British Journal of Addiction (1990) 85, 255-262

CONFERENCE REPORT

Licit and illicit drug policies: a typology

KENNETH E. WARNER, Ph.D., TOBY CITRIN, J.D., GEORGEPICKETT, M.D., M.P.H., BARRY G. RABE, Ph.D., ALEXANDERWAGENAAR, Ph.D. & JEFE STRYKER

Department of Public Health Policy and Administration, School of Public Health; Universityof Michigan, 1420 Washington Heights, Ann Arbor, Michigan 48109-2029, USA

SummaryTo foster comparison of policy interventions across the various categories of licit and illicit drugs, we develop atypology of policies intended to address drug abuse problems. The principal dimensions of the typology arepolicy type and intervention channel. While the typology has important limitations, as a mechanism toorganize information and stimulate thought it holds the potential to improve understanding of commonalitiesand distinctions among policies applying to widely discrepant drug problems, both within and across cultures.As such, it could contribute to the development of more effective approaches to grappling with a diverse set ofdrug policy issues.

IntroductionJust as knowledge of biochemical and behavioraldimensions of nicotine addiction can inform alcoholresearch, understanding of tobacco and health policymay offer lessons for both scholars and policymakers interested in alcohol policy. More generally,understanding policy dimensions of either of themajor licit substances of abuse might be expected toinform researchers and policy makers concernedwith illicit drug abuse; the opposite relationshipcould hold as well.

This paper develops a typology designed tocompare the nature and effects of policy interven-tions across categories of licit and illicit drugs.Comparison of specific policies across drugs clarifiessimilarities and differences in policy interventionsby type of drug and facilitates a search for lessonsthat cross barriers that now divide the communities

Presented at the seminar on 'Tobacco Use: A Perspective forAlcohol and Drug Researchers', Addiction Research Foundation,Toronto, 14 April 1988.

of interest. The analysis builds on other typologiesconcerning prevention activities (Ashley & Rankin,1988; Holder & Wallack, 1986; Walsh & Gordon,1986) and polydmg abuse (Wilkinson et al., 1987).

We begin with consideration of factors which mayjustify policy intervention to deal with a perceiveddrug problem. We then present our proposed drugpolicy typology, illustrate its use, and consider itslimitations.

Rationale for governmental interventionPolicy formation is triggered by societal and institu-tional perception of a problem for which a policyresponse appears warranted (Kingdon, 1984; Cobb& Elder, 1972; Merton & Nisbet, 1976). Given thatthe practice of public policy varies significantly fromone period to the next, it is tempting to adopt asimple empirical approach to defining the rationalefor government intervention: it is appropriate forgovernment to intervene when, with the consent of

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the governed, government determines it shouldintervene (Steiner, 1974). Although lacking inconceptual appeal (outside of a model of politicaldecision making), this answer at least offers thevirtues of simplicity and consistency.

Still, one senses that there ought to be distinctreasons to justify an intervention. This recommendsa search for a conceptual model. In reviewingdiscipline-based models of policy intervention, wehave derived a series of general principles thatstretch across disciplines and constitute a coherentset of reasons for consideration of intervention. Themajor weakness of these principles is that, in theirgenerality, they fail to draw sharp lines to determinewhen each condition is or is not met.

The point of departure for our model is thepremise that well-informed adults should have theright to engage in behaviors of their choosing so longas their actions do not impose harms or costs onothers. Many leading theorists would reject thispremise, particularly those who define society incommunitarian rather than individualistic terms(Beauchamp, 1975; Bellah, et al, 1985; Herzog,1987; Walzer, 1983). We adopt it here because itreflects what we interpret to be the dominant ethicof contemporary Western society and it exertssignificant influence in Western policy legitimationand fonnation. It should be noted, however, that theabsence of a more compelling theoretical rationalemay be a primary reason why drug-use policies areso frequent., challenged in intellectual, legal, andpolitical arenas.

The rationale for considering intervention, givenour premise, includes four basic propositions andtwo qualifications. Governmental intervention isproperly considered when any of the followingconditions exists:

(1) The consequence of drug use has significantadverse implications for members of societyother than the individual drug user, includingdestruction of property, reduced productivity,increased taxes or health care costs, crime, etc.

