Comparisons in the making: youth accounts of cannabis use in Swedish addiction treatment

Abstract

Research shows that cannabis is understood differently across cannabis cultures. In Sweden, young cannabis users are seen as vulnerable, problem-burdened and increasingly embracing drug-liberal attitudes. Despite low prevalence rates, youth cannabis use is considered a high-profile problem that warrants prohibition. Previous studies show that staff in Swedish addiction treatment legitimize resolute interventions by making up young users as irrational. The treated young people claimed instead that starting to use cannabis and quitting were informed decisions. In this article, we revisit interviews with 18 young clients in Swedish addiction treatment, and examine the data with a focus on comparisons (e.g. A is unlike B). We perceive comparison as a tool in the formation of narrative identity, rather than a logical outcome of accounts. We ask what is compared with what in young people’s accounts of cannabis use, and what these comparisons reveal about their thoughts on well-being, the self and the setting. The interviewees used comparisons that drew on cultural, institutional and organizational narratives when they discussed cannabis. Taken together, their accounts instantiated ideas about powerful drug effects, the primacy of the neoliberal subject and the potential of cannabis addiction. We discuss whether these accounts mirror rather than challenge drug prohibition.

Keywords:

• Cannabis
• youth
• narratives
• accounts
• comparison
• prohibition

Introduction

Comparisons are ubiquitous in human life and should as such be of profound analytical interest in qualitative drugs research. While the literature is rife with comparisons pertaining to the relative risks of different substances (e.g. Lachenmeier & Rehm, 2015; Nutt et al., 2010) and internal and external factors that may push certain behavior (e.g. Gray & Squeglia, 2018), in-depth research on how people use comparisons provide important insights about how they make sense of substance use. In this study we add to prior qualitative studies on comparison in the addiction field (Fraser & Ekendahl, 2018; Seear et al., 2020). We revisit interview data from a research project on youth cannabis use and treatment and illustrate how young cannabis users compare phenomena related to substances, people and settings to make symbolic boundaries (Copes, 2016; Lamont & Molnár, 2002) and form narrative identity (Loseke, 2007).

Traditionally seen as ‘alien’ to the universal (and some would say paternalistic) Swedish welfare state, cannabis use has been cast as a high-profile social and criminal problem in Sweden. The Swedish cannabis use prevalence rates are low in relation to European standards (ESPAD Group, 2020). Although the prevalence rates have been quite stable among young people during the past two decades (CAN, 2019), massive concerns about youth cannabis use are continuously voiced. Cannabis use, it has been argued, severely damages young people’s brains and may profoundly impact their health and well-being (see Månsson & Ekendahl, 2015). Among a range of factors shaping discussions on the substance, Swedish studies showing an excess risk of schizophrenia following cannabis use in male conscripts have been influential (Zammit et al., 2002), together with evidence from the New Zealand Dunedin cohort (Meier et al., 2012). Uncertainties in the scientific literature as to whether the association between cannabis use and outcomes on cognition and brain health is causal or not (for recent reviews, see Kroon et al., 2020; Lorenzetti et al., 2020) have typically been downplayed, and key policy players seem to selectively pick research findings supporting the official restrictive stance (Månsson & Ekendahl, 2015).

While most young lifetime users of illicit drugs in Sweden have tried cannabis a few times only (Karlsson et al., 2019), the Swedish position regarding cannabis or any other illicit substance is that all young persons who are caught with use must attend treatment. This treatment can encompass everything from short-term substance abuse assessment with urine testing to long-term psychosocial counselling and even out-of-home care. A previous study of treatment staff perspectives on youth cannabis use showed how the professionals painted a specific and local picture of cannabis harms (Ekendahl, Karlsson & Månsson, 2018). With reference to then new and supposedly valid knowledge about adverse effects on young brains (e.g. Meier et al., 2012), the substance was considered extremely dangerous and impossible to combine with healthy lifestyles.

