Costs and human suffering from drug use in four Nordic capitals



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Costs and human suffering from drug use in four Nordic capitals
Hans Olav Melberg (1)

Pekka Hakkarainen (2)

Esben Houborg (3)

Marke Jaaskelainen (4)

Astrid Skretting (5)

Mats Ramstedt (6)

Pia Rosenqvist (7)

(1) Health Economist at the University of Oslo (hans.melberg@gmail.com)

(2) Senior Researcher, The National Institute for Health and Welfare (THL), Finland

(3) Centre for Drug and Alcohol Research, University of Aarhus (eh@crf.au.dk)

14. February, 2009.
Abstract

This paper presents the results from a survey that explores different approaches to quanitify the human suffering related to drug use in the Nordic capitals. The results show that, with the exception of Finland, more than half of the respondents at some time have known and worried about the drug use of somebody they personally knew. Moreover, while the average reported harm was about 2 on a scale to 10, a significant minority (10%) of those knowing drug users indicated that the harm was very high, with females scoring significantly higher than males. The results can be used to give a more accurate estimate of the overall costs of drugs and its distribution which in turn is important in the debate about how large priority the drug sector should be given and how the money should be spent.


Introduction

There are at least two important and ignored topics in the literature on the social cost of illegal drugs. First of all it often ignores human suffering associated with drugs. Second, it does not focus on friends and family of the drug users. This study explores how population surveys could be used to fill this gap and reports on one such large survey in the Nordic capitals.


The quantification of human suffering is important in itself, but it is also has important policy implications. The immediate consequence of leaving out human suffering is to underestimate the social cost of drugs use. Often studies of the social cost of drugs quantify costs born by society at large – health costs, crime costs, lost income - but not the human consequences felt by those who are close to the user (see, for instance, French and Martin, 1996, Single et al., 1998, Culyer et al., 2002). This under-estimation may in turn lead to under-prioritization of the area as a whole. Moreover, if the success of a policy is measured by its ability to reduce the costs associated with drugs, then leaving out important cost categories will lead to skewed policies. We will get policies aimed at indicators that happen to be easily available, instead of policies that focus on indicators of the overall problem. For both these reasons, to avoid under-prioritization and misguided policy aims - it is important to get a better understanding of the human suffering associated with drug use.
Although important, the problem of measuring human suffering is sometimes viewed as both redundant and impossible. Redundant in the sense that existing policy goals and indicators indirectly take human suffering into account. Impossible in the sense that human suffering is believed to be beyond quantification. We will deal with each argument in turn.
The redundancy argument centers on the assumption that commonly used measures of the size the drug problem – like prevalence and social cost - are so strongly correlated with human suffering that there is no need to measure it separately. Although human suffering is related to prevalence, Caulkins and Reuter (1997) have pointed out that use-reduction is not perfectly correlated with harm-reduction. There are policies, such as needle-exchange programs, which make it easier to use drugs while at the same time reduce the harm associated with drug use (e.g. the risk of being infected with Hepatitis B). Because of the imperfect relationship between prevalence and harm it is important to avoid focusing only on prevalence goals. More generally, it illustrates that there is a need to work on alternative indicators of the size of the drug problem.