(2) The drug user is a minor.(3) The drug user does not possess sufficient

knowledge of the consequences of drug use tomake a rational decision on use of the sub-stance.

(4) Society finds that the drug use in question issimply unacceptable behavior, even thoughnone of the ingredients of the three precedingpropositions is present.

The first proposition is one which should receive

virtually unanimous assent in principle. The prob-lem with it, as suggested above, is the difficulty ofdetermining when the implications for others aresignificant enough to warrant intervention. Someindividuals are genuinely offended when otherschew gum, but in general (e.g. outside of elementaryschools), society does not currently view that assufficiently offensive to restrict the individual gumchewer's use of the product. Note that this qualitycan and does change over time; witness the case ofsmoking in public places (US Department of Healthand Human Services, 1989).

The second proposition is far more straightfor-ward. Western societies widely concur on theappropriateness of regulating the behavior of mi-nors, whether through compulsory education, re-strictions on their involvement in the labor force, ortheir access to licit drugs. This concurrence is basedon the assumption that minors are unable to protectthemselves and make mature, informed decisions(Gaylin, 1982).

Much like the first proposition, the third onesuffers from the lack of specificity. How muchknowledge is 'sufficient'? How does a societymeasure whether or not an individual possesses suchknowledge? Recent litigation in the United Statesover cigarette producers' liability for smokers'alleged lack of sufficient knowledge of the conse-quences of smoking illustrates the enormous com-plexities of addressing this proposition.

The fourth proposition falls perilously close tothe empirical model suggested above. Nevertheless,its inclusion is essential, as it undoubtedly repre-sents a major reason for governmental intervention.It may be particularly useful in explaining policiesthat are formulated to reflect changing publicopinion and social values by elected officials eagerto appear responsive to issues with high politicalsaliency (Price, 1978).

There are two significant qualifications to theserationales for governmental intervention, althougheach can be construed as covered by the four mainpoints. First, Donald Kennedy argues that govern-ment

"has special obligations to those exposed to riskwherever there is incentive to exploit (that is,wherever benefits accrue to the persons whogenerate the risk), and where there is a purposiveor commercial element in the addition of the risk"(Kennedy, 1983, p. 51).

Clearly, these conditions apply to both licit andillicit drug use, from the multi-billion dollar adver-

Drug policy typology 257

tising blandishments of the cigarette and alcoholproducers to the street corner tactics of the heroinpusher. We view them, however, as simply avariation of our third proposition.

The second qualification is that intervention maybe warranted when the substance in question isaddictive. We say may be warranted because it ispossible to conceive of a knowledgeable, rationaladult choosing to adopt a behavior which he or sheknows to be addictive. We do not consider addictionto constitute grounds for a wholly independentrationale for intervention because the major ingredi-ents are included in the four basic propositions,namely adoption of the behavior as an adult andpossession of adequate knowledge of the addictionpotential and implications.

Realistically, lack of appreciation of addiction bydrug experimenters creates a special situation inwhich addiction converts 'youthful indiscretion' intoa major adult problem. Surveys and simple commonsense strongly suggest that this characterizes mostcigarette smoking, much alcoholism, and muchdependence on the illicit drugs. (Bonaguro,McLaughlin & Sussman, 1987; US Department ofHealth and Human Services, 1988).

In outlining the four propositions, we have beencareful to describe them as circumstances underwhich intervention may be considered, rather thanautomatically undertaken. To convert considerationinto action, a contemplated intervention shouldhave to satisfy an additional criterion: it should haveto be sufficiently effective and efficient that the'cure' would not be worse than the 'disease'(Nadelmann, 1988; Wolf, 1988).

Policy typologyHaving determined when governmental interven-tion may be contemplated, we turn to the issue ofhow government can intervene. Governmental in-terventions range from the provision of informationto outright prohibitions on the possession or use of adrug. In Fig. 1, which presents our drug policyschema, three broad categories of intervention arearrayed at the top of the matrix from left to rightaccording to their increasing degree of coerciveness:information/education, economic incentives, andregulation (statutes and rules).

