We can learn a lot from the regulation of other substances such as tobacco and alcohol, including our own mistakes and successes, as well as international models of...
February 10, 2016
A common argument around reforming cannabis laws often draws on the idea that other, more harmful substances remain legal and regulated. This is primarily focused on the availability of tobacco and alcohol, citing the individual and social harms of these legally available drugs.
Given that tobacco and alcohol are more likely to harm the user and other people, it seems almost ludicrous and hypocritical that these drugs remain legal while cannabis is illegal. Although we are heading full steam towards legalization, it does not change the fact that Canadians continue to be arrested and persecuted for cannabis at this very moment.
In a recent paper, Ashbridge, Valleriani, Kwok & Erickson (2016) were interested in how people understand their use of two popular substances in Canadian society, one that is legally regulated, and one that remains illegal. Drawing on 202 in-depth interviews with across four cities, including Toronto, Vancouver, Halifax and Montreal, the study includes participants who smoke tobacco only, cannabis only, and users of both. (It’s important to note they excluded medical cannabis patients from this sample, noting that medical use and understandings of cannabis, and particularly experiences of stigma, may be very different among this population).
“For cannabis, this illustrates the expansion of normalization, moving from a substance that was once highly demonized and used in secret to one which has varying degrees of acceptability in different spaces, some of them public (parks, concerts) and others more private (homes, yards). On the other hand, tobacco users, reflecting accordance with denormalization efforts aimed at public health, recognized that smoking ‘‘anywhere’’ is not appropriate, and engage in a reflexive process using what they refer to as discretion and common sense to protect others from contamination”
The findings highlighted opposite trends: on the one hand, we are living through a process of “normalisation” when it comes to cannabis, and on the other, the “de-normalisation” of tobacco. Gone are the days when it was acceptable to smoke tobacco in restaurants, airplanes, and even doctor’s offices. What is very relevant about these findings is that it draws on people’s understandings and experiences of tobacco and cannabis, using this to inform how we think about normalisation. Both substances exist in a rapidly changing landscape, where it’s easy to see that tobacco regulation is certainly increasing in Canada. This increasing regulation, and overall denormalisation, is certainly tied to the severe and proven health consequences of smoking tobacco.
Cannabis, on the other hand, is facing the opposite trend with legalization on the horizon. Normalization is not a ‘free for all’, but rather looks at how different drugs may become a “normal” part of leisure time. This doesn’t just draw on frequency rates or actual policy, although this is certainly a part of it–it’s about how people engage in various risk-assessments about use, how they understand that use, and how non-users think about the drug in question.
While the normalization thesis, as developed by Parker and colleagues (1998), focused on youth, much of the more current research has really focused on the idea that normalization extends into adulthood. Further, a nuanced understanding of normalisation will typically draw attention to the idea that “some types of drugs and some types of drug use may be more normalized for some groups” (Shildrick, 2002), which accounts for why the normalisation thesis has primarily been useful in understanding cannabis use across age demographics.
There was a close connection with perceptions of health risks and how users discussed both cannabis and tobacco. For example, participants almost exclusively attributed health risks to tobacco, where cannabis was often framed as low-risk. Even if users smoked both cannabis and tobacco, they attributed most of the health risk to tobacco. For example, one participant said during the interview, “If I were to get lung cancer, it would definitely be from tobacco, not cannabis” (p.16). This was an interesting perception, and although not shared by everyone (some, for example, framed smoking as the issue), it highlights the societal awareness of smoking and lung cancer, which ultimately has contributed to this decline in social acceptability. I would infer here that the more we know about cannabis, health, and risk, the more normalised cannabis will continue to become.
Across all three groups, participants generally agreed with the increased regulation around tobacco. Although some tobacco users expressed a bit of frustration, they also understood why regulations around smoking seemed to be increasing across Canada. To this end, many tobacco users also often self-stigmatized their use – calling their habits around smoking tobacco as “gross”, “dirty” or “an addiction”. While cannabis use described their use as a choice, tobacco use was framed as an addiction. Further, when we asked if either user saw themselves smoking in 25 years, most cannabis users agreed they would continue to use cannabis, although less, while tobacco users consistently expressed regret and hoped not to be smoking in the future.
