What is the worse thing you can get hooked on (blomqvist)

373NORDIC STUDIES ON ALCOHOL AND DRUGS VOL. 26. 2009 . 4
Research
report
ABSTRACT
Introduction
Although simplistic and one-sided explana-
tions have been legion over the years, most
theorists tend today to see addiction as a
multi-factorial (bio-psycho-social) phenom-
enon. Moreover, although few endorse the
type of “vulgar constructionism” criticized
e.g. by Best (1995), many agree that addiction
is to some extent and in some sense a socially
constructed problem. Thus West (2007), for
example, contends that addiction is a social
construct with fuzzy borders, yet a condi-
tion in which many underlying pathologies
and abnormalities become manifest. Put in a
different way, even if addiction is not “just”
an invention by powerful claims makers, the
ways in which a “deviant” substance use or
behaviour is defined, how such deviances
are reacted to by society, and – thereby – the
consequences to the individual of her/his
deviance, as well as the long-term trajectory
of her/his condition, are strongly influenced
by norms and traditions that vary with time
and place (Blomqvist 1998a). This means that
addiction can be seen as an example of what
Hacking (1999) has named “interactive kinds”,
J. Blomqvist: What is the worst thing you
could get hooked on? Popular images
of addiction problems in contemporary
Sweden
Aims
To investigate potentially crucial aspects
of Swedes’ perceptions of nine different
addictions.
Data and methods
Population survey, sent out to 2,000
adult Swedes (18–74 years), focusing on
the perceived severity of, responsibility
for, options to recover from, and
character of addiction to cigarettes,
snuff, alcohol, cannabis, amphetamine,
cocaine, heroin, medical drugs, and
gambling.
Results
There are large differences in the ways
in which various addiction problems
are perceived. Whereas tobacco use,
and to some extent gambling, are
seen as relatively harmless “habits”,
not particularly easy to get hooked on
but easy to quit, the use of drugs such
as heroin, amphetamine, and cocaine
is seen as a major societal problem,
and users are seen both as “sinners”
who need to mend their ways and as
powerless “victims”. In between comes
the use and misuse of alcohol, cannabis
and medical drugs, about which
perceptions are more divided.
Conclusions
Respondents tend to downplay the
risks and dangers with addictive
habits that are common and familiar in
mainstream culture, and to dramatise
Jan Blomqvist
What is the worst
thing you could get
hooked on?
Popular images of
addiction problems in
contemporary Sweden

374 NORDIC STUDIES ON ALCOHOL AND DRUGS VOL. 26. 2009 . 4
i.e. phenomena, the official and/or predominant definitions
of which influence the self-definition and behaviour of those
defined, thereby in turn at least partly confirming the official
or institutionalised views.
Occasionally, the significance of others’ attributions and
labelling for the origin and developmental course of various
addictions, as well as for the options of finding a path out
has attracted the attention of researchers, not seldom from a
social historical perspective (e.g. Roman & Trice 1977; Gus-
field 1981; Room 1985; Goldberg 2000). Others have found
that dominating views that stigmatise the addict may pre-
vent him/her from seeking help or lead to discrimination
of ex-problem users in work life (Kilty & Meenaghan 1977;
Dean & Rud 1984; Blomqvist 2002). There is also reason to
contend that the long-term outcome of treatment is to a large
part dependent on what happens outside the clinic door (e.g.
Moos 1994; Blomqvist & Cameron 2002).
In Sweden, the clearly varying official discourses and
policies on alcohol and narcotics are well known and well
documented (e.g. Christie & Bruun 1985; Hübner 2001), and
there are also indications that the Swedish “doxa”1
on nar-
cotic drugs, picturing these as almost inevitably dependence
generating (Bergmark & Oscarsson 1988) may decrease other
people’s inclination to offer help and support (Blomqvist
2004). People who recover from a heroin addiction seem also
to be met with greater distrust than people who recover from
an addiction to alcohol (Klingemann 1992; Blomqvist 2002).
Moreover, the historical dominance, not least in the USA,
of the “popular disease theory”, describing alcoholism as
an inexorably progressive deteriorating process (cf. Pattison
1976), has been criticised by some as being directly counter-
productive to the options of resolving an alcohol problem
(e.g. Peele 1989). Finally, increasing research has shown in
recent decades that “self-change” is by far the most common
path to recovery from most addictions (e.g. Blomqvist 1996;
Cunningham 2000; Klingemann & Sobell 2007; Blomqvist et
al. 2007). Research on the processes and influences behind
such solutions has clearly demonstrated the important role
of other peoples’ support, demands, and general attitudes in
motivating attempts to overcome an addiction, as well as in
maintaining the resolution (e.g. Blomqvist 1999; 2002; Gran-
field & Cloud 1999; Bischof et al. 2004).
the risks and dangers
with such habits that are
uncommon or “strange”.
This may have unfortunate
consequences for addicts’
options to find a path out of
their predicaments.
Key words
Addiction, images,
consequences, population
data, Sweden.

375NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 26. 2009 . 4
Although there are thus clear indications
that the “governing images” (Room 1978)
or dominant “social representations”
(Moscovici 1981; 1989) of, various addic-
tions may play a not insignificant role to
the prevalence and long-term course of
these problems, as well as to the options
of finding working strategies to counteract
them, there is no conclusive and empiri-
cally founded knowledge of how these at-
titudes and images differ between e.g.,
various addictions, various cultures, vari-
ous demographic subgroups, and various
professions. Rather, the current focus on
the perceived need to develop “evidence
based practices” tends to distract attention
from what might be called “the social con-
text of recovery”. Even if there is certainly
good reason to improve the effectiveness
and responsiveness of prevailing treat-
ment systems (e.g., Humphreys & Tucker
2002; Blomqvist et al. 2007), this is un-
fortunate, given that only a small propor-
tion of all people with addiction problems
ever come into contact with these systems
(ibid.). The study reported in this paper
has been part of an effort to improve our
knowledge about the “images of addic-
tion” underlying how people with such
problems are met by their environment,
including professionals in the addiction
treatment field, and so to lay a foundation
for the development of more realistic strat-
egies to counteract such problems.
“The social context of
recovery” – aims and research
questions
The research project “The social context
of recovery – views of addiction and re-
covery in the population and in various
professional groups” has been financed by
a grant from the Swedish Research Coun-
cil (VR 2004–1831). The main objective of
this project has been to get a better under-
standing of the beliefs and assumptions
underlying how people who are trying to
overcome their addiction problems are met
by treatment professionals and significant
others. More concretely, the study endeav-
oured to ascertain what people believe
about nine different addictions or misuse
problems occurring in Sweden (addictions
to alcohol, cannabis, heroin, ampheta-
mine, cocaine, medical drugs, cigarettes,
snuff, and gambling). The main part of the
project has been a fairly extensive survey,
mailed out to a representative population
sample. In a complementary part, three
smaller surveys have been directed at three
samples of about 200 professionals each,
mainly working with addiction problems
in each of the social services, health care,
and criminal justice systems (cf. Samuels-
son et al. 2009; Christophs 2009).
The study has partly built on the in-
ternational so-called SINR study (Klin-
gemann 2003)2
, and the Swiss study on
popular attitudes toward “natural recov-
ery” and about the key elements of a “self-
change friendly society” that has been
reported by Klingemann (2005; Klinge-
mann & Klingemann 2007). Although the
present study has broadened the scope of
these studies, the latter study in particular
provides valuable options for comparison
regrading perceptions of self-change. Later
studies conducted in Finland (e.g. Koski-
Jännes et al. 2009), Canada (Cunningham
2009) and Russia, using basically the same
questionnaire as the Swedish study pro-
vide further possibilities for comparisons.
Another source of inspiration has been a
Nordic study on substance use and control

