Dopamine has the last word in a scientific controversy and discreetly enters politics

12The neurobiology of drugs developed in the 1970s, at a time when the discipline witnessed a renewal of interest sparked by the spread of heroin addiction. But dopamine was sidelined by early works on drug addiction. In fact, opiates such as heroin, morphine and opium, which were considered at the time to be “the archetype of all addictive substances”, [35] act through endorphins, a different class of neurotransmitters than dopamine. A few years later, neurobiologists working on another category of drugs, psychostimulants (primarily amphetamines and cocaine) finally became interested in dopamine. The 1980s consequently witnessed competition between two different models used to explain drug addiction. The first model, which originally seemed more legitimate, was based around heroin addiction and argued that drug dependence was first and foremost defined by the withdrawal symptoms (shaking, pain, sweating) provoked by the discontinuation of a drug’s administration and thus in the stimulation of endorphins. The second model suggested that drug dependence was also characterised by the psychological dependence produced by the consumption of psychotropic substances. This phenomenon was linked to the over-production of dopaminergic molecules along a specific neural pathway, called the “reward system”. It was ultimately this theory of dopamine that won out over its rival in 1988, when a group of Italian neurobiologists demonstrated, in a famous article, that the reward system is activated following the consumption of any psychotropic substance, regardless of whether the latter is an opiate, a stimulant, alcohol or even nicotine. [36] In addition to putting an end to a controversy that had raged for almost a decade in the field of neurobiology and addiction research, this discovery also paved the way for new forms of qualification of addiction practices by removing the barriers that had separated different psychotropic substances according to legality or illegality. Although at first glance the redefinition of drugs and dependence in the light of the dopamine theory seemed to function only in a scientific context, it in fact already possessed latent connections with politico-administrative issues. The foremost scientist studying dopamine in France is Jean-Pol Tassin, a neurobiologist working at Inserm and the Collège de France. His works were the first to circulate in the sphere of drug policies and helped certain political leaders to dress up their ideas in “scholarly clothing”. [37] Moreover, from the start Tassin’s research benefited from discreet administrative support, which helped it to gain access to a political space directly related to the problem of drugs and addiction. It was in fact a future representative of the Interdepartmental Mission for the Fight Against Drugs and Addiction (MILDT) who encouraged Tassin to study dopamine via psychostimulants. This civil servant was a clinical psychologist by trade and began his career in the 1970s at the Comité national de défense contre l’alcoolisme (CNDCA – National Committee Against Alcoholism), where he became familiar with the holistic approach to dependence that alcoholism specialists were championing at the time. [38] He then became a task-force director for the Mission interministérielle de recherche expérimentale (MIRE), at the time an agency of the Ministry of Health and Social Affairs, in the context of a working group run by Inserm/Direction générale de la santé (DGS - General Directorate for Health) on problems of public health linked to alcohol, tobacco and drug addiction. This was where he first met Tassin and financed a portion of his studies on dopamine. He then joined MILDT in 1989, where he remained for almost twenty years, and led an initiative to commission expert studies, presenting all of the existing knowledge on dependence on psychotropic drugs, regardless of their legal status. This first report which allowed information on dopamine to circulate freely within political and administrative circles was naturally Tassin’s work. [39] Yet at the time the document remained confidential and the “ideas” it contained were not mobilised by MILDT until several years had passed: in other words, until the conditions of their political appropriation had been outlined.

And during those years [1982-83], X called me, you must know him, and he said to me “What do you know about cocaine, would you be interested in working a bit in that field?” and so it was him that asked me to look at what cocaine and amphetamines did…
You knew him? Had you already met him?
No, I didn’t know him. Apparently, he did a bit of research and saw that I was working on dopamine, and he was looking for a French person in fact, well a French team anyway, that was working on addiction. Well, we didn’t talk about addiction at that time, we talked about drugs and then physical dependence. […] And well then there was a pretty important event, in 1990 or so, and then again X, ultimately he’s the one that can get a lot of things done, he told me it was time to write a book about addiction, a study of the neurobiology of addictions. And I had a doctoral student who was looking for funding and I was told we could get a lot of money. So we did this project together, which ended up being one of the first books on the neurobiology of addictions, and which came out in 1992 or something like that. [40]