In line with such reports from the Swedish context, Duff (2017) rightly notes that cannabis typically has been seen as a single ‘thing’. Duff (2017), however, rejects this singular view, instead maintaining that ‘… cannabis should not be regarded as a stable, singular entity, given the diversity of relations, practices, semiotic registers and political squabbles in which the drug is produced as an object of knowledge and practice’ (p. 677). Cannabis can be linked to a variety of functions or uses, including but not limited to recreation and medicine. As to medical motives, for example, a recent Danish study showed that common reasons reported by medical cannabis users were related to conditions such as stress and chronic pain, and to depression and anxiety (Kvamme et al., 2021). Other literature has identified consumption motives for cannabis use that partly transcend the recreation/medicine binary, including coping, enhancement, social, conformity and expansion motives (Simons et al., 1998). The scant Swedish research on the topic suggests that users report several different consumption motives, and a cannabis culture heavily influenced by prohibition (Ekendahl, Månsson & Karlsson, 2020a, 2020b). At the same time, the difference between medical and recreational motives is often blurred when cannabis users report their motives (Morean & Lederman, 2019; Pedersen & Sandberg, 2013).

Perhaps as a consequence of the ‘multiplicity’ of cannabis, there has been much empirical research on how to characterize use and the users. Most of this work has drawn upon normal population samples of young people to quantitatively or qualitatively explore the issue (Järvinen & Demant, 2011; Karlsson et al., 2019; Kolar et al., 2018; Parker et al., 1998; Sandberg, 2012, 2013). Fewer studies have been done on clinical youth samples, though with some exceptions (Järvinen & Ravn, 2014, 2015). Clinical data provide insights into how users make sense of their own cannabis use in relation to external pressures to quit, and on their sense of self and well-being within a prohibitionist context that portrays everything cannabis-related as despicable. At a more general level, the language of and the stories told by service users can give important clues into the values they endorse (Copes, 2016) and the ‘narrative environment’ of treatment (Andersen, 2015).

In this study, we are interested in how young former clients in youth addiction treatment account for their cannabis experiences through their use of comparison. Our aim is to analyze what is compared with what, and what such comparisons can reveal about the narratives young people draw on to make up and make sense of substances, people and settings. Instead of perceiving comparisons as valid representations of events and circumstances, they are here the primary analytical target, potentially yielding crucial information about the Swedish cannabis culture and youth treatment.

Comparison as a tool in identity formation

Comparison is a fundamental tool used by people to orient themselves in the world – ‘[w]e are all comparativists’ as French philosopher Isabelle Stengers puts it in an article on the topic (Stengers, 2011, p. 48; see also Fraser & Ekendahl, 2018). We make comparisons all the time, and it would be difficult to understand ourselves and our lives without them. As Festinger (1954) noted over 60 years ago in a landmark paper, ‘…if a person evaluates his [sic] running ability, he will do so by comparing his time to run some distance with the times that other persons have taken’ (p. 118). Likewise, the literature on relative deprivation posits that ‘persons may feel deprived of some desirable thing relative to their own past, another person, persons, group, ideal, or some other social category’ (Walker & Pettigrew, 1984, p. 14). In order to effectively describe and evaluate any object, person or thing, it needs to be placed in relation to, that is, compared with, another object, person or thing (Krause, 2016). How something ‘is’ is thus always relative to how something else is. The examples of how this logic of comparison works are numerous. For instance, the effect of a treatment intervention is in traditional randomized trials determined through comparison with some alternative condition. The assumption is that there is little to say about the intervention’s potential unless we have something to compare it with. Closer to the topic of this article, debates on the effects of cannabis policy rely on comparisons between time points (e.g. conditions before and after policy change) or across contexts (e.g. countries that initiated change vs those that did not).

Comparisons are central in cannabis and other drug cultures as well. As shown by Sandberg (2013), cannabis cultures largely center on differences. Comparisons may also be made in relation to other substances. Young cannabis users have been found to perceive cannabis as less harmful than tobacco smoking, and to portray the former as more ‘natural’ (Akre et al., 2010) and similar comparisons are typically made with alcohol, which is seen as more dangerous (Månsson & Ekendahl, 2013; Peretti-Watel, 2003; Sandberg, 2012). People who use cannabis for medical purposes also claim that it is more beneficial than prescription drugs (Kvamme et al., 2021; Pedersen & Sandberg, 2013).

Thus, it would be difficult to state convincingly that cannabis use is bad or harmful per se. For the argument to make sense, there is a need for comparisons along dimensions such as health vs sickness, responsibility vs irresponsibility, safety vs risk and the like. Such binary oppositions seem crucial when people make sense of addictive behaviors (Brook & Stringer, 2005; Ekendahl, 2012; Moore et al., 2017), and they are likely to give us clues as to what is valued in accounts of illicit drug use (see Sandberg, 2013). At the same time, any comparison simplifies or leaves something out (e.g. differences within the group being compared with another group). Studies by Fraser and Ekendahl (2018) and by Seear et al. (2020) in the addiction field underscore that other comparisons are always possible. We thus maintain that substances, users and local settings come into being and are made meaningful through processes of comparison.