Another often used indicator of the size of the drug problem is the social cost of drugs, but this approach has both empirical and conceptual problems. Empirically it is very difficult to get precise estimates of the various cost categories. For instance, drug related health costs are based both on imprecise estimates of the costs of treating various diseases and the fraction of these costs that can be attributed to drug use. Even if precise estimates were available, there is conceptual disagreement on what kind of costs that should be included. For instance, prison costs could be viewed as an external cost that drug users impose on society, but it might also be viewed as a control cost which society itself has chosen to incur by making drugs illegal. Including prison costs could also create problems if policy success is judged by the degree to which it reduces the social cost of drugs. This could create self-reinforcing policy justifications in which the high cost of drugs is used to justify tougher interventions and longer prison terms, which in turn might increase the estimated cost of drugs even more thus leading to calls for an even tougher policy. Other cost categories are equally controversial: lost income because of drug use (early death and or unemployment) is not an external cost, but a cost born by the drug users themselves. The cost of the drugs itself is sometimes included, but often excluded. The value of stolen goods is sometimes argued to be a transfer, and other times it treated as a social cost. Altogether these empirical and conceptual problems raise doubts about the reliability and validity of the cost-of-illness approach to measure the social cost of drugs (see also Reuter, 1999; or Moore and Caulkins 2006 for more on the problems with the cost of illness approach and suggestions on how to improve it).
In recognition of the problems with the social cost approach and prevalence as a policy goal, there has been an increasing interest in measuring harm and using harm reduction as a policy goal. This, in turn, has stimulated several attempts to create a harm index such as the UK Drug Harm Index (MacDonald et al, 2005, see also McFadden, 2006). To some extent this index is exempt from the criticisms above since it tries to quantify some of the human suffering associated with drugs. However, even this index does not include the suffering of family and friends of drug users. One of the reasons for the failure to include human suffering when measuring the drug problem is that it has been considered very difficult to quantify. For instance, the authors behind the UK Drug Harm Index understandably chose to focus on data that was available and the suffering of friends and family is not a number produced by a national statistical office. However, this leaves the research community with a challenge: Is it possible to develop methods to measure human suffering related to drug use?
Previous research on the monetary cost of human suffering is very sparse. In one of the few references to the issue, Kleinman (1999) has suggested that that including human suffering could increase the estimated cost of drugs by more than 80% if we assume that each drug user had 10 individuals who were willing to pay 1000 USD to help the drug user. However, Kleinman’s suggestion that willingness to pay could be used to estimate human suffering has not been investigated empirically. We do not know how many persons are affected or how much they are willing to pay.
In another study, Zarkin et al (2000) presents a pilot survey that quantifies society’s willingness to pay for treatment. On average people indicate that they were willing to pay 37 USD for a program that successfully treated 100 drug addicts. They also found that the willingness to pay for treatment did not change when the number of successfully treated addicts in the proposed program increased from 100 to 500. This reveals a common problem facing such studies. Many people have not thought about the problem and when asked to put a monetary value on something, they tend to give answers that reflect an underlying opinion more than a true quantification (“drug treatment is a good thing, I will support it”) or an answer that is largely influenced by random factors. This points to problems with measuring human suffering in money, but it does not imply that quantification impossible. By noting the problems, one may try to explore ways of quantification that reduce the difficulties. We have explored several such methods described in the next section.
Design and method

