Ideation, social construction and drug policy: A scoping review

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Abstract

Within drug policy scholarship there is a growing body of literature applying ideational and social constructionist approaches to address the complexity of drug policy making and the apparent failure of the evidence-based policy paradigm to free the process from controversy and contestation. Ideational approaches are concerned with the roles played by ideas and beliefs in policy making, while social construction explores the way policy problems are constructed, and agendas are set and delineated by dominant frames and narratives. Interest in these approaches has developed over the last two decades, but has rapidly gained momentum over the last five years. There has been limited reflection on the state of the field, therefore it is timely to conduct a review of the literature to assess the value of these approaches, capture emerging themes and issues, and identify gaps in the literature to support future research directions. Using the Arksey and O’Malley framework, a scoping review was conducted to survey the breadth of the field. Following database and hand searching, 48 studies from 1996 to 2016 were selected for inclusion in the review. A narrative synthesis was undertaken and the literature was grouped into five broad theoretical approaches: ideational policy theory, problem construction, narratives and frames (including media analysis), construction of target populations, and policy transfer and mobilities. The majority of the studies are focused on single countries and drug policy issues, with few studies undertaking comparative work or reflecting on general theoretical developments in the literature. This study found that the Arksey and O’Malley framework was effective in capturing a potentially diverse field of literature and demonstrates the importance of ideational and social constructionist approaches to drug policy scholarship. Further research is required to achieve expanded geographic coverage, test policy making models and undertake comparative work.

Introduction

Drug policy scholarship is an emergent field at the cross roads of public policy and public health. Inspired and informed by public health research findings, but drawing from the social sciences, drug policy research focuses on exploring the processes and outcomes of policy making in relation to illicit drugs. Those focused on reforming drug policy have highlighted the detrimental public health consequences of existing policy to argued for re-orienting drug policy away from a regime that penalises drug users to one that seeks to reduce the harms associated with drug use (Rhodes & Hedrich, 2010). The close alignment of the harm reduction movement and public health extends to embracing the evidence-based paradigm that has dominated policy making in recent years. Both the Vienna Declaration (Wood et al., 2010) and more recently, the statements issued by the Commission on Drug Policy and Health (The Lancet, 2016) appeal to governments and international bodies to bring public health evidence to bear in policy debates and considerations. However, as Ritter and Bammer capture, researchers have been “vexed” by the way evidence has been both utilised and underutilised in policy making and from this frustration has emerged a rich field of research that explores the complexity and messiness of the policy making process by introducing and testing concepts and models from political science (Ritter & Bammer, 2010). While a considerable body of scholarship continues to pursue the goal of achieving evidence-based policy (EBP), an alternative stream is drawing on ideational and social constructionist accounts of policy making to explore the roles in public discourse and policy formulation of evidence, politics, stakeholders, ideas and beliefs.

The research question posed by this review is how have ideation and social constructionism been used to analyse drug policy? These two broad theoretical approaches have been chosen as they have been identified as two of three dominant narratives of policy that are being used to explore and challenge drug policy (Stevens & Ritter, 2013). Under the other stream, characterised as ‘authoritative choice’ by Stevens and Ritter (2013), policy constitutes a technical process of solving problems where government is the key actor. The evidence-based policy (EBP) paradigm exemplifies this approach and has been subject to robust critique both generally (Nutley, Davies & Walter, 2007; Smith, 2013), and specifically in relation to drug policy (Bennett and Holloway, 2010, Monaghan, 2010; Nutt, King, Saulsbury, & Blakemore, 2007). This review, therefore, is concerned with the emerging literature that constitutes a post-EBP approach to policy analysis and a challenge to this dominant narrative.