Analytically, our focus on comparisons relates to work on narrative identity (Loseke, 2007) and symbolic boundary making (Copes, 2016; Lamont & Molnár, 2002). Narrative identities are produced at different and closely related levels, including the cultural, institutional, organizational and personal (Loseke, 2007). The narrative identity of a young client in addiction treatment cannot be understood without linking it to cultural ideas about youth behavior (e.g. recklessness), to institutionalized demarcations of group belonging (e.g. that some are vulnerable), and to organization-specific images of service users and services (e.g. that young drug users need to be responsibilized; Loseke, 2007).

Also, when telling stories, people draw symbolic boundaries – ‘conceptual distinctions made by social actors to categorize objects, people, practices, and even time and space’ (Lamont & Molnár, 2002, p. 168). Thus, there is a close link between narratives and symbolic boundary making (Copes, 2016). As noted by Copes (2016), drug users draw symbolic boundaries both in relation to other substances and in relation to other users of the same substance. Such comparisons typically distinguish ‘functional’ from ‘dysfunctional’ users, where an integral part is possession of control. In this article, we analyze how comparisons, seen as important building blocks or tools in making up narrative identity and doing boundary work, operate to challenge or neutralize taken for granted assumptions about reality.

Materials and methods

The study is based on interviews with 18 young persons who were recruited by staff at six youth treatment centers in the Stockholm area, Sweden. About half of those who were asked to participate declined due to time constraints and lack of research interest. The final sample consisted of 12 men and 6 women, with a mean age of 19 years. They were self-selected, and had attended treatment at some point preceding the data collection in 2016. At the time of interview, some were still in treatment, while some were not. Cannabis was the main substance used but a few had used other illegal substances regularly as well. The sample covered diverse social backgrounds, including both disadvantaged and more affluent ones. Being current or former clients, their accounts may not only draw on cultural narratives about substance use, but on institutional and organizational narratives too (see Loseke, 2007).

Interviews were conducted in Swedish and covered topics such as substance use, treatment and drug policy. Half were conducted face-to-face and half over phone, with a running time of approximately 45 minutes each. The young people chose by themselves where and when to talk to us. Settings included the researchers’ offices, cafés and parking lots. We tried to achieve dense narrative data by asking the interviewees to go into the details of specific situations in which they used cannabis or had contact with the treatment system.

Extracts relevant to the analysis were translated to English by the authors. The study was approved by the regional ethical vetting board in Stockholm (Registration number 2016/709-31/5).

The analysis below concentrates on how the interviewees used comparisons when they accounted for their experiences. In line with this focus, we retrieved and analyzed interview extracts that covered perspectives on ‘cannabis effects’, ‘group membership’, ‘cannabis normalization’ and ‘drug addiction’. The dimensions, or themes, that appeared theoretically valid and gave a good representation of what the young people accomplished with their narratives were: Making cannabis effects, Making neoliberal subjects, and Making cannabis addiction. These themes captured what assumptions and ‘truths’ the young people made up and iterated through their use of comparison, and answered how cannabis was understood as a substance, how the characteristics of people were evaluated and how the use of cannabis in Sweden was perceived. The themes are presented separately for analytical purposes, which does not preclude overlaps. While being simplified and abstract we believe that they capture key assumptions about reality that are naturalized through comparison.

Making cannabis effects

Drawing on the popular idea that drugs have discernible effects on their users (Fraser, 2020, p. 3; Keane, 2005, p. 99), the interviewees described cannabis as a substance with agency to transform perceptions, behavior and overall well-being. In both unofficial and official drugs discourse (Månsson, 2017) there is a tendency to differentiate people based on their use or non-use of specific substances. Widely circulated ‘formula stories’ (Loseke, 2007) in popular culture refer to users of different substances as people with different characteristics, for instance the stoner, the alcoholic, the crackhead (Copes, 2016), and in treatment and policy a distinction is usually made between users’ drug of choice. Drawing on such comparisons, the young people stated that cannabis use differs from other types of substance use. Their accounts encompassed two facets, or agents: an individual who chooses a specific drug, and a drug that affects the user in specific ways. Correspondingly, a key theme was that drug-related experiences are primarily personal and not social. As described by Kurt below, the drug affects the mood of the individual and not for example the ambience of the group.