376 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 6. 2009 . 4
policies carried out in 1995 and reported
e.g. by Hübner (2001), a study that also
provides some data for comparison.
This article presents the results from the
Swedish population survey, focusing on
differences between the nine different ad-
dictions with regard to how serious they
are judged to be as societal problems, their
perceived “addictiveness“, how easy they
are believed to be to recover from (with
and without professional or formally or-
ganised help), to what extent moral re-
sponsibility for developing and solving
the undesired condition is attributed to
the afflicted individual, and the perceived
basic character of the problem in question.
Q Method
The survey
“Addiction”, “dependence”, and “misuse”
are examples of the kind of “fat words”,
the use of which Christie & Bruun (1969)
lamented already four decades ago. It is
obvious that much of the conceptual con-
fusion from those days persists today, and
that there are a number of dimensions
and aspects that could be relevant when
it comes to the exploration of prevailing
images of various addictions. The delib-
erations that underlie the choice of study
variables for this investigation, has built
on a number of previous efforts to improve
our understanding of these issues. One ex-
ample is Mäkelä’s (1980) remark that so-
ciety’s response to any type of deviance
will be affected by the extent to which the
deviant individual is seen as doing harm
to her/himself and/or to her/his environ-
ment, and by whether effective means to
alter the deviance are believed to be avail-
able. Another has been Gusfield’s (1981)
distinction between the moral connotation
of social problems, and their cognitive sig-
nificance, and still another Brickman and
colleagues’ (1982) assertion that the issue
of moral responsibility for human prob-
lems actually involves two questions: the
question of blame (or responsibility for
causing a problem), and the question of
control (or capability and responsibility
for solving a problem). Based on these and
other considerations, the survey has tried
to capture some dimensions and aspects of
prevailing “images of addiction” that can
be assumed to be crucial to how people
with various addiction problems are met
and treated by others in practice.
Data collection
The survey was mailed out by Statistics
Sweden in 2005 to a representative popu-
lation sample of 2,000 adult Swedes (18–
74 years) drawn from the official Swedish
population data base (RTB). More con-
cretely the questionnaire contained, be-
sides questions about demographic and
socio-economic circumstances, questions
asking respondents to rank the “serious-
ness” of various addictions compared to
other social problems, questions about the
perceived risk of developing an addiction
to or dependence on the substances or
activities chosen for the study, about the
perceived responsibility for developing
and resolving an addiction to these sub-
stances or activities, and questions about
the perceived chances of recovery – with
and without treatment or other formal help
– from the same addictions. In addition,
information was gathered on respondents’
own experiences – by themselves or some-
one close – of the use of or addiction to the
substances/activities in question, of treat-
ment and/or “self-change”, and of having

tried to help others with addiction prob-
lems. Finally, a number of questions were
included aimed at capturing respondents’
political – ideological orientation, trust
in various authorities, “social distance”
to people with addiction and other social
problems, personal “locus of control”, and
perceptions of major obstacles to recovery
from and desirable societal strategies to
counteract various addictions.
Response rate and potential attrition bias
Valid responses were provided by 1,098
respondents, giving a response rate of
54.6%. Although this is a low figure, it is
not uncommon for surveys like the present
one covering issues such as problem con-
sumption of alcohol and use of illegal
drugs (cf. Hague & Irgens-Jensen 1987;
Kühlhorn et al. 2000; Hübner 2001). Attri-
tion was somewhat lower among women
than men, in the oldest age group (60–74)
than among younger respondents, among
respondents who were married or cohabi-
tating than among singles, in the high-
est income groups than in lower groups,
among native-born Swedes than among
people born in other countries, and among
respondents with university education
than among respondents with lower edu-
cation. In an effort to account for sampling
and attrition bias, data were weighted,
using the mentioned variables and place
of residence (rural, urban, or metropoli-
tan) as calibration variables. All reported
analyses except sample sizes are based
on weighted data, although a number of
test analyses showed few and insignifi-
cant differences between results based on
weighted and unweighted data. In spite of
the weighting process, it must be born in
mind that the validity of the results may
to a certain extent have been jeopardized
by the low response rate. This means that
caution is needed in generalizing results
to the population level. Since problem
drinkers and users of illegal drugs can be
expected to be overrepresented among
non-respondents, and socially “undesir-
able” behaviour can generally be expected
to be underreported (e.g. Kühlhorn et al.
2000), this caveat will be particularly rel-
evant with regard to future analyses of the
connections between respondents’ images
of various addictions and their own expe-
riences with potentially dependence gen-
erating substances or activities. However,
as concerns the differences between their
images of various addictions, which is the
focus of the present paper, the results are
likely to be more reliable.
The respondent group
Table 1 describes the respondent group in
terms of some basic demographic charac-
teristics, showing e.g., an even distribution
of women and men, that just under one
third were university educated whereas
a quarter had only completed elementary
school, that one third lived in the metro-
politan area and one tenth in rural areas,
and that the great majority of the respond-
ents were native-born Swedes.
Table 2 describes respondents’ lifetime
experiences with potentially addictive
substances, which by and large seem to
mirror the Swedish “addiction scene”3
fairly well, the most common experiences
being, in order of magnitude, with drink-
ing, smoking, snuff use, and – although to
a much lesser degree – cannabis use, and
where experiences with amphetamine, co-
caine, (illegal use of) medical drugs, and,
in particular, heroin, are very limited. The

most obvious difference between respond-
ents’ reports and what is known about the
overall prevalence of the habits in ques-
tion in Sweden, is that the proportion of
present smokers and snuff users seems to
have been higher in the respondent group
than what was the case in the population
at the time when the survey was conduct-
ed, although this difference may partly be
due to differing definitions.
Table 3, finally, shows respondents’ re-
ported experiences with addiction prob-
lems, their own or those of somebody
close (family or close friend). As can be
seen, with the exception of dependence
on tobacco, few admit to having experi-
enced such problems personally. For ex-
ample, although more than nine out of
ten are previous or present drinkers, only
about six per cent, the same proportion as
those who never drank, report having been
addicted to or dependent on alcohol. The
fact that more than four out of ten admit
to being or having been dependent on to-
bacco suggests that this is seen much less
stigmatising than other addictions. At the
same time, almost two thirds of all re-
spondents report being aware of a present
or former dependence or misuse problem
in someone close. However, less than half
of these respondents report that they per-
sonally tried to help some of these people.
Table 1. Respondent characteristics
Women (N = 545) Men (N = 553) All (N = 1.098)
Characteristics n % n % n %
Age 44.2 (s =15.5) 44.1 (s=14.8) 44.2 (s=15.7)
Married /cohabiting 243 44 7 237 42.9 481 43.8
University education 175 32.2 147 26.5 322 29.3
Only elementary education 126 23.2 148 26.7 274 25.0
Living in a metropolitan area 197 36.2 163 29.5 360 32.8
Living in a rural area 52 9.6 60 10.8 112 10.2
Born in Sweden 467 85.7 466 84.3 933 85.0
Table 2. Personal substance use experiences (N = 1.098)a
Never used Previous use Present use
Substance n % n % n %
Alcohol 65 6.0 68 6.3 948 87.7
Cigarettes 320 29.5 429 39.7 333 30.8
Snuff 669 61.6 213 19.6 205 18.9
Cannabis 918 84.5 150 13.8 18 1.7
Medical drugs 1029 95.1 34 3.2 19 1.8
Amphetamine 1032 95.4 43 4.0 6 0.6
Cocaine 1057 97.5 18 1.7 9 0.9
Heroine 1076 99.3 5 0.5 2 0.2
a) The table shows valid answers and valid percentages