Ideational theorists contend that ideas are a primary source of political behaviour, as they shape not only how we understand political problems but how we subsequently develop and embrace (or reject) approaches to those problems (Béland and Cox, 2011, Braun, 1999). Ideational approaches provide a way of accounting for a myriad of influences in politics by including actors whose roles had previously been marginalised in political analysis, such as non-political organisations and networks. Ideas are also at the heart of social constructionist approaches to exploring policy making with a particular focus on problem construction, the impact of the construction of target populations, and frames and narratives. Rather than see policy making as a rational, linear process where solutions are produced in response to recognised and understood problems, social constructionists see the problems themselves as being constructed through the policy making process. Bacchi’s (2009) work has been particularly influential in this regard, inspiring extensive use of her framework which asks what the problem is represented to be, in order to challenge underlying assumptions as to the policy problem that is being addressed.

This growing literature applying ideational and social constructionist approaches to drug policy has developed over the last two decades, but has particularly picked up pace in the last five years with more works appearing in peer review journals and on conference programs. It is therefore timely to scan the field to establish the emerging themes, issues and theoretical approaches. While some impressive studies exist that address particular drug issues or interventions, there is surprisingly little work that has yet to reflect on the state of the field of scholarship and its future directions.

This literature review applies the Arksey and O’Malley (2005) framework for scoping reviews in order to capture and summarise the breadth of scholarship in this field. A rigorous search strategy was employed, data charted and the results collated and summarised in a narrative synthesis organised by guiding themes. This framework was chosen as it provides a means of methodically scoping and describing the body of literature concerned with ideational and social constructionist approaches to drug policy, and identifying gaps in the literature. This review focuses on the body of work that is emerging as a critical response to the rise of evidence-based policy approaches to drug policy and therefore a scoping exercise to understand the extent and nature of the work is appropriate. This paper is organised to reflect the five stages of the review framework, as described in the method below, and concludes with a discussion of the results and consideration of the limitations of the review.

Section snippets

Method

The Arksey and O’Malley (2005) framework for scoping reviews provides a means of summarising and capturing the breadth of literature in a particular field. It has similarities with the systematic review method, but where systematic reviews generally focus on narrow areas of inquiry with an emphasis on the quality of studies, scoping reviews are more concerned with the “extent, range and nature of research activity in a particular field” (Brien, Lorenzetti, Lewis, Kennedy, & Ghali, 2010). The

Stage 1: the research question

A broad research question was established, asking how have ideational approaches and social constructionism been used to analyse drug policy? Drug policy is narrowly defined, focusing on government policy that addresses the issues arising from the use of illicit drugs, with a particular but not exclusive focus on health outcomes. Excluded from the area of inquiry (unless there is an explicit link to drug policy) is literature primarily concerned with drug addiction, drug treatment, drug supply

Stage 5 collating, summarising and reporting the results

In keeping with Arksey and O’Malley’s (2005) framework, this final stage of the review presents the results in two parts. The first section reports the outcomes of applying quantitative analysis to the charted data to present a picture of the scope and distribution of the literature. The second part presents a narrative synthesis of the literature which is organised thematically according to the dominant theoretical approaches that were first analysed through the initial charting of the data.

5.1: Scope and distribution of the literature

Discussion

The application of the Arksey and O’Malley (2005) framework to a scoping review of this nature has proved both appropriate and efficient. While there are some limitations (discussed below), the method works to capture the breadth of literature in this field by initiating the search through rigorous database querying, augmented by hand searching. As the results demonstrate, drug policy scholarship’s adoption of ideation and social constructionist approaches goes back only twenty years and as a

Conclusions

This scoping review has served to capture the body of literature that has emerged in response to the challenge of understanding contemporary drug policy making as a post-evidence-based policy construct. It has demonstrated the potential of both ideation and social construction to explore critical questions that relate to the role of evidence, the influence of stakeholders and the power of problem construction and framing. Arksey and O’Malley’s (2005) framework proved to be an effective means of

Author declaration

I wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

I confirm that I have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing I confirm that I have followed the

Conflict of interest statement

The author declares that there is no conflict of interest.

Acknowledgements

Vanessa Gstrein is a recipient of an Ulster University Vice-Chancellor’s Research Award. Thanks to Ann Marie Gray, Karl O’Connor and Gordon Marnoch for their comments on an earlier draft of this paper.

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