It feels like everything already good gets better. You forget things that are already bad. But it’s not like with alcohol that you lose control and always do weird stuff, you are calm sort of, calm just chilling with your friends. There’s nothing special that you do. You think the food tastes better, the music gets better, you just watch movies with no idea what’s going on. It’s fascinating in a way. To me at least, to change all of a sudden how your brain works for an hour or so. (Kurt)

As stated in previous research (Månsson & Ekendahl, 2013; Brochu et al., 2011; Peretti-Watel, 2003; Sandberg, 2012), users often depict cannabis as better than alcohol. Kurt, for example, claims that drinking is associated with loss of control which he wants to avoid. Cannabis, on the other hand, makes him feel good, forget about troubles, and able to enjoy the mundane aspects of life (see also Ekendahl, Månsson & Karlsson, 2020b). For Kurt, cannabis is not only better than alcohol; it also fulfills several purposes simultaneously. This reasoning evokes substance-specific effects on a demarcated and autonomous subject. Kurt’s account instantiates himself as an ’otherwise neutral body’ (Fraser, 2020, p. 3) by appreciating how the substance lets him alter ‘how your brain works’, which underscores that cannabis use is motivated through individual preferences rather than social concerns. Moreover, Kurt’s comparison of the two substances (cannabis and alcohol) does not only characterize cannabis as an external force with material effects, it also alludes to what effects that are valued as good (e.g. making one calm) and what are bad (e.g. losing control). As Copes (2016, p. 200) notes, drug users’ stories typically mirror the values of the broader culture, in which a principle such as self-control is crucial. Similarly, Albin draws on the cultural narrative of cannabis as a path to deep thoughts and reflection when he exclaims: ‘You really turn into the world’s best philosopher’. While this and similar accounts of cannabis use are well documented (e.g. Sandberg, 2012, 2013) and may seem insignificant, it is here relevant to recapitulate that other comparisons are possible. For example, comparing cannabis with stimulants or psychedelics would probably reveal other assumptions about desirable behaviors and mindsets (including e.g. vigor and creativity). Cannabis use was neither described as a trivial activity (similar to e.g. habitual tobacco use) or as mainly intertwined with the social setting (such as e.g. dancing or conversating).

The potential, but absence, of such accounts in our data highlights that dominant cultural narratives about cannabis, such as its status as a potent but controllable drug, a ‘foreign matter’ (Fraser, 2020, p. 3), were reproduced through comparison. While the young people mentioned friends or acquaintances who were also interested in the substance, cannabis use was hardly normalized to the extent that it surfaced in unexpected social situations. The views on cannabis use in this Swedish clinical sample thus deviate from the pronounced sociality surrounding cannabis observed in other settings (Hammersley et al., 2001; Scott et al., 2017). This valorization of conscious decision making, and thus the choosing of deviancy in a prohibitionist context, rather echoes the individualized perspectives on cannabis use reported by adult cannabis users in Sweden (Ekendahl, Månsson & Karlsson, 2020b) and other countries (Chatwin & Porteous, 2013). In the next quote, Benjamin describes how cannabis made him able to shut off the outside world:

It’s hard to describe really, but I’ve never felt something like that before, what I felt back then. It was really like living here and now, and everything was fun, everything was good, everything was positive. And I simply felt really, really good. (…) In the beginning it was not that frequent. Well I tried it, and then there was this deal with urine tests and things like that. Then I stayed away from it…yeah, maybe a few months, and then everything went wrong in school, and I was like: ‘Ah, what the hell, that was really nice sort of’, when I tried it. But it was only to escape from my feelings. Only to escape from something, and sort of end up in my own world, my own good world where nothing was bad. (…) It was becoming more and more like that, because the older I got there was more and more responsibility, more school, more everything, more stress and more worries about the future. And that made me get away from it all, and not to think about anything, and just feel good. (Benjamin)