Finally, it should be mentioned that
less than five per cent of all respondents
reported personal experiences of addic-
tion treatment, whereas one quarter was
aware of a treatment episode experienced
by someone close. About four out of ten
judged these treatment experiences to
have been helpful. At the same time,
further analyses revealed that about one
fifth of the respondents claimed to have
quit what they saw as an addictive habit,
predominantly smoking or using snuff,
without treatment, and just over one third
reported similar experiences in someone
close. Data on respondents’ political-ide-
ological orientation, “social distance” to
people with addiction problems, personal
“locus of control”, trust in various authori-
ties etc. will be the object of future analy-
ses, and are not presented here.
Q Some theoretical caveats
Besides the uncertainties caused by the
low response rate, a few words are war-
ranted about what can and what cannot
be captured by asking respondents to re-
port their attitudes to, and perceptions
of, rather complex matters by answering
survey questions with pre-coded response
alternatives. Thus, as pointed out by Hüb-
ner (2001), the basic idea that there exists a
“public opinion” that can be measured by
traditional polls to representative samples
is certainly open to debate (cf. Bourdieu
1972; Österman 1998). For example, there
is no reason to believe that all respond-
ents have the same competence in, or the
same knowledge of, the issues covered by
the survey (ibid., Hübner 2001). Further,
it is important to consider that opinions
in real life are created in interactions be-
tween individuals and groups, and are
formed in situations where taking a posi-
tion means choosing between real groups
that are in conflict (ibid.). This means that
an opinion poll carried out at one certain
point in time can only “scan the surface”,
but not give an in-depth understanding of
how opinions are mobilised, and what a
certain standpoint means to various re-
spondents (Österman 1998). In addition,
the problem posed by a poll will always
correspond to specific interests that gov-
ern the meaning of the responses (ibid.).
Respondent her/himself Somebody close Tried to help
somebody a
Dependence to n % n % %
Alcohol 72 6.8 519 48.6 49.4
Tobacco 448 42.3 575 55.1 42.7
Cannabis 23 2.1 149 14.2 56.7
Gambling 27 2.6 128 12.3 59.2
Medical drugs 31 2,9 122 11.2 57.2
Narcotic drugsb
12 1.2 135 13.0 59.9
Any addiction 471 42.9 723 65.9 42.2
a) Percentage of all respondents who were aware of a problem by somebody close; b) Except cannabis
Table 3. Experiences of dependence/misuse problems in oneself and/or somebody close (N =
1.098)

These interests are not likely to be shared
by all respondents, which means that it
is not unproblematic to assign the same
value and the same “meaning” to the same
response by various respondents. Finally,
attitudes and perceptions are not individ-
ual characteristics but processes, governed
by changing circumstances, actual events
and various kind of information, which in
turn means that connections captured by
opinion polls may be rather casual (Öster-
man 1998; Hübner 2001). Another general
caveat is that the wording of questions and
response alternatives may influence sur-
vey results in a significant way, especially
when the issues concerned are emotion-
ally or ideologically “loaded”, something
that can be said to be true at least about
the drug issue in Sweden (Hübner 2001).
Of special interest here may be that there is
no obvious equivalent to the concept “ad-
diction” in modern Swedish, and that the
survey therefore consistently asked about
“misuse of or dependence on” various sub-
stances and behaviours. At the same time,
“addiction”, “misuse”, and “dependence”
are all “fat words” (cf. above), and in Swe-
den the two latter could be expected to be
used more or less interchangeably, by lay
people and various “experts” alike, to sig-
nify the same broad class of phenomena
as the English term “addiction”. All in all
this means that the results presented in
this paper need to be interpreted and dis-
cussed with regard to the currents of the
“addiction scene” (see Note 3), and the dif-
fering “instutionalised responses” to and
media representations of matters like alco-
hol, narcotic drugs, tobacco and gambling
in Sweden (Hübner 2001)4
. It also means
that the survey results should only be seen
as an “aerial photo” of prevailing images
of or attitudes towards various addictions
in contemporary Sweden. A fuller under-
standing of the meaning of this “aerial
photo”, warrants further analyses, explor-
ing the connections between respondents’
images of various addictions, and e.g.,
their living situation, their own experi-
ences in the field, their appreciation of the
stigma attached to various addictions, and
their political-ideological orientation. In
addition, further inquiry will be needed
into the processes by which respondents’
images of various addictions are formed.
Results
Based on the considerations discussed in
the Methods section, the present analysis
focuses on three basic dimensions of pre-
vailing “images of addiction”: (a) the per-
ceived severity of various addictions, (b)
the attribution of moral responsibility for
various addictions, and (c) the perceived
“character” of various addictions. These
three basic dimensions have, as will be
seen, in turn be operationalised into more
specific aspects. Even if the choice of as-
pects has by necessity been somewhat ar-
bitrary, the ambition has been to focus on
what might be crucial to how people with
various addiction problems are met and
treated by others in practice.
Q Which is the “worst” addiction?
There are many ways in which the sever-
ity of an addiction problem could be de-
fined. On a societal level, severity could
refer e.g. to the prevalence of the problem,
the aggregate costs for the harm caused by
addicts, or society’s efforts to prevent the
problem and/or treat addicts. On an indi-
vidual level, severity could refer e.g. to the
stigma surrounding various addictions,

the “addictiveness” of (or the risk of get-
ting “hooked” on) a certain substance or
a certain habit, to what extent and how an
addictive habit impairs the user’s mental
and physical health and/or causes harm
to the environment, as well as to how
easy the addiction is to “cure”, and what
it takes to do so. The survey has tried to
capture at least some of these aspects, and
in the analysis the relations between dif-
ferent aspects have been explored in an
effort to further clarify the significance of
respondent’s judgements.
How dangerous are different addictions to
society?
As mentioned in the discussion on opin-
ion polls in the introduction, the fact that
there may be wide differences in the ex-
tent to which an issue concerns various re-
spondents is crucial to the interpretation of
their images of various drugs or activities.
To gain some estimation of this, respond-
ents were asked to rank fifteen such issues
on a ten-point scale with the anchor-points
“not severe at all” and “very severe”. The
general outline of this question was bor-
rowed from the Nordic survey reported
by Hübner (2001), although some issues
were added, and the wordings of some is-
sues were changed. The exact wording of
the question was (in translation): “How
serious do you think that the following
societal problems are on a scale from 1 to
10?” Table 4 shows respondents’ average
ratings of the fifteen issues mentioned in
the question.5
As can be seen, violent crimes end up
in a class of their own as the most severe
societal problem, followed by “hard”
drugs6
and environmental problems, and,
in a separate class, crimes against prop-
Rank Problem M (s)
1 Violent crime 9.26 1.42
2 Drug problems (except
cannabis)
8.66 1.93
3 Environmental problems 8.63 1.78
4 Property crimes (theft,
burglary etc.)
8.46 1.84
5 Cannabis problems 8.15 2.32
6 Financial crimes (fraud,
taxation crimes)
8.13 2.18
7 Poverty 7.99 2.27
8 Ethnic discrimination 7.89 2.35
9 Prostitution 7.61 2.60
9 Alcohol problems 7.61 2.17
11 Misuse of medical drugs 7.33 2.44
12 Gender inequality/gender
discrimination
7.01 2.40
13 Wage differences 6.94 2.44
14 Gambling problems 6.44 2.54
15 Tobacco use 5.75 2.49
Note: Differences between groups of items are statisti-
cally significant (paired samples t-tests of all subse-
quent pairs of items; p < .05)
Table 4. Rated severity of various societal
problems (scale 1 – 10; N = 1.098)
erty. Cannabis is ranked clearly below
other narcotic dugs, together with finan-
cial crimes and poverty, whereas all other
addiction problems appear at the lower
end of the ranking list. Alcohol problems,
together with prostitution, are ranked be-
low ethnic discrimination, but above the
misuse of medical drugs, and gambling
problems and tobacco use are ranked as
the two least severe concerns among the
available options, below gender discrimi-
nation and wage differences. As indicated
by the standard deviations, it also fol-
lows from the fact that “hard” drugs are
ranked close to the upper end of the scale,
that there is fairly widespread consensus