While we believe that this classification schemacovers all relevant policy options (with the impor-tant exception of the null option, i.e. doing nothing),it must be emphasized that each of these three broadcategories encompasses a diverse set of policy

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options with varying degrees of coerciveness. Theinformation/education category, for example, in-cludes everything from the least directive healthinformation presentation (e.g. the US Federal TradeCommission's publication of the tar and nicotineyields of cigarette brands) to formal education inelementary and secondary schools. The category ofeconomic incentives includes excise taxation of licitdrugs, restrictions on producers' deduction of ad-vertising expenses for tax purposes, mandatoryinsurance coverage of drug treatment and rehabili-tation, and so on. The regulatory category can rangefrom the relatively innocuous, such as the largelyignored minimum purchase age for cigarettes, to themost stringent of controls, such as felony penaltiesfor violating laws regarding the sale of narcotics.

Figure 1 includes a second dimension: the pointof intervention. Interventions can be applied di-rectly to the end user of a drug, or they can operateindirectly on the end-user through their effect onthe supply chain or other intermediaries, i.e. otherindividuals or organizations, In each case, the effecton the end user is of ultimate interest.

The point of intervention of a direct interventionis the drug user or potential user. For example, a lawprohibiting possession of marijuana for private useaffects the user directly. Interventions that influ-

258 Kenneth E. Warner et al.

ence the user through their application to someother group are indirect. Within the category of'other groups' are organizations that are part of thedrug supply chain—producers, wholesalers, retailers—and other intermediaries, groups or systems thatare neither end users nor part of the supply chain,such as the school system or restaurant owners.

As reflected in the structure of the typology,indirect interventions often represent different pol-icy types for the intervention channel and the enduser. To illustrate, the law prohibiting the posses-sion of narcotics with the intent to sell is a formalregulatory intervention from the perspective of theparties immediately impacted by the law—drugdealers—but from the perspective of the narcoticsuser (or potential user) it represents an economicintervention, because it drives up the price of thedrugs. A state law requiring public schools toprovide health education about alcohol and drugs isa regulatory measure as perceived by the schools(which are categorized as 'other intermediaries',since they are neither end users nor part of the drugsupply chain). To the ultimate recipients of thehealth education program, however, the interven-tion is informational and educational.

Classification of prominent drug policiesThe use of the typology is demonstrated by placinga dozen major policies (Table 1) within the typologycells and considering the policies' applicability toeach of four categories of drugs: the two principallicit drugs, tobacco and alcohol, illicit drugs takentogether as a category (e.g. marijuana, heroin andcocaine), and prescription drugs (as they are abusedby legitimate recipients of prescriptions; we con-sider fraudulent acquisition of prescription drugs torepresent illicit drug use).

Table 1. Prominent drug control policies

1. Mandated education2. Public service announcements3. Product warning labels4. Broadcast advertising ban5. Supply interdiction6. Excise taxation7. Mandated insurance premium differentials8. Possession ban9. Restriction on use by place10. Minimum age of purchaseU. Product composition regulation12. Mandated workplace screening

These twelve policies appear in the drug policytypology in Fig. 2. A line through a substance nameindicates that the specific policy is not feasible forthe specific drug typej brackets indicate a potentialbut not currently existing policy for the relevantdrug type; otherwise there is an existing policy forthe identified drug category.

This selection of policies shows that prominentpolicy options pertain to each of the drug types, foreach state of existence (i.e. existing policy, poten-tial, infeasible), and for each of the three policytypes. In general, policies channeled to the end userthrough an intermediary (supply chain or other)reflect regulatory measures imposed on the interme-diary.

Four of the cells are occupied by two policies. Ineach instance, comparison of the two policies offersinsight worthy of generalization. The pairing of the'mandated education' and 'broadcast advertisingban' policies in cell 19 offers an obvious conclusion:policies that seem related qualitatively often will fallwithin the same cell of the matrix. These twopolicies operate in opposite directions, the formerproviding information, the latter withdrawing it. Butthe shared objective is to increase the effectivenessof the desired message, either by supplying more ofit or by restricting the availability of competingmessages.