In order to quantify the human suffering of friends and relatives of drug users, it is necessary, first, to determine how many are affected. Second, we need to know in what ways they are harmed. The third and most difficult challenge is to convert the various harms into one unit so it can be aggregated and give us an indication of total harm. This may, but need not, be in the form of harm measured in terms of money.


The results in this paper are based on a representative survey of 3092 individuals above 18 years old in the four Nordic capitals (Copenhagen, Stockholm, Oslo, and Helsinki). The survey consisted of 34 questions and was conducted by the Synovate. They have recruited a representative sample of the population in a panel. The members in this panel received an e-mail invitation to participate in the survey by filling in answers anonymously in a web-form. A choice was made to sample only the capitals and not the population of the whole country because this would have required many more respondents. Because the prevalence of drug use is higher in the Nordic capitals than in other parts of the countries, it was supposed that we can reach a sufficient amount of respondents influenced by somebody's drug use in our sample. However, it should be noted that the population in the capitals is not representative of the whole country, so one should be careful to limit the generalizations from the sample to the capitals only and not the whole country.
Table 1 The gender composition, average age and the education of the sample compared to the general population*

Country

Percentage female

Average age

(of population above 18)

Percentage who have completed a university education




Sample

Capital

Country

Sample

Capital

Country

Sample

Capital

Country

Denmark




50,5

50,7







39,6




15,2

7,2

Finland

52

53.3

51

44.3

40

40.9

32.6

24

15

Norway




50,2

50,2




44.9

47.5




10,1

4,5

Sweden

50,3

50

49

44,2

43,1

44

53,2

27

19

* Some numbers are still missing.
As seen in the Table 1 the figures for Finland differ from the figures for the whole country especially in the level of education of the population. One third of our respondents were completed a university degree. The average age of the respondents was also a bit higher than in the population. The sample from Stockholm was also clearly overrepresented by people with a higher education with more than half having completed a university education compared with 27% in the general population of Stockholm. Men and women seem however to be accurately represented as well as the age structure.
Although the participants were recruited from a representative panel, there is still the quite likely possibility that those who agreed to participate were more interested in the topic of drugs than the average panel member. In the end, more than 50% of those who were invited accepted and responded. This means that although there may still be some selection effects, the survey did not only get answers from a small minority of the representative panel.
The questions were designed to test several different ways of measuring suffering. Given the problems associated with direct monetary questions, we decided not to focus exclusively on measuring harm in monetary values but also to explore three different quantifications of harms. First, after determining how many people who are affected we asked about the prevalence of specific types of harm such as fear of violence, having to call the police and seeking professional help. Moving one step closer to measuring aggregate harm, we also asked the respondents to indicate how much they had been affected on a scale from 0 (no negative impact) to 10 (my life has been destroyed). In these questions the respondents gave answers both in terms of life experiences as well as the past 12 months
In order to better interpret the reported harm we asked the respondents to compare drug addiction to several other illnesses or events such as being paralyzed, becoming blind, or suffering a severe burn injury. Finally, we also ask about monetary valuation. In these questions we distinguished between willingness to pay in general and willingness to pay for a friend or a relative. In this way the survey was designed to explore different methods, to compare the consistency of the answers and to explore which method that seemed to give the most valid and reliable answers.
Before completing the survey each respondent was informed about the aim of the study as well as the definition of key phrases. Of special importance is the phrase “a drug user you personally know.” This was explicitly defined in the instructions as “a person who is close to you, a relative or a friend, or a person you at least know the name of and have talked to.” The aim of this design was to avoid exaggerating the share of the populations that was affected as well as making sure that the respondents interpreted the question in the same way.
The answers were analyzed using SPSS. During the analysis it was discovered that the responses contained a few answers that seemed to reflect misunderstandings of unwillingness to confront the difficult choices presented in the questions. For instance, some respondents reported a willingness to pay that was a above 999 million or below 1 for a spouse. Although logically possible, the survey format was such that they had to give an answer to go on to the next question. Because of this it seems like these respondents simply filled in many zeros or nines in order to indicate a refusal to answer or to express an infinite value. Including these numbers when calculating averages was difficult since it implied that a few observations would influence the results greatly. For this reason we decided to use only those responses which indicated a willingness to answer the question when discussing the monetary values.
How many are affected?

In Copenhagen, Oslo and Stockholm more than half of the respondents had at some point in their lives been worried about drug use for somebody they knew personally. In Helsinki their share remained a little below a half (45 %). Consequently the share of worried respondents within the past 12 months was over 20% for Copenhagen, Oslo and Stockholm, and 13 % for Helsinki. A large share of the population, a majority in Stockholm and more than one third in other capital cities, personally knew somebody who had been treated for addiction to illegal drugs. For more than 10% this had taken place within the past 12 months.



Table x: “Have you ever felt worried about the drug use of a person you know personally?” and “Do you personally know somebody who has been treated for addiction to illegal drugs?”




yes, know + worried




Yes, know treated




life

12




life

12



















Copenhagen

67

27




38

10

Helsinki

45

13




38

14

Oslo

61

22




49

14

Stockholm

56

28




54

18

These numbers indicate, first of all, that drug problems are not isolated to a small minority. In most capitals more than half of the respondents had personally known and been worried about somebody with a drug problem. This is perhaps a better and more easily understood measure of how large the problem is than an abstract and inaccurate monetary estimate of the social cost of drugs. However before accepting the numbers as reliable and valid, one must examine the numbers more closely with particular attention to the numbers from Finland.