among respondents about the severity of
these drugs, whereas the opinions on the
severity of, e.g. tobacco and gambling as
societal problems are more divided. It is
possible that the “high profile” of narcotic
drugs as a societal problem should partly
be seen as an effect of the fact that the sur-
vey was mainly about addiction problems.
However, this interpretation is contradict-
ed by the fact that alcohol problems, the
misuse medical drugs, gambling problems
and tobacco all turn up at the end of the
list. As claimed above, another dimension
that may be important for the interpreta-
tion of respondents’ images of different
addictions is their personal acquaintance
with various substances and activities.
Albeit these relations will be the object
of future, separate analyses, this suggests
that the low ranking of tobacco use as a so-
cietal problem should be seen in the light
of the fact that tobacco dependence seems
to be surrounded by less stigma than other
addictions (cf. above). In addition, since
respondents were explicitly asked to rank
the severity of the fifteen issues as societal
problems, it is also important to consider
the way in which such problems are of-
ficially defined and handled, which may
influence people’s attitudes towards espe-
cially such issues with which they have
little personal experience. Thus, respond-
ents’ ratings of the severity of narcotic
drugs should most likely to a large extent
be seen as reflections of the strong official
stance in Sweden against any use of these
drugs, and the fact that objections to this
policy have been more or less banned in
the media (cf. Note 1).
Although the two studies are not totally
comparable, it is also fairly obvious that
opinions have not changed much since
1995, when the study reported by Hübner
(2001) was carried out. Thus, drug prob-
lems ranked next to violent crimes in the
previous study, too7
, whereas both alcohol
problems and smoking ranked relatively
low8
. The most obvious difference seems
to be that prostitution, which ranked low-
est among men and third lowest among
women in 1995, has “moved up the scale”,
which may be due to the relatively large
media attention during the past decade to
the issue of “trafficking” and to the change
in the legislation in this area in 1998, that
made buying sex a crime. In addition,
cannnabis, which was not distinguished
from other narcotic drugs in the previous
survey, may in reality have moved down-
ward on the severity scale. One might per-
haps also have expected that the changes
in alcohol policy that followed Sweden’s
accession to the EU in 1995, and the sub-
sequent, rapid and large increase in con-
sumption (e.g. Leifman 2004; Boman et
al. 2007) should have reflected in alcohol
problems moving “up the scale”. That this
is not the case may partly be explained by
most respondents making a clear distinc-
tion between “normal drinking” and “al-
cohol problems”, partly by the fact that
the recent increase in drinking seems, un-
like the simultaneous increase in Finland,
so far to have had fewer negative conse-
quences than might have been expected
(e.g. Norström & Ramstedt 2006).
Perceived severity of various addictions at
the individual level
Another crucial aspect of the “dangerous-
ness” of various substances or activities
concerns the risk for individual users of
“getting hooked”. To get a grasp of this
aspect respondents were asked, using a

four-point scale9
to rate the perceived risk
of developing a dependence or misuse if
experimenting with each of the nine sub-
stances or activities included in the study.
As touched upon in the introduction, one
of the reasons for setting the study up was
the experience that people’s success in try-
ing to recover from various addictions is
influenced not least by whether they are
met with trust and support or with dis-
trust and repudiation by others – family
and friends as well as professionals. Thus,
respondents’ “change optimism” in this
sense can be claimed to constitute another
crucial aspect of the perceived severity at
the individual level of a certain addiction.
To asses this, respondents were asked to
rate the perceived probability for recovery
from various addictions – with and with-
out the help of professional or formally or-
ganised treatment – including mutual help
groups such as AA, NA etc. These prob-
abilities were rated on a five-point scale,
ranging from “no or very little probability”
to “very high probability”. Table 5 shows
the ranks and mean ratings for the risk of
getting hooked on, and the overall options
of recovery from, the nine addictions in
questions. For all addictions, except snuff,
the overall options of recovery meant the
rated probability of finding a path out with
treatment (see further below).
As can be seen, there is, by and large,
an inverse relation between respondents’
views on which addictions it is easiest
to “get into” and “get out of”. Thus, the
“hard” drugs (heroin, amphetamine, and
cocaine) are not only seen as a large so-
cietal problem, but also as highly addic-
tive and very difficult to quit. At the other
end of the scale, drinking, gambling, and
snuff are seen as much less dependence
generating, and as relatively easy to quit,
should an addiction develop. Cannabis
and medical drugs are allotted middle
ranks in all these respects, whereas ciga-
Table 5. Overall perceived risk of becoming addicted and overall “change optimism” (scales
1–5; N = 1.098)
Perceived risk Change optimism
Problem with Rank M (s) Problem Rank M (s)
Heroin 1 4,26 (0,97) Heroin 9 3,52 (1,16)
Cocaine 2 4,17 (0,97) Cocaine 8 3,57 (1,13)
Amphetamine 3 3,99 (1,00) Amphetamine 7 3,67 (1,04)
Cannabis 4 3,64 (1,09) Cannabis 6 3,83 (0,98)
Cigarettes 5 3,18 (1,14) Medical drugs 5 3,84 (0,96)
Medical drugs 6 2,96 (1,07) Gambling 4 3,90 (0,92)
Snuff 7 2,78 (1,06) Cigarettes 3 3,98 (1,01)
Gambling 8 2,65 (1,02) Alcohol 2 3,98 (0,88)
Alcohol 9 2,59 (0,98) Snuff 1 4,02 (1,00)
Mean 3,36 (0,72) Mean 3,82 (0,70)
Note: Regarding responsibility for causing the problem, differences between subsequent pairs of problems are
significant except for cigarettes – gambling, cannabis – amphetamine, and cocaine – heroin – alcohol (paired
samples t-tests, p < .05); regarding responsibility for solving the problem, all differences between all subsequent
pairs of problems are significant.

rettes are rated as moderately addictive,
although smoking is judged as fairly easy
to quit. The small standard deviations also
indicate that there is relatively good agree-
ment between respondents both concern-
ing the high risk of getting “hooked” on
the “hard” drugs and the fairly low risk
of getting “hooked” on alcohol and gam-
bling. Concerning rated options on finding
a path out of the addiction, standard devi-
ations indicate fairly good agreement that
it is relatively easy to successfully treat
drinking and to some extent gambling
problems, whereas opinions seem to be
more divided regarding the same options
when it comes to “hard” narcotic drugs.
Harm to whom? Perceived severity at the
societal and individual levels compared.
How is the perceived dependence-gener-
ating capacity of various substances/be-
haviours related to how serious they are
judged to be as societal problems? To shed
light on this relation, the two ratings10
have
been brought together in Figure 1.
As shown in the figure, the perceived
“dangerousness” at the societal and indi-
vidual levels seem to converge regarding
“hard” narcotic drugs and to some ex-
tent cannabis, in the sense that these ad-
dictions are judged to be the most severe
ones on both levels. However, gambling,
and the misuse of medical drugs and al-
cohol are all seen as more severe societal
problems than tobacco use, although the
latter is judged to be stronger dependence
generating. Whereas respondents’ ratings
of the “addictive potential” of various sub-
stances and activities seems to fit fairly
well with what at least some researchers
have claimed (cf. West 2007), the ratings
of their severity to society fit rather poorly
with what is known about e.g. the preva-
lence and aggregate costs to society of vari-
ous such problems in Sweden (cf. Note
3). This strengthens the assumption that
these ratings to a large part represent the
official stance on and the prevailing media
image of these problems, and that there is
a strong relation between the perceived
1
2
3
4
5
6
7
8
9
10
Tobacco Gambling Medical
drugs
Alcohol Cannabis
Individual risk to get hooked
„
Severity to society
Other narc.
drugs
„
Figure 1. Severity at the societal and individual level (standardized ratings, 1–10)

