoRAD's present Director. The Department was able benefit from the large networks of these two people in the recruitment of researchers. SoRAD started out with two professors, two researchers, two research assistants and also two visiting researchers, but it soon grew. In 2005, there were four full-time professors (Kühlhorn, Olsson, Room and Anders Romelsjö), one part-time visiting professor (Vera Segraeus), eight researchers and 20 research assistants, of whom nine were PhD students. During these first years, SoRAD built up its capacities and gained a reputation in Sweden as a national research centre. It became involved in several comparative projects and established international collaboration.
The aims of the Centre, as formulated during the very first years, were to stimulate and conduct social science research on alcohol and illicit drugs, including improving methods, increasing theoretical understanding and enhancing links to policy; to provide a nexus for interdisciplinary research training, research networks and collaborative studies in Sweden; and to serve as an interdisciplinary focal point in Sweden for collaboration on comparative and international projects.
While SoRAD's emphasis was originally on only alcohol, due to the political background of the establishment and the fact that alcohol is a much bigger question, drugs have periodically taken a bigger share of research interests. The ups and downs have been caused not only by the interest of the researchers; in 2002, the Swedish Government set up its own drug coordinator office, and with this also came funding for drug-related research projects. The office was dissolved in 2008. From 2001 to 2005, the Centre also carried out studies on gambling, starting with an evaluation of the first Swedish State-owned casinos. Here, SoRAD could draw upon Robin Room's experiences of similar studies in Canada.
From the beginning, the Centre was engaged in both qualitative and quantitative research that focused upon diverse topics. Of the 45 projects listed in the 2005 annual report, six came under the heading of ‘Alcohol and drug use in youth cultures and subcultures’, 14 under ‘Adult population use patterns and trends’, 11 under ‘The social response to alcohol and drug problems’, 12 under the title ‘Prevention and policy impact research’ and two under ‘Gambling problem studies’. Eight of these projects were international and comparative.
Financially, SoRAD initially had two main pillars of funding support. The Swedish Council for Working Life and Social Research (FAS) gave core funding to last for 8 years, but did not play a major role in the development of the research programme. Secondly, the Ministry of Social Affairs and Health funded several long-term projects covering alcohol and drug use patterns, perceptions of drinking and intoxication and prevention of problems among youth and young adults, surveys on drinking and drinking problems in the general population and a socio-ecological study of the treatment system. The initial projects were put forward by SoRAD at the invitation of the Ministry, identified by the senior researchers as core issues for a national centre. The only demand was to integrate a gender aspect into the treatment system study. Thirdly, the Swedish National Institute of Public Health gave support for project planning, guest researchers and research conferences.
There was an active internal discussion in SoRAD of the pros and cons of taking on such a task before the Ministry started to fund the ‘Alcohol purchase and consumption monitoring project’ in 2000, with its still ongoing monthly surveys of the general population. On one hand, this funding provides a platform for SoRAD, both in terms of funding and data, but it also binds resources, with expectations from the funding agency for regular reporting and to deliver. Over time, these data have, however, become increasingly fruitful for stimulating additional research projects.
It is notable that SoRAD has no teaching obligations, even if most senior staff teach. Doctoral students at SoRAD have, for instance, to be accepted by the university's teaching departments, take their courses at these departments, but conduct their research work and obtain their funding from projects at SoRAD. SoRAD's senior researchers, as affiliated with these teaching departments, can act as their supervisors. This construction gives senior researchers at SoRAD more time for research, but also implies less automatic and continuous contacts with young talents—a possible problem for recruitment. Good contacts and collaboration with other researchers, particularly at the university, is crucial for SoRAD; but if SoRAD can provide funding for doctoral students, the teaching departments will also gain credits from their examinations in terms of future funding.