The policy pairing in cell 11, involving theinterdiction of drug supply and excise taxation,offers an intriguing lesson: policies that on theirsurface appear to be unrelated may in fact sharemuch in common. The former applies to illegaldrugs, while the latter pertains to legal products. Yetin both cases, the measure represents a regulatoryintervention imposed on the supply chain intendedto reduce drug consumption through an economicincentive which operates on the end user. In bothcases, the net effect of successful policy implemen-tation is to raise the price of the drug type andthereby discourage consumption. Supply interdic-tion appears here to be the analog for illicit drugs toexcise taxation of licit ones. In this context, theeffectiveness of supply interdiction can be inter-preted in terms of its effect on street price and, inturn, the effect of street price on consumption. Thefirst of these has been estimated recently (Reuter etai, 1988). The effect of street price on consumptionhas not been studied thoroughly, but careful analysisof the price elasticity of demand for cigarettes andalcoholic beverages (Cook & Tauchen, 1982; Lewit& Coate, 1982) provides a model for considerationof the likely effects of price increases for illegal

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drugs. Similarities in response to price or cost forthe legal and illegal drugs of dependence have beendemonstrated in laboratory studies with bothhumans and animal models (Griffiths et al., 1980).

The policy pairing in cell 3 combines the twopreceding conclusions. An outright ban on posses-sion (policy 8) and restriction of use by place

(policy 9) sound similar in nature, yet each appliesuniquely, the former to illicit drugs and the latter tolicit drugs. Thus, there are policy types that arequalitatively similar, even if they can only beapplied to one category of drug or the other.

The final policy pair, in cell 12 (minimum age ofptirchase and regulation of product composition).

260 Kenneth B. Warner et al.

offers an intriguing comparison of policies for thelicit drugs and the 'in between' category of prescrip-tion drug abuse. We consider the latter 'in between'licit and illicit because prescription drugs are notavailable for unrestricted purchase, yet neither arethey illicit. Minimum age of purchase (policy 10) isan existing policy for tobacco and alcohol and apotential policy for prescription drugs. Conversely,the regulation of product composition (policy 11)applies currently to prescription drugs and remainspossible for tobacco and alcohol.

The fact that several cells, comprising threeentire rows, are blank does not mean that nointerventions are available. For example, educationprograms for restaurant and bar owners concerningtheir liability under 'dram shop' laws would fit intocell 6 and the liability which is placed on the ownerwould fall into cell 9. A sharp increase in the cost ofa liquor license might fall into cell 9 as well. Thus,this brief examination of findings from the typologymust be considered simply illustrative of thepotential lessons that can emerge from use of thetypology.

Limitations of the typologyThe first limitation is that use of the matrix is bothtime- and place-dependent. While policies mayalways fall within the same cell conceptually, thestate of application of the policies (existing, poten-tial, infeasible) will depend on when the analysis isoccurring and where the jurisdiction for policyimplementation lies. Legally, some policies may befeasible at one level of government but not atanother. For example, under current U.S. law, statescannot regulate the labeling of cigarettes or contentof cigarette advertisements. Thus, the feasibility ofchanging the Surgeon General's warning on ciga-rette packs and advertisements differs for states(infeasible) and the federal government (feasible).With regard to time dependency, this distinction didnot exist prior to federal legislation in the 196O's.

Similarly, certain long-available policy typesbecomes politically fashionable in different timeperiods, viz. today's interest in legalization of illicitdrug use and military intervention to restrict drugimportation. Thus, there is a dynamic dimension touse of the typology that is not captured in the staticformat shown here.