“strangeness” of various problems and the
extent to which they are seen as dangers to
society (cf. above; Christie & Bruun 1985).
Change optimism and confidence in
treatment
As already noted, respondents were asked
to rate the probability for recovery from the
nine addictions both without professional or
formally organised help (“self-change”) and
with such help. Based on these rankings,
Figure 2 shows the perceived probability
for “self-change”, and what treatment is as-
sumed to be able to add in finding a solution.
As can be seen, the perceived options
to quit without professional or formally
organised help are high concerning tobac-
co use and to some extent gambling, and
lowest concerning “hard” narcotic drugs
of which few Swedes have personal expe-
rience (cf. Note 3 and Table 3). A closer
analysis reveals that only eleven percent
of the respondents believe that a heroin
addict has any chance at all of finding a
resolution on her/his own, whereas the
same proportion for snuff use is close to
seventy-five per cent. With the exception
of tobacco use, the figure also indicates
that Sweden is rather far from being the
type of “self-change friendly society” that
for example Klingemann (2005; Klinge-
mann & Klingemann 2007) has argued for.
Rather, respondents’ views of the options
for self-change seem far more pessimistic
than topical research about the prevalence
for such solutions can be claimed to give
grounds for (Klingemann & Sobell 2007;
Blomqvist et al. 2007). In fact, if the scale
used in the figure should be transformed
to a percentage scale, it would mean that,
besides tobacco dependence, the rated
probability for self-change would vary be-
tween about twenty (heroin addiction) and
slightly below fifty per cent (gambling).
This should be put in the perspective of
topical research, indicating that the large
majority of recoveries from dependence
not only on alcohol, but also on most nar-
cotic drugs, take place outside the treat-
ment system (e.g. Blomqvist 2009).
On the other hand, the figure also indi-
cates that this pessimism is to a large ex-
tent compensated for by a strong general
confidence in the effectiveness of addic-
Snuff Cigarettes Gambling Alcohol Cannabis Cocaine Heroin
1
2
3
4
5
With treatmentSelf-change
Amphe-
tamine
Medical
drugs
Figure 2. Change optimism with and without treatment (scales 1–5)

tion treatment, where type of addiction
does not seem to matter much. Thus,
whereas the probability for a successful
outcome of treatment of alcohol prob-
lems, using the transformed scale, would
be set at about seventy-five per cent, the
corresponding probability for treatment
for amphetamine misuse would be set at
almost seventy per cent. The figure also
shows that the relative importance of ex-
pert help, i.e. the difference between the
rated probabilities for recovery with and
without treatment, is consequently judged
to be larger for the “hard” drugs (heroin,
amphetamine, and cocaine) than for e.g.,
addiction to alcohol and cannabis11
, and to
be more ore less non-existent for depend-
ence on tobacco (and even negative for
snuff). By and large, this may be said to
reflect the current situation in the addic-
tion field in Sweden, where more energy
and, in relative terms, more resources are
spent on treating a rather limited number
of drug addicts, than on treating a much
larger number of problem drinkers and al-
cohol misusers (cf. Blomqvist 2002; Mel-
berg 2006), and where treatment of smok-
ers and snuff users is rare12
.
It is not self-evident how to interpret re-
spondents’ high confidence in addiction
treatment. Potentially, it could be seen
as an indication of a generalised strong
trust in (or at least nostalgia concerning)
the benevolent welfare state (cf. Rothstein
1994) and/or as mirroring the promises of
increasingly “effective cures” (mainly of a
medical kind) that are recurrently report-
ed by the media (cf. Note 4). Whereas no
final conclusions can be drawn from the
fact that studies in Finland (Koski-Jännes
et al. 2009) and Canada (Cunningham
2009) show a similar strong trust in addic-
tion treatment, further comparisons with
studies in countries with less developed
welfare ambitions may resolve this issue
with time. The fact that both Canadian and
Swiss respondents (Cunningham 2009;
Klingemann & Klingemann 2007) are
clearly more optimistic about the options
for self-change from problematic cannabis
use than Finns (Koski-Jännes et al. 2009)
and Swedes, and the fact that Finns rate
alcohol as a much larger societal problem
than Swedes13
, certainly shows that views
and attitudes differ between countries and
contexts. In sum, however, respondents’
ratings on the severity, “addictiveness”,
and options to “get out of” various addic-
tions, rather clearly suggest that the less
common and familiar – to the common
citizen or in mainstream culture – a habit
or a substance is, the “worse” – in most
aspects – it is judged to be.
Q Who is responsible? The moral aspect
As mentioned, drawing on the work of
Brickman et al. (1982) respondents were
also asked to what extent they ascribed
the responsibility for causing, as well as
for solving the nine addiction problems to
the single individual. The answers to these
two questions are displayed in Table 6.
As shown by the high means in the first
column of the table, addiction problems
seem largely to be seen as the individual’s
own fault. At the same time, there is a
tendency that the more severe an issue is
rated to be as a societal problem (cf. Ta-
ble 4), the less likely the individual suf-
ferer is to be blamed for having caused the
problem. However, there seems to be two
exceptions to this. Thus, the group of ad-
dicts who are to the greatest extent seen
as “victims” are those addicted to medical

drugs. In addition, problem drinkers are
on the average blamed less for their condi-
tion than are users of at least cannabis and
amphetamine. A possible explanation is,
in the first case, that the misuse of medi-
cal drugs is seen to have been “created” by
doctors or by the health care system who
should therefore also take responsibility,
whereas in the other case the results might
be a reflection of repeated claims – from
different parties with differing agendas14
–
that alcoholism is a “disease”.
As regards the responsibility for solving
an addiction problem, respondents seem
to put even greater pressure on the single
individual, a fact that could at the same
time and in some sense be said to refute
the assumption of a widespread disease
notion of addiction. Since this question
asked whether the responsibility for solv-
ing a problem should rest primarily with
the individual or society, it should be
pointed out that the high means do not
necessarily imply that the majority view is
that society is not obliged to offer help, but
rather that the main responsibility for solv-
ing the problem lies with the individual
client or patient, whether she or he is in
treatment or not. Thus the majority stance
should probably be interpreted according
to the common view that you cannot help
someone to quit an addiction, unless she
or he really wants to do so. The rankings
of various addictions are again, with the
partial exception of the misuse of medical
drugs, clearly related to their perceived
“dangerousness” as social problems, mak-
ing the individual the more responsible
for the solution the less severe and/or the
less risky a certain substance use or activ-
ity is considered to be. However, the main
impression from the data shown in Table 6
is that the blame for developing an addic-
tion, as well as the responsibility for find-
ing a path out is to a large extent attributed
to the single individual.
Table 6. Degree to which the individual is deemed responsible for causing and solving the
problem (scale 1– 4; N = 1.098)
Causing Solving
Problem with Rank M (s) Problem with Rank M (s)
Snuff 1 3,33 (0,76) Snuff 1 3,64 (0,58)
Cigarettes 2 3.27 (0,76) Cigarettes 2 3,60 (0,62)
Gambling 3 3,25 (0,77) Gambling 3 3,22 (0,74)
Cannabis 4 2,91 (0,84) Alcohol 4 3,09 (0,63)
Amphetamine 5 2,90 (0,88) Cannabis 5 3,01 (0,72)
Cocaine 6 2,89 (0,89) Amphetamine 6 2,91 (0,77)
Heroin 7 2,87 (0,90) Cocaine 7 2,86 (0,81)
Alcohol 8 2,87 (0,75) Heroin 8 2,84 (0,82)
Medical drugs 9 2,54 (0,87) Medical drugs 9 2,77 (0,83)
Mean 2,97 (0,61) Mean 3,11 (0,56)
Note: Regarding responsibility for causing the problem, differences between subsequent pairs of problems
are significant except for cigarettes – gambling, cannabis – amphetamine, and cocaine – heroin – alcohol
(paired samples t-tests, p < .05); regarding responsibility for solving the problem, all differences between all
subsequent pairs of problems are significant.