In 2006, Robin Room left the post as head of the Centre, due to approaching the mandatory retirement age under Swedish law. The change of directors coincided in time with the gradual withdrawal of FAS's core funding. Additionally, the projects funded by the Ministry, apart from the monitoring project, had come to an end. The role of the Swedish National Public Health Institute was redefined slightly to include more research, and university funding in the country was undergoing changes. The first financially secure years were followed by the normal, less predictable situation of research units. SoRAD experienced what threatened to become a vicious circle: Robin Room moving, a shrinking core budget, the disappearance of some senior researchers for economic or career reasons, fresh PhD students having to look for other jobs, fewer senior researchers to apply for new funding, and thus less funding and fewer staff.
CURRENT FRAME AND PROGRAMME OF WORK
After a couple of difficult years the economic situation has now substantially improved again. Hard work with applications was rewarded. This also involved Robin Room, who maintained his contacts in the position of guest professor, giving SoRAD the possibility of benefiting from his competence, his networks and also from his publications, and the two new professors, Jukka Törrönen and Jan Blomqvist. Since the beginning of 2008, the Centre has been funded through two main sources. An annual core grant, renewable on a regular basis, is paid through the budget of the faculty of social sciences at the university, amounting to approximately 25% of the Centre's budget. The remaining 75% is covered by external grants, mainly from national research councils, but also from the EU's research programmes and national authorities, particularly the Swedish National Institute for Public Health. International funding has played and still plays some, but not a major, role: for instance, at the moment the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is providing funding for a study on effects of alcohol taxes and for research on alcohol-related mortality. Crucially, however, with the recently received 10-year Centre of Excellence grant and the research programme attached to it, ‘Exclusion and inclusion in the late welfare state: the case of alcohol and drugs’, the prerequisites to consolidate and develop the research further are now at hand. The Centre of Excellence grant is funded by FAS and was given to SoRAD, as an internationally competitive research institution, in competition with other Swedish research units after an evaluation by international reviewers. After a period of down-sizing, staff numbers are growing again and consist currently of three regular professors (Olsson, Blomqvist and Törrönen), two part-time visiting professors (Robin Room and Kerstin Stenius), nine senior researchers, eight PhD students, four research assistants and one administrator.
SoRAD's basic or applied research still follows the broad mission statement of the first years. The researchers represent sociology, psychology, social work, criminology, economics, political science and history; the multi-disciplinarity to be found at SoRAD is a key strength. The Centre cooperates with departments within Stockholm University and elsewhere in Sweden. Cooperation around problem-orientated research is also established with several public organizations, such as the above-mentioned Swedish National Institute of Public Health, the Board of Health and Social Welfare and the National Board of Institutional Care. Internationally, SoRAD is active in several ongoing projects and in the planning of future research.
The research agenda of SoRAD is determined by four main factors. First, because research funding is gained mainly through open national competition with researchers from other fields, the calls for grants have an impact. For one thing, this competition forces SoRAD's staff to consider projects that would be of interest to a broader scientific audience, especially nationally. It is also important that one of the three big Swedish research funds, the Swedish Council for Working Life and Social Research (FAS), usually announces thematic priorities for the annual applications and sometimes announces focused grants. The grant on ‘Women, substance use and health’ (see below) was received within such a special announcement. Secondly, the research interest and competence of the researchers has an important role to play. The Centre of Excellence application on marginalization and normalization was born out of Centre discussions around how SoRAD's previous addiction research and the plans for the future could be strengthened under a common umbrella that would be theoretically as well as empirically relevant for social research and welfare policy in general. Thirdly, the former Nordic Council for Alcohol and Drug Research, today Nordic Welfare Centre, Finland, has played an important role in instigating collaborative Nordic research projects and as an enlarged research network in the addiction field. Fourthly, some of the projects at the Centre are the result of requests from the Ministry of Health and Social Affairs to perform specific analyses. These requests have always respected the right of SoRAD to refuse.
SoRAD has undergone two major external evaluations, both with very positive results. The impact of the new types of evaluations, based upon publication and citation counts, are not yet visible, but pose a potential threat to the centre's focus on national questions and mixed methods. The fact that Sweden is a small country, the research community limited and the relations between science and politics not remote is certainly important. For research, this means that the competition is limited and also that strict specialization is not particularly favourable.