This quote pinpoints both specific drug effects on an individual agent and how he rationalizes pursuing such effects. The comparisons made in the opening of the quote concentrate on the difference between well-being and distress. Benjamin appears overwhelmed that cannabis can make him as happy, satisfied and consciously present as citizens in contemporary society are supposed to be (Ayo, 2012). This strive for pleasure, usually referred to as an enhancement motive, is further into the interview rephrased into a coping motive where cannabis is used to curb feelings of stress and worry (see e.g. Hecimovic et al., 2014). While this account exemplifies the blurring of recreational and medical motives (Pedersen & Sandberg, 2013), it also suggests how cannabis effects are made up as tools for the individual to use in navigating a complex social world (Ekendahl, Månsson & Karlsson, 2020b). Looking specifically at Benjamin’s account above, it appears as if cannabis can stabilize an uncertain situation. It is made meaningful as a determinant between pleasure and pain (makes everything all right), between being young and grown up (increasing demands are forgotten), the external and the internal (provides a private and safe space), and confrontation and flight (ameliorates threats). These comparisons all draw on cultural narratives (Loseke, 2007) about how society works, how young people ought to think, feel and act, and how substances can bridge differences between expectancies and reality. Corresponding with Swedish drug policy, cannabis is thus attributed with the power to transform people in several and profound ways. Regardless if described as a panacea or as a substance that clouds the mind, and if it is characterized as one or the other, cannabis is made up as a substance that matters.

Making neoliberal subjects

Almost irrespective of what cannabis-related occurrences the interviewees described, the cultural narrative of the neoliberal subject who acts responsibly, independently and autonomously (Moore & Fraser, 2006, p. 3036) was used to compare behaviors, character traits and persons. In a previous article we concluded that the young people appeared responsibilized in perceiving both starting and quitting with cannabis as based on rational decision making (Ekendahl, Månsson & Karlsson, 2020a). Here we will illustrate how the primacy of the neoliberal subject is also reflected in the practice of treatment, forming a powerful organizational narrative (Loseke, 2007) that is echoed in the interviewees’ self-understandings and accounts. In the first quote, Olivia reflects on her being released from residential treatment, and how she during that time period approached her old circle of friends.

And sure, for a while it was OK to hang with those people without smoking yourself. But in the end, you fell back. And I think I got it from treatment really, thinking like: ‘Regardless of how much I cared for these people, had they even thought about me?’ No, their minds were on the drugs really. It was like, I can’t just sit here and think that I should help them. They must make their own decisions. And if I continue to think that I must be there for them, so that nothing bad happens, it will be a risk factor for me, for me falling back. So, I thought I have to fix my life instead. And they can make their own decision. (Olivia)

Several comparisons made in this quote can be traced back to the neoliberal subject. The social clique Olivia previously smoked cannabis with is depicted as an anonymous mass of homogenic ‘people’ (see Seear et al., 2020) she is no longer affiliated with. They are seen as cannabis users only, who care more for drugs than interpersonal relationships, which provides a stark contrast to the responsibility and care that Olivia associates with her new drug-free self. The account clearly draws on the cultural narrative of drug users as essentially faulty compared to ordinary citizens (Brook & Stringer, 2005). Olivia also highlights the demands on self-efficacy and commitment to abstention that hanging out with cannabis users places on her. By rejecting her previous relationships as ‘risk factors’, she both maintains a boundary between her old and new selves, and instantiates the organizational narrative (Loseke, 2007) that youth deviance derives from the balance between risk- and protective factors (Stone et al., 2012). In the final statement she underscores her own individuality and sovereignty by distinguishing between ‘they’ and ‘I’, concluding that no one but herself can ‘fix my life’.

Corresponding with the notion that responsibilization can be perceived as a dominant organizational narrative in Swedish youth treatment (Ekendahl, Karlsson & Månsson, 2018), the next quote from Daisy exemplifies how the neoliberal subject is preserved as a benchmark for how young people should behave even after treatment.

It’s what (name of service provider) talked a lot about, ‘If I get cravings, what shall I do then?’ And we made like a reminder card, and it’s at another level sort of, when I’m involved in deciding what to do, when I want it myself. Because then it’s easier to sort of stick with it. I think if you don’t want it yourself, then you won’t do it when you're out there. (Daisy)

Daisy here talks about what she can do when experiencing cannabis cravings after release from treatment. Implicit in this account is the idea that urges to use again are to be expected and that they are problematic (Larimer et al., 1999). This comparison between having and not having cravings does not only associate youth cannabis use with the cultural narrative of addiction and loss of control (more about that below). It also highlights that she has embraced the prohibitionist policy assumption that cannabis use is inherently bad. From this perspective, cannabis use (and craving) challenges the neoliberal subject who handle risks and act rationally. By comparing how things would turn out if someone else determined what she should do, with if she did it herself, Daisy also stresses the significance of mastering her own destiny. She must believe in acquired skills (in this case a reminder card to visualize during cravings, popular in relapse prevention, see Larimer et al., 1999), for them to be effective when she is ‘out there’, freed from staff control, manifesting her responsibilized new self. Her use of comparisons thus illustrates how cultural narratives about young people being dependent on adults, organizational narratives about effective treatment techniques and personal narratives about growth and independence are meshed together in youth accounts of cannabis use.