While cannabis users agreed that the stigma around cannabis use is declining, they still spoke to this idea of “anticipated stigma”. Primarily focused on family and work, they worried that employers could find out about their use, or their parents would find out they used cannabis. This signals that stigma and normalisation work on different levels. While on a broader, societal level, cannabis use may be more acceptable, on a more individual level, people still selectively conceal and reveal their use of cannabis along personal and professional lines. They did acknowledge an increase in acceptability in different spaces like parks, and many cannabis users spoke to becoming less concerned with being known as a cannabis user as they got older.
Tobacco users on the other hand, really felt like it was a “shrinking world for smokers”, and actually expressed feeling more stigmatized than in the past. This actually limited the places, particularly in public, they felt comfortable smoking in and really felt a general ‘public eye’ was watching. In order to manage this, they often positioned themselves as a “considerate smoker”. This means that they spoke about informal norms around ‘appropriate places’ to smoke tobacco and often talked about other’s rights to not be exposed to smoke because of the health consequences. Cannabis users also employed informal norms around consideration, respect and responsibility. It’s interesting to note that tobacco users didn’t express the same concerns as cannabis users for being “found out” as a tobacco smoker. They didn’t hide this status as a tobacco smoker, which again signals this difference between stigma on an individual level and (de)normalisation on a broader societal level.
The perceived health consequences of each substance really mattered to these participants, and informed how they spoke about both cannabis and tobacco. This shaped both the stigma they felt came with using either substance, as well as what was considered appropriate use. However, tobacco smokers felt what was “appropriate” spaces were rapidly diminishing, while cannabis users felt like their options were expanding with more tolerant societal attitudes. As the authors state:
“For cannabis, this illustrates the expansion of normalization, moving from a substance that was once highly demonized and used in secret to one which has varying degrees of acceptability in different spaces, some of them public (parks, concerts) and others more private (homes, yards). On the other hand, tobacco users, reflecting accordance with denormalization efforts aimed at public health, recognized that smoking ‘‘anywhere’’ is not appropriate, and engage in a reflexive process using what they refer to as discretion and common sense to protect others from contamination” (pg.9).
Participants across the sample – even the tobacco only group – rejected cannabis prohibition and agreed that reform was needed, but most agreed with increased controls around tobacco use, particularly in the ways it could affect the health of others. They also framed their understanding of how cannabis could be regulated using what they knew about tobacco and alcohol. More libertarian ideals around the unregulated availability and cannabis consumption in any form wasn’t evident in how these respondents framed potential legalization, despite the acknowledgment that reform was needed. An interesting question pointed out in the article is whether this is influenced by our broader “Canadian” approach to health care – one which favours public responsibility over individual choice.
Overall, while the regulatory landscapes are changing, so are the attitudes and public perceptions of both substances. Moving forward, our efforts should be focused on pushing our political leaders to immediately stop arresting people for cannabis until they’ve implemented some regulation around cannabis legalization. NORML Canada, for example, has started a campaign urging for “the government…[to] end all ongoing non-violent cannabis-related prosecutions. There is no justification for one additional person to go to jail for an act that never should have been criminalized”. Coupled with the fact that most Canadians believe cannabis reform is needed, we can learn a lot from the regulation of other substances such as tobacco and alcohol, including our own mistakes and successes, as well as international models of cannabis reform.
Ashbridge, M., Valleriani, J., Kwok, J., & Erickson, P. (2016). “Normalisation and De-normalisation in Different Legal Contexts: Comparing Cannabis and Tobacco”. Drugs: Education, Prevention, and Policy, Special Issue on The Normalisation Thesis: 20 years later. DOI: 10.3109/09687637.2015.1118442.
Parker, H., Aldridge, J., & Measham, F. (1998). Illegal Leisure: The Normalisation of Adolescent Recreational Drug Use. Great Britain, UK: Routledge.
Shildrick, T. (2002). “Young people, illicit drug use, and the question of normalisation”. Journal of Youth Studies, 5(1): 35-48.