Today, research at SoRAD is organized under three thematic umbrellas, all relevant from a general marginalization and normalization perspective; (i) consumption, problems and norms; (ii) alcohol and drug policy and its implications; and (iii) addiction and dependence—societal reactions, treatment and recovery processes. The themes are built up by a range of integrated subprojects, which in several cases concern more than one theme. The themes have only recently been identified, work has just begun and their integration is only beginning. The first theme, with its classical epidemiological focus, uses mainly internationally established public health measures, and in Sweden nationally non-controversial public health methods and reasoning to study the links between population consumption and harms. The second theme reflects the fact that SoRAD has an arms-length distance to policy makers and rather than developing or modelling implementation of policy measures analyses policy and looks at policy measures from a post-factum perspective. The third theme has predominantly taken the perspective of the individual citizens or vulnerable groups who are the targets of societal measures.
Research conducted within theme 1 studies levels and patterns of alcohol and drug use and their association with various related problems. Topics included are, for example, methodological analyses of various measures of drinking and harm, analyses of the link between alcohol-related problems and changes in consumption level and drinking patterns, and qualitative studies of the role of alcohol and drugs in people's lives. The focus is upon Swedish society, although several projects have a comparative approach. One important project is the monitoring project mentioned above, a large national alcohol and tobacco (since 2003) survey with 1500 monthly telephone interviews since 2001. It is used to calculate monthly estimates of total consumption (including unrecorded sources), drinking patterns, problems and attitudes in different socio-demographic groups in Sweden. The unique opportunity it offers to conduct time–series analyses on the basis of self-reported data and estimated per capita consumption including unrecorded alcohol will be exploited further in future studies. Another important area is population-level time–series analyses of the association between per capita consumption and alcohol-related harm in different countries and drinking cultures. At present, one project analyses data from Eastern European countries and another data from the United States, while another collaborative project with researchers in Melbourne, Australia, starts in 2009—this theme is led by associate professor Mats Ramstedt, an epidemiological sociologist and associate professor Peter Wennberg, a psychologist.
Under theme 2 SoRAD studies the marginalization and normalization processes of the late welfare state from three perspectives: (i) how substance use is perceived and defined in the policy field, in the media and among the general population; (ii) what kinds of system-level implications (including side effects, stigmatizing features) alcohol and drug policies, programmes and institutions have had and have; and (iii) what kinds of concrete and specific effects particular alcohol and drug policies have. In all these perspectives it is important to identify what kinds of consumption patterns are understood as normal and what is seen as problematic. Another important aspect is how women's and men's alcohol and drug use is defined, regulated and targeted in all of these research areas. Ongoing studies focus both upon the discursive and upon the performance level in alcohol and drug policies. On the discursive level, tensions between public health and free-market policies in international, national and local alcohol policies is studied; the governing images of alcohol, drugs, tobacco and gambling in the media are investigated; the framing of alcohol policy programmes targeted to pregnant women is studied; and media discourse on (illegal) alcohol and drugs is analysed. Studies of specific alcohol and drug policies and measures cover the effects of tax cuts on drinking; evaluations of alcohol (and drug) prevention programmes in the workplace, among students and at local level; effects of drug-related legislation and harm reduction policies; and studies of the interplay of restaurant cultures, young people's drinking habits and alcohol policy.
‘Changes in the cultural position of drinking’ is a project that spans several themes, and examines the boundaries between normal drinking (inclusion) and problematic drinking (exclusion) by analysing how the cultural position of drinking has changed during the last four decades. The project uses quantitative and qualitative data sets in a historical and comparative perspective, comparing young people's drinking habits and generations in different time periods, and comparing Sweden to Finland and Italy. In Sweden and in Finland the quantitative part of the study is focused upon two generic themes, drinking patterns and attitudes towards drinking. The qualitative part concentrates on three different perspectives on the generational cohorts in these countries. Theme 2 is led by two sociologists, Professor Börje Olsson and Professor Jukka Törrönen.