Q What kind of problems?
Although the choice of dimensions and
aspects in trying to capture the prevail-
ing popular images of various addictions,
has – as already mentioned – by neces-
sity been somewhat arbitrary, the analyses
presented so far could be claimed to have
given a reasonably coherent and meaning-
ful result. There are, however, still some
aspects that might be added to provide a
more comprehensive understanding of the
ways in which the percieved characters
of various addictions diverge. One means
for such an understanding would be to ex-
plore how respondents’ perceptions of the
severity of various addictions are connect-
ed to each other, and to their perceptions
of the severity of other social problems (cf.
Hübner 2001). To this end, a factor analy-
sis was conducted, using the data shown
in Table 4. As can be seen in Table 7, a
four-factor solution in this analysis result-
ed in a set of quite distinctive dimensions,
explaining a fairly large proportion of the
total variance.
The first factor can clearly be interpret-
ed to represent an addiction or misuse
problems factor with high loadings for
the “traditional” addictions, as well as for
gambling and to some extent prostitution.
The second factor can be interpreted as a
“social/political” factor, with high load-
ings for issues that concern social and eco-
nomic justice, gender and ethnic discrimi-
nation, and environmental protection.
The third factor stands out as a relatively
distinctive “crime factor” with high load-
ings for all of the, rather different types of,
crimes that were included in the question.
Finally, the analysis discerns “tobacco
Variables: Rotated factor matrix
Cannabis problems . 812 .059 .382 .065
Other drug problems . 786 .124 .398 .032
Misuse of medical drugs . 686 .415 .203 .203
Gambling problems . 639 .414 .015 .367
Alcohol problems . 605 .151 .240 .417
Ethnic discrimination . 195 .762 .155 .123
Poverty . 280 .762 .243 .031
Environmental damage .098 .580 .354 .257
Gender inequality/discrimination -.037 .575 .144 .065
Prostitution .524 .572 .144 .065
Large wage differences .009 .562 ..206 .539
Violence crimes .303 .268 .741 -.018
Property crimes .395 .011 .739 .201
Financial crimes .250 .353 .502 .086
Tobacco use .337 .068 .086 .824
Eigenvalue 6.90 1.48 1.01 .86
Explained variance b
46.01 % 9.89 % 6. 75 % 5.71 %
a) Varimax rotation; b) Total explained variance: 68. 4 %
Table 7. Factor analysis of ratings of various societal problems. Principal componentsa

use”, as an own – but as also indicated in
Table 4, not particularly important – di-
mension in Swedes’ apprehension of so-
cial problems.
It can be noted that a similar analy-
sis conducted on data from the above-
mentioned Nordic survey (Hübner 2001),
yielded three dimensions, represent-
ing a “moral”, a “social/political”, and a
“crime” factor, where smoking problems
were grouped together with alcoholism,
drug abuse, and prostitution in the first
factor. The main difference is thus that to-
bacco use here appears as a separate fac-
tor, something that may to some extent be
due to the fact that the two studies used
partly different items and different word-
ings (cf. above)15
. In sum, this analysis can
be claimed to suggest that the public dis-
course on addiction problems in Sweden
is largely separated from the political dis-
course, and that a distinction is also made,
even if the border is somewhat blurred,
between “addictions proper” (most clearly
represented by heroin and other “hard”
drugs) and “bad habits” (most clearly rep-
resented by snuff use and smoking).
Another way of trying to summarise the
perceived “character” of various addic-
tions would be to apply to them the four
“models of helping and coping”, deline-
ated by Brickman’s and colleagues (1982).
As already mentioned, these authors claim
that the attribution of moral responsibility
for human and/or social problems involves
not one but two basic dimensions, namely
the question of blame (“who caused he
problem”) and control (“who is capable of
and responsible for solving the problem”).
By combining these two dimensions, they
arrive at what they refer to as four “mod-
els” of how a certain problem could and
should be handled. According to the
“moral model” people are held responsi-
ble for creating a problem as well as capa-
ble of and responsible for solving it, which
means that help essentially takes the form
of punishments and rewards. According to
the “treatment model” (or perhaps rather
the “expert model”) on the other hand,
problems are seen as caused by forces
beyond the subject’s own control, and as
curable only by professional experts. By
and large these two models correspond
to the “badness-illness” dichotomy that
has often been used to illustrate different
ways of looking at addiction problems (cf.
Mäkelä 1980). To this common figure of
thought, the authors add the “enlighten-
ment model”, according to which people
are blamed for having caused their prob-
lems, but are at the same time seen as inca-
pable of solving them. As a consequence,
the subject’s best hope for a solution lies
in submitting to a higher moral authority
that can help her or him to overcome their
destructive impulses. Since this author-
ity could obviously be both of a spiritual
and a profane character, “fostering” might
in fact be a better name for this model (cf.
Blomqvist 1998b16
). Finally, in the “com-
pensatory model”, people are seen as
subjected to certain handicaps or obsta-
cles imposed on them by the situation or
by nature but as basically capable of and
responsible for managing their own lives.
Accordingly, they may be entitled to cer-
tain help, given on their own terms, and
aimed at empowering them to solve their
own problems and manage their own lives
on the same terms as other citizens.
Previous research suggests that the dis-
tinctions suggested by Brickman et al.
(1982) may be more fruitful when applied

in e.g., overarching socio-historical analy-
ses (cf. Blomqvist 1998b), than in clinical
contexts (e.g. West & Power 1995), and it is
not self-evident how the four models could
and should be operationalised, using the
survey questions. One option would be to
dichotomize the two questions on respon-
sibility for causing and solving various
problems, the answers to which are shown
in Table 3. However, as indicated by the
same table, that would obviously mean
that a large majority of the respondents
would be claimed to apply the “moral”
model to all addictions, a result that does
neither stand out as particularly meaning-
ful nor as particularly informative in the
present context. Further, as already indi-
cated, the wording of the question on re-
sponsibility for solving various problems
was not ideal, asking respondents to rate
to what extent this responsibility should
be put on the individual or on society. Fi-
nally, the “control” dimension in the work
of Brickman et al. (1982) seems on closer
scrutiny to be at least as much about the
capacity to solve a problem as about the
responsibility for doing so. Therefore, the
rated responsibility for developing various
addictions has here been combined with
the rated options for “self-change” from
the same problems17
. The resulting distri-
bution of preferred “models for helping
and coping” over the nine addictions is
shown in Figure 3.
When interpreting this figure, it should
first be noted that with the operationali-
sation used, it follows from respondents’
ratings of the individual as largely respon-
sible for acquiring an addiction (Table
6), that the “moral” and “enlightenment/
fostering” models are overall more com-
monly endorsed than the “compensatory”
and “treatment/expert” models. This said,
it should be noted that respondents seem
to apply different models for different ad-
dictive substances or activities. At one end
of the scale, tobacco use (snuff and ciga-
rettes), and to some extent gambling, are
predominantly seen as “moral concerns”
or “bad habits”, in the sense that both
starting and terminating these activities
is predominantly seen as the individual’s
0
10
20
30
40
50
60
70
80
% Moral Enligtenment
Snuff Cigarettes Gambling Alcohol Cannabis Cocaine HeroinAmphe-
tamine
Medical
drugs
Treatment Compensatory
Figure 3. Preferred model of “helping and coping” with various problems (%)