While some interviewees claimed to know more about cannabis than service providers and the generalized adult world, the very idea of informed decision making and productive lifestyles were hardly doubted. Some described severe psychosocial problems but self-identified anyhow as cannabis users by choice, thus evading dominant cultural and institutional narratives suggesting that cannabis users are self-destructive, marginalized or otherwise compelled (see Järvinen & Ravn, 2015). Fred too, acknowledges his mother’s mandate to determine what is good and bad for him, and can through comparing parent and child, and healthy and unhealthy, endorse two seemingly opposing narratives; he is both a good son who respects parental judgement, and a person with the integrity to make own decisions.

Yeah, it’s a normal reaction that mum…I do understand her hundred percent. It’s not that it’s healthy for me this thing [cannabis use] but, yeah, really, she is my mum after all, and of course she gets worried. Nothing strange with that. (Fred)

While downplaying the risks with cannabis elsewhere in the interview, Fred states in the quote that some people (his mother) lack sufficient knowledge and can thus be legitimately worried about cannabis use. This reasoning builds on us-and-them thinking, where the key comparison is made between those who know and can deal with the substance, and those who have bought into public scaremongering and lack their own experience (Månsson & Ekendahl, 2013; Sandberg, 2012). This comparison of different people instantiates both the primacy of the independent and autonomous subject, and the status of cannabis as a potent substance (see above). Following this line of reasoning, Paul notes that all individuals are different and that he is too troubled to use cannabis moderately.

I’m the kind of person who is easily pulled in. All persons are different. So, I got pulled in very easily. Maybe due to my history with a lot of problems as well. Then it’s more and more and more, and then you buy and buy and buy, and then you’re full on inside it. It’s a vicious circle. Then you smoke every day, and it is more and more and more and more. (Paul)

Paul here indirectly compares himself with the neoliberal subject who is not troubled, and who does not let cannabis consumption get out of control (see Lupton, 1995). By referring to his own problem burdened history, locking his body in a ‘prison of repetition’ (Keane, 2005, p. 99), he can reject the voluntary and recreational cannabis use narrative (e.g. Parker et al., 1998), without blaming the substance for inducing loss of control. Through comparison, Paul thus illustrates how cultural narratives about what constitutes a good life, and organizational narratives of how responsible citizens should behave, are reproduced also in accounts of problematic use.

Making cannabis addiction

In tandem with the interviewees’ instantiation of the neoliberal subject as standard, their accounts of how and why cannabis should be used carried strong views on what is normal and deviant. They distinguished between different patterns of and reasons for cannabis use, and saw addiction as a yardstick for what is bad and unwanted. Addiction was made up by drawing on cultural, institutional and organizational narratives that associate the phenomenon with loss of control, disease and deviance (e.g. Fraser et al., 2014). This worked to separate functional from dysfunctional cannabis use, and to strengthen the assumption that cannabis, like other potent substances, holds potential harms that users must dodge (Copes, 2016). Jonathan explains how he, but not all his friends, was able to use cannabis for celebrational purposes only.

It was like during festivities but people were smoking. If any of us had a birthday or something good had happened. For instance, if one of our friends graduated or like passed an important test or something good happened in the family. If someone felt much better after being at the hospital. Any good thing that happened during the day, we were like ‘Ah, let’s celebrate!’ We used to celebrate like that. (…). When you felt there was a good occasion, not like all the time. Then, sure, some of us crossed the line, some of my friends couldn’t hold back as much. (Jonathan)

When emphasizing that consumption situations were chosen with care, Jonathan uses non-controlled cannabis use as a latent counterpoint to his argument. By clearly linking his own cannabis use to cultural narratives of what is normal, good and virtuous, such as celebration, graduation and health, he also pinpoints that it is not always like that. In his account, inability to control the substance is merely mentioned as a possibility ascribed to some of his friends. Still, making a reference to the ‘formula story’ (Loseke, 2007, p. 664) of control loss suffices to instantiate these phenomena as significant in relation to the substance. This illustrates how addiction can be both present and absent in youth accounts of cannabis use. Michael expands on this issue by accounting for the related affliction ‘substance abuse’:

My entire family thought that I was on the wrong track. (…) They found out about it. You do notice if a person enters a long-term substance abuse. The person changes…small things change, which then get bigger, and you don’t notice it yourself. But everyone around you notices it. (Interviewer: What can it be, small things that get big?) Well, they…for instance, you get much lazier, you don’t bother picking things up, cleaning. You become grumpy, sulky. You don’t conversate normally. You’re just: ‘No, go away!’, and so on. Like I was disrespectful, or how to put it. (Michael)

This quote builds on strong institutional narratives that distinguish the normal from the deviant. Using a common term in Swedish drug policy, Michael describes his cannabis use as ‘substance abuse’ (Edman & Olsson, 2014; Rødner, 2005) and links it to behaviors that could be considered insignificant in another context. Drawing on institutional narratives about antisocial and lazy young cannabis users, and on the harmful effects of substances on vulnerable people (Moore et al., 2015), Michael’s personal narrative situates classic youth problems within the framework of addiction (Månsson & Ekendahl, 2015; Ekendahl, Karlsson & Månsson, 2018). It would have been possible for him to account for ‘bad behavior’ without using comparisons that iterate addiction-related binaries such as right vs wrong track and insight vs ignorance (see Fraser et al., 2014, p. 236). The next quote from Ines is beset with similar comparisons.

I mean, I’d done worse things than to smoke cannabis. I was like, I had no consequential thinking at all. After all no one had. I didn’t care about people or what they felt. I was already quite numb. Because I hung out with people who were also like that and we created our own small world for us to live in. Where nothing really mattered. I was not scared at all to try cannabis. Ehm, because of everything you’ve heard of it not being that dangerous…Alcohol is worse and I had already been drinking, the first time I drank I was like twelve, eleven or something. So, it was like, well not that dangerous, for me anyway. (Ines)

In downplaying the dangers of cannabis through comparison with alcohol (see above), Ines simultaneously draws a clear line between the institutional and organizational narratives of sober normality and intoxicated deviance. Describing the latter as more relevant to her, even before starting to use cannabis, she qualifies the idea that it is cannabis that makes certain young people numb and detached from society; characteristics she already had experienced. These comparisons of substance-specific dangers and of identity before and after starting to use cannabis shifts focus from drug effects to the characteristics of people and settings. In this way, Ines’ account draws on institutional and organizational narratives where youth substance use indicates a slippery slope of risk-taking, psychosocial problems and ultimately addiction (see Winters & Kaminer, 2008, and for a critique, see Allen et al., 2020). She thereby produces a symbolic boundary to young people who are less troubled and marginalized than herself.

Discussion

Revisiting data from interviews with young clients in Swedish addiction treatment, this study analyzed how interviewees used comparisons when accounting for their experiences. As we have argued, comparisons, being fundamental in human reasoning, are crucial analytical targets in qualitative work on substance use. While comparisons in accounts of cannabis use could be made along a multitude of dimensions, in the data they largely revolved around the substance, people and settings. As to the effects of cannabis, the substance was often attributed with agency, capable of affecting the user’s perceptions, behavior and well-being. Throughout, comparisons were made with alcohol, which was defined as more dangerous, but generally not with other illicit substances. The point of reference was not more ‘deviant’ substance use (e.g. stimulants) but a conventional substance. By depicting cannabis as more harmless and controllable than alcohol, it appeared as if the interviewees considered their behavior to be closer to cherished principles of risk minimization and rationality. In fact, and clearly paradoxical, the effects of using illegal cannabis were generally believed to make them better citizens than consumers of legal alcohol.