Theme 3 focuses upon an analysis of the societal definitions of, and reactions to, problematic substance use, and how these have changed with changing societal conditions; historical and social–ecological studies of the help-system, with a special focus upon processes of marginalization and integration; and studies of assisted and unassisted recovery processes from addiction problems and of individual and contextual prerequisites for such processes. A strong ambition is to apply a comparative perspective and combine quantitative and qualitative methods. In the long term, the aim is to develop models for the analysis of addiction and recovery and of the help system and its functions; to contribute to debate about, and the development of, working societal interventions; and to throw light upon basic processes, for instance of inclusion and exclusion, in late modern society. The study ‘What is care’ studies the historical development of drug treatment in Sweden, its focus and legitimation. The project ‘Social citizenship and local addiction care’ compares local reactions in Sweden and Finland to heavy abusers from the 1930s to the present day. Another study, ‘How does the treatment system work?’ is a 5-year follow-up study of clients in various parts of the treatment system in Stockholm County, looking at catchment, interventions and different short- and long-term outcomes. This study includes comparisons with a similar study in California. The project ‘Towards better addiction care?’ studies the implementation and consequences for users of the system of national guidelines and the idea of ‘evidence-practice’ in treatment. A series of studies are conducted under the common heading ‘Drug policy, opiate abuse, and evidence-based practice—on substitution or maintenance treatment in Sweden’. The project aims to present a picture of prevailing discourses on opiate substitution or maintenance. The project ‘The social context of rehabilitation’ aims to capture the ‘governing images’ of addictions to tobacco, alcohol, gambling, cannabis, amphetamine, cocaine, heroin and prescribed drugs that guide how people with such problems are met in their natural, lay environment, as well as by treatment professionals. It includes comparisons with similar studies from Switzerland, Canada and Finland. The project ‘Use or misuse—perceptions of problematic and unproblematic consumption of alcohol, cannabis and central stimulants’ is analysing lay and professional respondents' images of and reactions to various addictions. This is a mixed-methods study, and part of a larger international cooperation (‘Images of addiction’), with participants from Finland, Sweden, Germany, Russia, France and Canada. Theme 3 is led by Professor Jan Blomqvist and guest Professor Kerstin Stenius, both with doctorates in social work.
SoRAD has also received a large grant under the heading ‘Women, substance use and health’. Several studies will start within this project and be integrated under the three themes: gender-specific diagnoses in the treatment system in a historical perspective, a gendered analysis of the contemporary use of coercive care, a study, using survey and interview data, on patterns of smoking cessation among women and men, analyses of ‘Women's and men's substance use and health in Swedish press’, and a study on how the state and the media use the research results concerning drinking of pregnant women.
It is a difficult task to pick the five most important publications during the last 5 years, but we could mention the following: Blomqvist , Ramstedt , Room et al., Storbjörk & Room  and Törrönen & Maunu , which represent the various directions of SoRAD's research: epidemiology, policy, treatment system, natural recovery and cultural studies, and qualitative as well as quantitative approaches:
A SORAD CULTURE
SoRAD has developed a specific working culture during the 10 years of its existence. A key feature is the ambition to promote a cross-disciplinary approach to social alcohol and drug research, including a strong ambition to mix methodological approaches. Although the research is organized in different themes, priority is given to cooperation across themes; thus, bringing researchers with different perspectives and methods together is regarded as important.
Several means are used to support cross-disciplinary work. A regular seminar series is run with internal seminars arranged every third week and with the responsibility alternating between the different research themes. It is possible to raise a wide range of topics during these seminars, from general theoretical work to an open discussion on concrete research issues, e.g. how to proceed with a work in progress. Attendance at the seminars are more or less obligatory for the staff and it is expected that participants have read a text distributed in advance, and will have prepared at least one comment or question. This procedure is thus a way to endorse regular communication between the different research areas. In addition to the internal seminar series, there is also a tradition of inviting external researchers, often people who are visiting SoRAD. At present, a more formalized external seminar series is about to start, with each research theme inviting someone each term. Contacts with researchers from outside the addiction field are regarded as important for the theoretical and methodological development of the Centre. As one example, in spring 2009 a seminar around inclusion and exclusion in the Swedish society was arranged, with invited researchers on welfare state economics and the role of the third sector in the Swedish welfare system.