A second limitation is really a qualification:characterization of the policy-type dimension asprogressing from the least coercive category (infor-mation/education) to the most coercive (regula-

tion) can mask differences in coerciveness that strayfrom this rule of thumb. Clearly, there is consider-able variation in the coerciveness of policies foundwithin any given cell. An example is the differencebetween an excise tax often cents per bottle of beerand a tax of $10,000 per ounce on the importation ofmarijuana. While conceptually similar in one respect(i.e. they are both product-specific taxes), theyreflect quite different policy objectives. Similarly,the actual coercion associated with a specificregulatory measure may fall dramatically short ofthat associated with an economic incentive. A lawoutlawing the sale of cigarettes to minors, ifunenforced and subject to no penalty, is signifi-cantly less coercive than the aforementioned mariju-ana tax (DiFranza et al., 1987).

The remaining limitations are more substantive.As it now stands, the typology does not considerwhether alternative policies are politically accept-able or institutionally implementable. Nor does itconsider the political and bureaucratic processes bywhich policies are selected and implemented, or therelationship between drug policy and other policyareas on a national political agenda. Thus, we cansay very little about the intensification in the 198O'sof public and governmental concern over drug useand related, policy options and the concomitantlegitimation of a range of policy options that wouldhave been deemed politically unthinkable in priordecades.

For a variety of reasons, the typology is of limitedutility in assessing policy effectiveness. For anyindividual measure, the matrix offers no insight intoinherent effectiveness potential. Beyond the inher-ent potential, a variety of forces will infiuence theextent to which that potential is approached. Forexample, the discretion of the implementing agencywill influence effectiveness to varying degrees,depending in pan on inherent characteristics of thepolicy and of the law or regulation defining it. Thelevel of compliance with a policy will influene itseffectiveness; again, the matrix is silent on thismatter, both within cells and even within specificpolicies. Finally, the nature and level of enforce-ment may profoundly impact realized effectiveness(Hardin, 1982; Hawkins, 1984; Russell et al, 1986).Each of these factors could be included in thetypology matrix as an added dimension, but at theprice of introducing complexity that might obscurethe basic purpose of the typology.

One unanticipated 'finding' in Fig. 2 reflectsmany of the typology's limitations and shows howuncritical application of the typology can lead to

Drug policy typology 261

misinterpretation of the policy environment. For thepolicies categorized in Fig. 2, three indicate thattobacco policies exist while comparable alcoholpolicies do not but could (i.e. they are 'potential');none indicates the reverse (i.e. existing alcoholpolicies but only potential tobacco policies). Thiscould leave the reader with the impression that thereis more (and perhaps implicitly better) policypertaining to tobacco than to alcohol in the UnitedStates. Such an impression could be erroneous. Thefailure of Fig. 2 to show this reflects, for example,the fact that both tobacco and alcohol are recordedas having existing minimum age of purchase laws(policy 10). When one considers the nature andextent of such laws and of their enforcement, onerecognizes there is a dramatic distinction betweenminimum age laws in the cases of tobacco andalcohol. Our typology does not capture suchdistinctions.

ConclusionAs the preceding discussion suggests, the limitationsof this exercise in drug policy classification aremany. At the same time, the potential for use of thematrix to generate insights into constructive ap-proaches to drug policy development seems con-siderable. The process of identifying and classifyingpolicies as they pertain to different types of drugproblems can broaden perspectives on optionsavailable. Comparisons such as the supply interdic-tion/excise taxation pairing in Fig. 2 (cell 11) holdthe potential of generating understanding of themechanisms by which policy interventions maywork, and of their possible effectiveness.

A significant strength of the policy matrix is itspotential to contribute to fruitful comparativeanalysis at several levels, including comparisonsbetween the major licit drug problems, tobacco andalcohol; between illicit drug issues (e.g. marijuanaand cocaine); and between the broad categories oflicit and illicit drugs. The typology lends itselfnicely to cross-cultural or cross-national compari-sons, serving as a device to stimulate considerationand analysis of different countries' approaches toboth similar and divergent drug problems.

As the discussion of limitations demonstrated,this approach to classifying drug policies holds littlepromise of offering definitive answers to pressingsocial questions. Nevertheless, as a mechanism toorganize information and stimulate thought, it mayrepresent a device worthy of exploration anddevelopment.

AcknowledgmentThis work was supported by a grant from theMichigan Governor's Prevention Initiative, ad-ministered by the Office of Substance AbuseServices.

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