The second striking fact about the table is that a significantly smaller share of people in Helsinki personally knows a drug user with a worrying consumption. If we are to believe the numbers and take them as indicators of the size of the drug problem, this difference needs an explanation. One way of examining whether the pattern in the table is reasonable, is to compare the results with prevalence numbers. If one excludes the alternative that people in Helsinki have fewer friends or do not care so much about the level of drug use among their friends, the results above indicate that drug prevalence in Helsinki should be lower than the other capitals. The actual prevalence numbers are presented in Table x. In agreement with the results on knowledge of drug users, Denmark has both the highest drug prevalence as well as the largest share of people who personally know and worry about a drug user. As expected the Finnish prevalence rates are significantly lower than Denmark but the difference between Finland and the other Nordic countries in terms of lifetime cannabis prevalence is not very large and cannot explain the difference between Finland and Sweden/Norway. However, consumption of hard drugs is often a cause of more concern and this is higher in Norway than Sweden. Lastly, the number of heavy drug users has traditionally been higher in Sweden than in Finland (Olsson et al 1997). In fact, the drug situation in Finland was very moderate for a long time, and it did not change until the second half of 1990s, which may be reflecting in the lifetime figures of knowing and worrying (Hakkarainen & Tigerstedt & Tammi 2007). In sum, the share of population who know and worry about a drug user in the capitals has a general trend that is in agreement with the prevalence numbers, with Denmark scoring highest in both categories.

Table x: Life time prevalence of drug use in the Nordic countries


Country

Year

Age range all adults

Sample size all adults

Cannabis

Cocaine

Amphetamines

Ecstasy

LSD




 

 

 

 

 

 

 

 

Denmark

2005

16–64

13310

36.5

4

6.9

1.8

1.7




























Finland

2006

15–64

2802

14.3

1.1

2.2

1.6

1.1




























Norway

2004

15–64

2669

16.2

2.7

3.6

1.8

1.1




























Sweden

2000

16–64

1750

12.5

0.7

1.9

0.2

0.3




























Source: EMCDDA (http://www.emcdda.europa.eu/stats08/gpstab1a)

Affected in what way?

In all the capitals more than 20% of the respondents answered that they had experienced fear of violence from a drug user they knew personally in their lifetime, with between 5% and 9% having experienced this during the past 12 months. Roughly 10%, had sought professional help for themselves as a result of their relationship with the drug user, and 3% had done so during the last year. With the exception of Finland few had called the police because of the illegal drug use of somebody they knew personally – between 3 % and 11 % had ever done so and between 1% and 3% had done so during the last year.



Table x. Have you ever feared violence/sough professional help/called the police because of the use of drugs among somebody you know personally?”




Feared violence

Sought professional help

Called police




Life

Last 12 months

Life

Last 12 months

Life

Last 12 months






















Copenhagen

21

5

8

2

3

1

Helsinki

30

9

12

4

11

3

Oslo

20

5

10

4

4

1

Stockholm

23

7

13

3

6

1

One of the striking facts about the results in Table x, is that despite having the lowest prevalence and lowest share of people who know and worry about a drug user, Helsinki ranks highest on several indicators of how badly affected those who know drug users are. In Helsinki those who know drug users have a higher fear of violence and a much higher history of calling the police. One interesting explanation for this could be that the rarer drug use is, the more frightening it is for those who are close to a drug user. Denmark, for instance, has traditionally de-mystified drug use and although the prevalence numbers are high, they score low in term of how badly people are affected. On the other hand, until to the end of 1990s drug policy in Finland was based mainly on police control, and it is possible that people still put reliance on police authorities as their first reaction (Tammi 2007). However, it is also possible that the measured categories do not capture all the main dimensions of harm to others and for this reason a broader question was necessary. This brings us over to the next question which made the respondents reflect on the overall impact they had experiences as a result of knowing a drug user.