SoRAD also has a tradition of stimulating attendance at national or international scientific meetings and collaborative projects. Since 2005, SoRAD has arranged a yearly national research meeting within a network called the Swedish Social Science Network for Alcohol and Drug Research (SONAD). SONAD aims at forging and strengthening relationships between social science researchers in the field from all over Sweden by arranging yearly 2-day conferences in different Swedish research settings. The conferences include research presentations and workshop meetings on various topics, e.g. epidemiology, youth, policy, gender and treatment. The SoRAD staff is also represented in the yearly research meetings arranged by the Swedish Association for alcohol and drug research (SAD), as well as in most meetings for Nordic researchers arranged by the Nordic Welfare Centre Finland (former Nordic Council for Alcohol and Drug Research [NAD]). Many SoRAD researchers attend the annual meetings of the Kettil Bruun Society (KBS), which is arguably the most important international scientific meeting in the area of social alcohol research. The staff has representation on the governing groups of the Kettil Bruun Society, the International Society of Addiction Journal Editors and the International Society for the Study of Drug Policy.
Swedish social research in the alcohol and drugs field has its roots in the Nordic critical traditions established from the 1950s and 1960s by sociologists, criminologists, statisticians and psychologists. The multi-disciplinary approach was supplemented with comparisons, first within the Nordic countries, and more broadly later. The work conducted at SoRAD has no clear political or bureaucratic constraints and is described more accurately as led by science and scholarship, than by direct political usefulness. The intellectual independence of research from government is emphasized and well respected by decision makers. SoRAD clearly has a different role than, for instance, the Swedish National Institute of Public Health. As noted, the direct financial role of the government in connection with the Centre has also decreased since the early years. This does not rule out links between SoRAD researchers and policy making; the most obvious example of continuous use is the alcohol consumption statistics produced within the monitoring project. Over time, SoRAD's researchers have also had several positions in national committees. Alcohol and drugs are widely debated political issues in Swedish society, and as Robin Room  notes, ‘(T)he Swedish tradition of commissioning official investigations and then inviting formal submissions commenting on the investigation's report ensured that relevant researchers were involved in the policy process’. A sign of how relatively unproblematic the relation between SoRAD and the political administration is the fact that SoRAD has no written policy for staff advocacy or any specific restrictions for staff to take part in public debates.
SoRAD has a fairly good balance between senior and junior researchers and so far has been able to recruit good students, despite not being a teaching department. Junior researchers are inspired by the multi-disciplinary discussions at SoRAD, the fact that they are accepted immediately as valuable members of their research group and that they are encouraged to attend international conferences. Own initiative and intellectual independency are the desired qualities in this environment. The facilities at SoRAD play an important role in the shaping of a sense of Centre identity: the long common corridor, which for many years housed only SoRAD researchers, and the big kitchen, used for common lunches, seminars and the weekly coffee party. During the SoRAD's expansive period the junior researchers have established a strong sense of community, with common celebration traditions and informal contacts also after work. Robin Room set an example for an atmosphere of discussion by always having his door open and being available for questions, a tradition which has continued. A special feature of SoRAD's organization has also been the relatively small administration; until this year it has functioned with only one administrator.
With the establishment of SoRAD, the biomedicalization of Swedish alcohol research was at least temporarily balanced ; but the challenge remains for SoRAD, as for other social- and humanistic departments with increased competition for research funding with basic and biomedical research. The new governmental bill on research policy proposes a system where university grants will be dependent upon external funding and upon publication in journals with high impact factors, which alcohol and drug research journals generally do not have. For a research field which lies within applied social science, and which has a role as a national research centre, this is a considerable threat—even in a country where concern over alcohol and drug problems is high.