own business. At the other end of the scale
is the use of “hard” drugs (heroin, cocaine,
and amphetamine), where opinions are
more divided, but where the “enlighten-
ment” and “treatment” models, both im-
plying that the individual needs external
help to overcome her/his predicament,
and that the addict should be seen either
as a “sinner” or a “crook” who needs help
to mend his/her ways, or a powerless “vic-
tim” who needs expert treatment, clearly
predominate. In a “middle group” are ad-
dictions to alcohol, cannabis and medi-
cal drugs, where opinions are even more
spread, but where the “compensatory”
model gets more “votes” than it gets with
regard to the “hard” narcotic drugs.
The fact that tobacco dependence stands
out from the other addictions as being al-
most exclusively seen through the eyes of
the “moral model”, is in line both with the
fact that this seems to be a fairly common
and mundane experience (Table 3), as well
as with the fact that tobacco use is ranked
low as a societal problem (Table 4), and
is singled out as an “own” dimension in
the factor analysis (Table 7). In addition,
it suggests that respondents’ assessments
of the severity and character of tobacco
use pay little attention to matters such as
mortality, morbidity, and harm to others.
Together, these data rather suggest that
smoking and snuff use, in spite of recur-
rent campaigns pointing to tobacco as a
large public health problem, are predomi-
nantly seen as “private” as opposed to
either moral or political concerns in con-
temporary Sweden.
The figure also indicates that legal sub-
stances or activities are to a greater extent
seen as moral matters than are illegal sub-
stances – cannabis being a partial excep-
tion here. The fact that the enlightenment
or “fostering” model is the one most en-
dorsed by respondents concerning both al-
cohol and narcotic drugs may partly have
to do with the growing popularity of, and
media attention to, AA, NA and other mu-
tual help groups (cf. Note 4), partly with
the fact that coercion has always been –
and is probably been seen by most – as an
integral part of society’s efforts to counter
addiction problems. The relative unpopu-
larity of the “treatment (or expert) model”,
in spite of respondents’ strong confidence
in the treatment system (see Figure 2), can
perhaps be seen in the same light.
In sum, the results presented above may
be claimed to hint that respondents down-
play the severity of and risks with hab-
its and conditions with which they have
some – direct or indirect – personal experi-
ence and/or which are seen as part of main-
stream culture, whereas problems that are
more uncommon or “alien” are perceived
as more severe or dangerous. In addition,
the former problems seem to be regarded as
more “private” and to a larger extent as the
individual’s own business, whereas users
of “hard” drugs in particular are seen as be-
ing both a threat to society and as victims of
powers stronger than themselves.
Discussion
This article presented analyses of data
from a survey aimed at capturing prevail-
ing popular images of nine different ad-
dictions in contemporary Sweden. The
results show that these images vary greatly
between different addictions, and in a fair-
ly consistent way. These differences seem
to have little to do with known facts about
either the prevalence of different addic-
tion problems, their harmful and hazard-

ous effects on user’s health and wellbeing,
or their “costs” to society in the form of
premature deaths, health care expendi-
ture, lost years in work life, or potential
harm to others. Rather, the popular images
of various addictions seem to a large extent
to reflect beliefs of a rather “ingrown” and
stereotypical character. This is true above
all as concerns respondents’ images of
the “hard” narcotic drugs (amphetamine,
cocaine, and heroin), which are clearly
in line with the basic conceptions which
have been used to justify Sweden’s tradi-
tionally very restrictive drug policy, de-
picting narcotic drugs as extremely dan-
gerous and poisonous, with the capacity
to quickly enslave every user, and almost
impossible to quit (cf. Bergmark & Oscars-
son 1988), a picture that has also recur-
rently been reproduced by the media (cf.
Hübner 2001). At the other end of the con-
tinuum are the images of some relatively
mundane and familiar “habits” – smoking,
using snuff, and to some extent gambling
– the dangers and addictive character of
which seem rather to be played down by
the respondents. In between come addic-
tions to alcohol, cannabis, and medical
drugs, about the severity and character of
which there seems to be less consensus in
popular thinking, perhaps due to the fact
that rather divergent views on these issues
have come to light repeatedly over the
years, also in the media (cf. Hübner 2001;
Blomqvist 2004).
The fact that respondents largely at-
tribute the responsibility for the devel-
opment of addictive problems, as well as
the responsibility for solving them to the
individual, may seem surprising, not least
considering the fact that survey answers
reflect a generally strong confidence in
the addiction treatment system and its po-
tential benefits. One possible explanation
may be that “treatment” of these problems
is not mainly thought about in terms of,
“expert” or “professional”, specific inter-
ventions, but as much – in line with what
the media tend to pay attention to in this
area – in terms of AA, NA or other mutual
help groups, backing up people who have
made a decision to quit, and/or in terms of
coercive care, exerting external control to
make them do so.
Since “self-change” is today known to
be the most common path out of many ad-
dictions (e.g., Klingemann & Sobell 2007),
and since supportive and encouraging, al-
though not undemanding, social networks
have been found to be crucial in such proc-
esses (e.g., Blomqvist 1999; 2002), it can
be deemed unfortunate that so few of the
respondents endorse what Brickman et al.
(1982) term the “compensatory model”,
which guarantees the individual the nec-
essary support, but without putting blame
on her/him for their distressing condition,
and without expressing scepticism or dis-
trust. This is the more regrettable given
that only a minority of the respondents
who had reportedly experienced an addic-
tion problem in someone close, actually
had offered any personal help.
It is also tempting to dwell on the fact
that dependence on smoking and snuff in
particular are more often seen as “bad hab-
its” than as “real addictions” or “diseas-
es”, and to relate this to the fact that smok-
ing has decreased substantially in Swe-
den during the past two decades, largely
due to “rational” reactions to measures
such as information on health risks, price
policy and, in particular, rendering smok-
ing more difficult and more expensive.

Since earlier studies have shown that the
adoption of a “disease notion” of alcohol
problems may in certain respects function
as a self-fulfilling prophecy, one might
wonder whether a de-stigmatisation and
wider acceptance of a view of substance
use problems as a “central activity” in the
subject’s way of life (Fingarette 1988) or as
“lifestyles leading to predicaments” (Drew
1989), might not increase addicts’ options
of cutting loose from their addiction (cf.
Blomqvist 1998a; Blomqvist & Cameron
2002). This may also have a bearing on the
present new wave of “bio-medicalisation”
of addiction problems, proclaiming these
problems to be “diseases of the brain” (see,
e.g. www.hjarnfonden.se), a tendency that
may thus in a longer run not necessarily
prove to be particularly productive to ad-
dicts’ options for finding a path out.
However, it needs to be pointed out that
there are a number of study limitations
that imply that these conclusions should
be regarded as tentative. First, the relative-
ly low response rate means that generalisa-
tions need to be made with caution, even
if attrition bias does not seem to be a major
problem. Secondly, as has already been
pointed out, a survey of this kind can only
“scan the surface” when it comes to peo-
ples’ conceptions and beliefs about vari-
ous addictions. For example, the way in
which this study was been conducted has
not left room for more nuanced statements
from the respondents, e.g. to the effect that
the perceived risk of becoming addicted or
options for self-change may vary not only
with type of addiction, but also with vari-
ables such as age, gender, socio-economic
status, and social context.
To overcome these limitations, more
research will be needed. Further analysis
of the data from the study presented here
will focus on how respondents’ percep-
tions of various addictions relate to their
personal addiction experiences, to socio-
demographic factors such as age, gender,
ethnic background, educational level, and
family situation, and to wider political-
ideological inclinations and attitudes, as
well as to the stigma surrounding various
addictions. In addition, the issues under
study in the present survey will be ex-
plored in further investigations, using
qualitative methods, in an attempt to cap-
ture more subtle aspects of prevailing con-
ceptions of addiction and how these con-
ceptions have been formed. To get a better
grasp of how the “images of addiction”
are influenced by various kinds of per-
sonal addiction experiences, such studies
should include not only lay people and
professionals, but also persons with past
and present addiction problems (cf. Koski-
Jännes et al. 2009). Finally, and consider-
ing that similar research is ongoing in sev-
eral countries, cross-cultural comparisons
in this area offer, as already disussed, an
interesting option.
Jan Blomqvist, Professor
Centre for Social Research on Alcohol and
Drugs, SoRAD
Stockholm University
SE-106 91 Stockholm, Sweden
E-mail: jan.blomqvist@sorad.su.se