When those who knew drug users were asked to sum up to what extent the drug use had affected them on a scale from 0 (no harm) to 10 (“it has ruined my life”), the average answer was between 2 and 2.6 in a life perspective and slightly higher than 1 during the past year in all the capitals. This time respondents in Helsinki reported the lowest average, thus indicating that this question captured different dimensions of harm than the previous question about fear of violence, calling police and seeking professional help. This, then, seems to be a better indicator of overall harm among those who are affected.
A total score of 1 or 2 may not seem like a large harm on a scale of 10, but this average conceals a minority who are significantly negatively affected. This is visualized in Figure x which shows the share of respondents who report a harm of 5 or higher. In Copenhagen and Oslo more than 20% of those knowing drug users reported a harm of 5 or higher as a result of knowing drug users during their lifetimes. In Stockholm it was close to 20%, while in Helsinki it was about 15%. Even limiting the period to the past year, almost 10% reported to have been seriously negatively affected. This gives some indication that although the average impact may be low and most people knowing drug users are only moderately affected, there is a significant minority – about 10% of those who know drug users – who suffer greatly.
The answers about harm also contain a significant gender imbalance. As illustrated in Figure x, females reported much higher negative harm as a result of knowing drug users as compared with males. The tendency was the same in all the capitals and it shows a gender dimension of human suffering that estimates of social costs often overlook. When using reported harm as an indicator of drug problems, it is easy to identify groups that suffer more than others and to quantify exactly how much more they are affected.

Table: If you know somebody who use drugs regularly, how would you say it has it affected you on a scale from 0 to 10 (0 is no negative effect and 10 is “it has ruined my life”)




Life perspective

Last 12 months

Expected (if friend started to use)

Copenhagen

2.6

1.2

3.9

Helsinki

2.0

1.1

5.7

Oslo

2.6

1.4

6.1

Stockholm

2.5

1.2

6.2















Figure: “How has it affected you during the last 12 months?” Percentage responding with 5 or more on a scale where 0 is no negative effect and 10 is “it has ruined my life”


Figure x: Gender differences in harm. If you know somebody who use drugs regularly, how would you say it has it affected you on a scale from 0 to 10 (0 is no negative effect and 10 is “it has ruined my life”)

In order to better understand the harm scale the respondents were also asked to rank some other illnesses and situations on a scale from 0 to 10 (Figure x). In this way one may hope to find a reference point for how bad a harm of 2 or 5 is interpreted to be. For instance, the respondents indicated that for a young adult becoming addicted to drugs was about as bad as becoming blind with a harm score of about 7.5. Becoming paralyzed or getting lymph cancer was ranked as slightly worse than drug addiction while having diabetes or asthma was given a value of about half that of becoming a drug addict.


Although the numbers are interesting, one needs to be careful when interpreting these results. In addition to the unavoidable problem of how different people interpret “becoming addicted to drugs”, “cancer” and so on, there is a problem of determining the validity of the scores. People who have not experienced something themselves often have wrong conceptions of how bad or good something is. This means that one should not to simply use the results to argue that “becoming addicted to drugs is about as bad as becoming blind.” Or that “people reporting 4 on the harm scale when asked about how they have been affected by drug use among friends means that they suffer a harm equivalent to getting diabetes.”
The problem is well illustrated by comparing answers about experienced level of harm among those who know drug users to expected level of harm among those who do not drug users (Table x). Those who do not personally know a drug user believe they would experience very high levels of harm if they had had a friend who used drugs. The expected harm was more than twice as large as the experienced harm reported among those who actually knew a drug user. This shows that it is difficult to rely on expected harm to assess the actual level of harm. It also reveals something about how many people view drug addiction compared to other illnesses and events. This is interesting information is in itself since it shows how society view different illnesses and events - which in turn has consequences for how much effort we put into preventing these. It is also interesting to observe that the answers are remarkable similar in different countries. Together these answers suggest that an important part of the harm of drugs is related to fear and that the fear itself is not well founded. Those who actually experience drug use among their friends do not suffer as much as one may expect.