Contrary to long-standing narratives of youth peer pressure as key in driving illicit substance use (Coggans & McKellar, 1994), the interviewees shouldered responsibility for both starting and quitting with cannabis (see Ekendahl, Månsson & Karlsson, 2020a). No comparisons were made between themselves as innocent victims and villain peers who push them to unwanted behavior. In fact, we were surprised by the marginal role social influence or victim narratives played in their accounts. Cannabis effects were personal matters that interviewees experienced without apparent guidance or pressure from seasoned users (see also Järvinen & Ravn, 2014). While we cannot know whether this is the ‘true’ story – an issue we, frankly, find quite uninteresting – it illuminates something important about the cultural ‘“tool kit” of symbols, stories, rituals, and world-views’ (Swidler, 1986, p. 273; see also Sandberg, 2013) that is employed to justify cannabis use in a prohibitionist society where individuals are highly responsibilized (Kemshall, 2008). Among the many comparisons found in the data, few summoned the classical ‘outcast’ narrative rejecting conventional norms and values. We did observe some occasional distancing from non-users, allegedly lacking valid cannabis knowledge, but the ideal of the autonomous, prudent subject was not abandoned in favor of alternative ways of life. On the contrary, the neoliberal subject always served as the narrative framework of their comparisons.

Comparisons used in accounts can shed light on what key assumptions people have about their lives and living conditions, but they also give us the opportunity to ponder upon what realities they leave out (Fraser & Ekendahl, 2018; Seear et al., 2020). Our analysis reveals that the young people in their comparisons drew on culturally, institutionally and organizationally naturalized narratives about cannabis having objective drug effects, the individual being responsible and autonomous and the persistent risk of use getting out of control. Even if some expressed doubts about the relevance of keeping youth cannabis use a high-profile problem in Sweden (on grounds of alcohol being more harmful), our general impression is that their accounts anyhow reproduced the pillars of drug prohibition.

Their understanding of cannabis as a potent and specific substance, their valorization of individual freedom and risk minimization, and their strong view on cannabis use being potentially addictive for those who lack the characteristics of neoliberal subjects, all revolved around ‘difference’ rather than normalization (Sandberg, 2013, p. 76). Albeit somewhat counterintuitive, this rhymed well with the political strive of hindering yet other substances to gain a strong foothold in the general population (e.g. Olsson, 2019; Socialdepartementet, 2016). The possibility that young people would, if they could, use a substance commonly known as less harmful than alcohol (e.g. Nutt et al., 2010), and the potential mismatch between people’s felt and actual control over substance use, fuel the notion that Swedes should be kept from choosing cannabis.

There was thus not much ‘rebellion’ echoed in this clinical sample of young Swedish cannabis users. It is obvious that their involvement with the treatment system might have steered their accounts toward problem-oriented narratives that are disseminated in Swedish addiction treatment (Loseke, 2007). Anyhow, it is worth mentioning what their comparisons left out; that is, unexpressed but latent assumptions that could potentially bring about change in the Swedish cannabis culture. Cannabis was not described as having multiple and context-dependent effects and meanings (Duff, 2017). Such multiplicity, should it be accounted for, would make it relevant to abandon vague binaries such as addiction vs non-addiction and dependence vs independence (e.g. Fraser et al., 2014) when comparing dysfunctional with functional use (Copes, 2016). Their accounts also tended to leave out the aspects of sharing and collectivity characterizing many cannabis cultures (e.g. Belackova & Vaccaro, 2013; Coomber & Turnbull, 2007; Sandberg, 2013; Zimmerman & Wieder, 1977), which could challenge the strong focus on individuality in contemporary Sweden. Finally, they did not abandon the omnipresent narrative that loss of control, the foundation of addiction, dwells as a risk in all (illicit) substance use. It would have been more oppositional in relation to dominant drug-related narratives to problematize excessive cannabis use as a stigmatizing health problem, social nuisance or bad habit, similar to how tobacco smoking is characterized in Western societies (Peretti-Watel et al., 2014; Stuber et al., 2008).

Taken together the results show how a sample of young Swedes in treatment used specific comparisons when accounting for their cannabis experiences. Their comparisons instantiated a highly local cannabis culture built on knowledge that cannabis is a potent substance impossible to ignore, that users (and non-users) are neoliberal subjects with freedom to choose, and that all substance users risk becoming self-destructive and uncontrolled. This knowledge obviously sits well with a prohibitionist drug policy that struggles to keep cannabis a dangerous anomaly in the Swedish welfare state. The results also indicate that some young people turn to cannabis when expressing their freedom of choice and for coping with demands on self-realization, achievement and happiness. The societal tendency to frame cannabis as ‘forbidden fruit’ will probably not change cannabis-positive attitudes among those who grow up today.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The present research was financially supported by Forskningsrådet om Hälsa, Arbetsliv och Välfärd (Grant 2019-00378).