NOTES
1) Bergmark & Oscarsson (1988) use this term
to refer to a set of undisputed, and alleged-
ly undisputable, themes that they claim to
provide the unreflected basis for any debate
on and public action targeting the drug
problem in Sweden. According to Hübner
(2001) this “doxa” has, by and large, also
been adopted by the media, thereby leaving
little room in the public debate for oppo-
nents to the official Swedish drug policy,
based on zero tolerance.
2) Societal Images of Natural Recovery. This
study explored the confidence in “self-
change” from different addictions, based
on 30 “key informants” (representing
addiction professionals as well as “lay
therapists” and “common people”) in nine
large cities in seven different countries.
The Swedish part of this study, reported
by Andersson et al. (2004), was led by
the present author. The results pointed to
considerable differences between various
addictions, but also between settings, and
between professionals and lay people.
3) Regarding alcohol, less than 5 per cent of
the adult Swedish population are today
lifetime abstainers (Blomqvist et al. 2007),
whereas slightly more than 10 per cent
could at the time of the survey be charac-
terised as “frequent binge drinkers” (Selin
2004). With regard to tobacco use, the
proportion of daily smokers in Sweden
decreased from 36 per cent of the men
and 29 per cent of the women in 1980, to
14 per cent of the men and 19 per cent of
the women in 2004, and has decreased
further since (Lundquist 2007). At the same
time snuff use has increased, partly as a
substitute for smoking, and 23 per cent of
the men and 4 per cent of the women were
daily users during 2004 (ibid.). As concerns
narcotic drugs, Sweden’s extremely restric-
tive policy in this area, making any use of
narcotics classified substances a punishable
crime, has been fairly successful in keeping
youthful, recreational use on a low scale
(Olsson 2009). For example, lifetime use of
any narcotic substance among nine-graders
has during the past decades fluctuated bet-
ween six and ten per cent (Leifman 2008).
However, seen in a European perspective,
Swedish drug policy seems to have been
less successful in keeping down “heavy”
drug abuse and drug-related mortality in
particular (ibid.). Still, the use and misuse
of narcotic drugs is uncommon in Sweden,
as shown by the fact that, since the turn
of the millennium, past year prevalence
of cannabis use has been estimated to less
than 2.5 per cent, and the use of other
narcotic drugs to less than 1.5 per cent
(ibid.) As for the misuse of medical drugs,
there are no reliable reports on illegal use
of drugs sold on prescription (which is
probably not very common), albeit that the
Swedish National Association for Helping
Misusers of Pharmaceutics (RFHL), claim
that a quarter of a million Swedes are
dependent on (illegal or legally prescribed)
such drugs. Finally, Jonsson et al. (2000)
found that one and a half per cent of the
population over 15 years were present
problem gamblers, and that as many were
former problem gamblers. The highest
prevalence was found among the youngest
men (ibid.).
4) By and large, Sweden has long spent more
per-capita resources in care and treatment
of alcohol and drug problems than most
comparable countries. The main responsi-
bility for this care lies with the municipal
Social Services, and has to a large extent
been focussed on social and psychosocial
rehabilitation, although treatment for alco-
hol problems has largely been more “thera-
peutic” in character, and treatment for drug
problems more aimed at re-socialisation
(Blomqvist 2004). However, in recent years,
the quest for “evidence-based practice”
that has accompanied various attempts to
make the public sector more rational and
more cost-effective, has also given way
for an increasing “bio-medicalisation” (cf.
Blomqvist et al. 2009). This has become
evident not least in the official rhetoric and
in the media, where more attention seems
at present to be paid to “promising” phar-
macological treatments and to “disease-
based” mutual help groups such as AA and

NA, than to traditional psychosocial care.
In recent decades, with increased interna-
tionalisation and increased Internet access,
new forms of gambling have appeared
and have become an integral part of the
entertainment industry, including TV. At
the same time, gambling problems have re-
ceived increasing attention, and a number
of separate treatment facilities for such pro-
blems have been established. There are also
a few specialised facilities for persons who
misuse medical drugs, although those enga-
ged in these matters often claim this to be a
“hidden” problem, more or less neglected
by both the prescribing doctors and the
media. Finally, smoking has been officially
discussed largely as a health issue, and as
an economic burden to society, but seldom
in terms of an individual “disease”. Ac-
cordingly, the official strategy in this area –
which has been fairly successful (see Note
3) – has largely consisted in a combination
of health information (pamphlets, warning
labels etc.), and campaigns and measures
aimed at rendering smoking more difficult.
Regarding snuff use, there has been some
debate concerning potential health risks,
but by and large, snuff has not been a big
issue neither to the authorities nor in the
media.
5) Although not necessarily statistically cor-
rect in all aspects, paired t-test was consis-
tently applied to all ratings to test whether
the mean rating of a certain problem was
statistically different from its next lower or
higher counterpart.
6) It should be noted thought that the official
drug discourse in Sweden does not make
this distinction between e.g. cannabis and
“harder” drugs
7) In this study, “crimes against the person”
(murder, rape a.s.o.) ranked highest before
“family violence” and “drug abuse”.
8) In places seven and nine out of ten respec-
tively.
9) Transformed in the analysis, for the sake of
comparability, to a five-pont scale.
10) It should be observed that severity on
the societal level was, except for alcohol,
gambling, medical drugs, and cannabis,
only rated for “tobacco” and “other narco-
tic drugs” (than cannabis). Therefore, the
individual risk to develop tobacco depen-
dence has been calculated as the mean risk
for cigarettes and snuff, and the risk to get
“hooked” on other narcotic drugs (“hard
drugs”) as the mean risk for amphetamine,
cocaine, and heroin.
11) Although paired t-tests showed these dif-
ferences to be statistically significant for all
these addcitions (p < .05).
12) Except for the use of substitutes such as
nicotine pills, chewing gums or plasters
(or, for that part, substituting cigarettes for
snuff ). It should also be noted there is an
increasing commercial launching of such
means.
13) This may at least partly be explained by
the Finnish “experiment” with lower taxes
on liquor to counter increased private im-
port, that lead to a rapid increase in alcohol
mortality and alcohol related harm during
the years before the Finnish survey was
conducted in 2007.
14) Whether the assumptions about metabolic
or other physiological aetiological factors of
the popular disease model of the 1940s (cf.
Pattison 1976), AA: s concept of “spiritual
disease”, or topical claims of all kinds of
addictions as “brain diseases”.
15) In addition it can be noted that in a three-
factor solution using the present data,
“hard” drugs and cannabis got grouped
together with all types of crime in a “moral-
legal” factor, the “social/political” factor
looked much the same as in the four-factor
solution, and tobacco got grouped together
with alcohol and gambling in what could
be seen as a “bad habits” factor.
16) In this article, ”guilty” vs. “victim”, and
“capable” vs. “incapable” are distinguis-
hed as the two basic dimensions of the
Brickman et al. model, and “discipline” or
“fosterage” and “conversion” are discus-
sed as the implications in practice of the
“enlightenment” model.
17) Responsibility entirely or mostly on
the individual vs. entirely or mostly on
circumstances; and no or relatively low vs.
moderate to very high probability for “self-
change”.

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