Figure: On a scale from 0 to 10, how bad is the following for a young adult …



Money

Social costs are often measured in money. The question then becomes whether it is possible to convert the harm suffered by friends and family into money in order to include this in the measure of the social cost of drugs? One way of doing so would be to explore individuals’ willingness to pay in order to treat drug addicts. The problem is that it is difficult to know whether the answers reveal a true willingness or if the answer is influenced by the wording of the question and other well known mechanisms that may distort the answer. In order to examine this, we asked several questions. Firstly, we asked about willingness to pay for a friend. Secondly, we asked about willingness to pay for treatment for a drug addict in general by way of increasing taxes. Thirdly we asked more open ended questions in which the respondents could state the amount of money they were willing to pay in order to pay for the treatment of their children, their spouses, and their friends.


The results in Figure x, show that in Norway and Denmark there was a slight majority in favour of a tax increase of about 100 Euro for each tax-payer to finance the treatment of 800 more addicts each year, while in Sweden and Finland about 40% agreed. When asked whether they would contribute about 500 EURO to help finance treatment for a friend, the respondents gave slightly more positive answers in all countries, with the exception of Sweden where asking about a contribution to a friend gave a significantly higher positive response (an increase of 12 percentage points to 52%) than a tax-increase for more treatment.

Figure: Willingness to accept tax increased to pay for more treatment vs willingness to contribute financially to the treatment of a friend

The results about willingness to pay for treatment of individuals are highly dependent on the nature of the relationships. There is also a large degree of variation between the respondents and some individuals reported extremely high sums. In this case it is more informative to report the median response so as to avoid averages that are heavily influenced by a few observations.


In all the capitals the highest median willingness to pay was observed for the respondents spouse, followed by their child, sibling and, lastly, friend. For friends and siblings, the answers are very similar with willingness to pay for friends being about half of that for siblings. In Helsinki, the absolute willingness to pay for spouses and children was substantially less than in the other countries, but the relative willingness to pay for spouses compared to children was high in Helsinki.
Table: About how much of your own money do you think you would be willing to pay for the treatment of your own …(median answers converted to EURO)




friend

sibling

spouse

child

Copenhagen

678

1 356

13 563

6 782

Helsinki

500

1 000

5 000

2 000

Oslo

575

1 149

11 494

5 747

Stockholm

505

1 009

7 569

5 046


Human suffering measured in money?

By combining the information in the various questions it is possible to get an idea about importance of human suffering. Using Kleinman’s suggestion about measuring human suffering by the willingness of friends to pay for treatment, we first examine the number of respondents reporting to have friends who also report to be willing to pay at least 450 Euros to pay for the treatment of a friend. For instance, in Oslo 14% of the respondents fulfilled these two conditions. When 14% of the adult population is willing to pay at least 450 Euro, this implies that human suffering associated with drugs is at least 29 million Euro or about 52 Euros per capita. As a comparison, about 30% of jail inmates are convicted of drug offences which imply an average prison cost of about 17 Euro per capita. This shows that human suffering is a large component of the social cost of drugs and that ignoring it would produce very misleading estimates.


One might argue that reported willingness to pay is often higher than actual willingness. This is sometimes true, but it should be noted that the estimate above is conservative for several reasons. Some of the respondents reported that they were willing to pay much more than the sum listed in the question and used in the calculation (450 Euros), some have more than one friend whom they would be willing to pay for, the estimate does not include willingness to pay for spouses and children, and some are willing to pay for treatment even when they do not personally know people who use drugs. Taking into account all of these factors would produce a much larger sum. However, to establish the importance of human suffering compared to other cost categories, it is not necessary to get into the more complicated calculations since even the very conservatively estimated monetary measure of human suffering produced a sum that was larger than the other costs.
CONCLUSIONS

Our results show that it is important to include human suffering to get a more accurate picture of the overall cost of drugs in society. Ignoring this could lead to under-estimation which in turn could result in under-prioritization of the area as a whole. In this way the results are useful in a general debate about how much resources society should allocate to the drug sector. The results also show that every year about 25% of the population of the capital cities know and worry about a drug users and that about 5% of those knowing drug users report a harm of more than 5 on a scale from 0 to 10. Finally, the results highlight the unequal distribution of the costs. The main costs were not born by the state or society at large, but the females who were close to the drug user. Although this is not surprising, the extent and size of the difference between suffering reported by males and friends on the one hand, and female relatives on the other, was very large.



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Appendix. The survey questionnaire

(Some changes were made in the different countries)
Preface

This survey is part of a project in which we try to measure and compare the human and monetary cost of illegal drugs in the Nordic countries. All the answers are anonymous. Some of the questions involve comparisons between seriously bad health events and states. You should be warned that these may at first seem odd or somewhat insensitive, but please try to answer as best you can. We greatly appreciate your effort and input.


Many of the questions use the phrase refer to people you “personally know.” This means different thing to different people. In this survey we use “personally know” about a person who is close to you, a relative or a friend, or a person you at least know the name of and have talked to.


1. How many individuals do you personally know that you believe have used drugs regularly during the past 12 months (Write a number)

- Friends ___

- Close family ___

- Relatives ___

- Colleagues ___

- People living in my area ___

- Other ___

2. Have you ever felt concerned about the drug use of a person you personally know?

(Only for those that know somebody who has used drugs)



During the past 12 months During my lifetime

  1. Never ___ ___

  2. Sometimes ___ ___

  3. Frequently ___ ___

3. Do you personally know somebody who has received treatment for drug addiction

- during the past 12 months? (yes/no/do not know)

- during your lifetime (yes/no/do not know)

In order to examine the seriousness of the drug problem for friends or relatives, we will now ask a few questions about your experiences.
4. Have you ever called the police because of the drug use of somebody you personally know?
During the past 12 months During my lifetime


  1. never never

  2. sometimes sometimes

  3. frequently frequently



5. Have you sought help for yourself from a doctor, a social worker or some other professional because of the drug use of somebody you personally know?
During the past 12 months During my lifetime

  1. never never

  2. sometimes sometimes

  3. frequently frequently


6. Have you ever felt a fear of violence because of the drug use of somebody you personally know?
During the past 12 months During my lifetime

  1. never never

  2. sometimes sometimes

  3. frequently frequently


Preface to the next section: In order to say something about the human suffering caused by drug use we would like to ask you some questions that tries to reveal this, both on its own and by comparing addiction to other events and people’s willingness to pay to avoid this.

7a. If you personally know somebody who use or have used illegal drugs on a regular basis, how much would you say you have you been affected by this on a scale from 0 (no negative impact) to 10 (it has ruined my own life)?

- During the past 12 months ___

- During my lifetime ___
7b. If you personally do not know somebody who use or have used illegal drugs on a regular basis, how much do you believe you would have affected if a friend started to use illegal drugs on a regular basis, on a scale from 0 (no negative impact) to 10 (it would ruined my own life)?

- During the past 12 months ___

- During my lifetime ___

8. On a scale from 0-10 where 10 is the worst possible that could happen to a young adult, how would you rank the following events or states. Please assign each option a number between 0 and 10 (It is possible to give different events the same number)

- Blind


- Paralyzed

- Diabetes

- Death

- Lymph cancer



- Drug addiction

- Asthma


- A paralyzed arm

- A paralyzed leg

- Paralyzed both legs

- Alcohol addiction

- Very severe burn injury
9. Assume a tax increase of 100 EURO per tax-payer per year could finance a drug treatment program that could treat 800 drug addicts. Would you support such a tax increase?

a. Yes


b. No, I cannot afford or do not want any tax increase
c. No, if there is a tax increase I´d prefer it to be spent on other things

d. I do not know


10a. Imagine that one of your friends is addicted to drugs. Would you be willing to spend 500 EURO of your own money to help pay for treatment?

(yes, no, do not know)


10b About how much of your own money do you think you would be willing to pay for the treatment of …

- your friend

- your brother/sister

- your child

- your wife/husband/partner

(state sum. If you do not have children or siblings, please imagine a situation in which you do)


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