Dopamine attached to a new public debate on the decriminalisation of marijuana

13The years 1994 and 1995 were pivotal for drug policies. This was when drug policies moved towards risk reduction strategies: i.e., the development of new public health tools to regulate drug usage, in particular heroin usage. Needle exchange programmes, substitution therapies (methadone, buprenorphine), etc. become policy instruments and were adopted as medical technologies by a sector that had long rejected such advances. This change was due to both generational renewal among the professional and political leaders in charge of the fight against addiction, and a paradigmatic shift in the medical definition of this illness. In fact, this period witnessed the end of psychoanalysis as the dominant form of knowledge among the health professionals concerned, ushering in instead the use of cognitive and biological behavioural approaches. [43] This huge change favoured the repositioning of addiction specialists in relation to the legal framework of drug policies. From the 1970s to the beginning of the 1990s, abstinence, as the primary therapeutic objective (of the psychoanalytical paradigm) was a good fit with the principle of prohibition. But as soon as health professionals began to believe that counselling could be provided to non-abstinent drug users, they increasingly called into question the prohibitionist ideal and the criminalisation of narcotics. [44] It was in this context that the political issue of decriminalisation emerged, to which the question of dopamine would be associated thanks to the overlapping use of two new expert reports which were crucial in circulating this scientific information in the field of drug policies. And even if, during this period of time, the dopamine theory was still missing a few of the properties that would ultimately favour its future appropriation, these two reports undeniably facilitated the first expressions of its “implicit political theorisations”. [45] We can also see here the extent to which the success of an idea in the world of policy is based not only on its availability, but also the weakening of competing reference points. [46]

14In 1994, the Comité consultatif national d’éthique (CCNE – National Consultative Ethics Committee) published an expert report on “addictions” (the plural is significant) which sought to re-examine drug classifications from a perspective that included the most recent scientific information. [47] The work of Tassin was abundantly cited therein. The CCNE was created in 1983 and has gradually gained an important role in the diffusion and legitimisation of neuro-scientific knowledge in political and intellectual spheres. [48] The report in question challenged the legitimacy of the existing legal classifications which distinguished legal from illegal substances without a basis in a transversal comparison of their toxicities. The theory of dopamine was used here to justify the need to redefine existing classifications, arguing that the current mode of drug regulation (the criminalisation of narcotics) was not appropriate for all substances. Despite not adopting a specific, clearly defined political position (in fact, such a position would remain largely concealed by the apparent neutrality conferred by scientific knowledge), the CCNE’s report suggested that the two-fold distinction between licit and illicit substances on the one hand, and between soft and hard drugs on the other, would not hold up to the dopamine test. The report then called upon supplementary studies to be conducted on the neurobiological effects of psychotropic substances in general. Despite being on the outskirts of political and administrative decision-making circles, and entirely outside of the institutional landscape of drug policies, this expert report constituted an essential step in dopamine’s political career, in the sense that it suggested the molecule’s possible uses in debates on narcotics legislation. This marked the beginning of political appropriation, a kind of indexing that began to seem necessary, but which did not yet link the theory behind dopamine with a specific political position: although debates on drug policies were already forced to address neurobiological research, the latter had not yet been assimilated with the anti-prohibitionist cause. Consequently, in the development of a “ideational process”, [49] before an idea can help to shape an attempt at reform, its inclusion on the political agenda, and the definition of public policy, there is one step that appears to come first: attaching the idea to a dominant political issue.

15

In light of the new information that has been contributed these past few years by neurobiology and pharmacology, the legal distinction between legal and illegal drugs no longer seems to have a valid scientific basis. Non-prohibited drugs (alcohol, tobacco, pain medication, psychiatric drugs) are potentially just as dangerous, overall, as prohibited drugs. And with regard to the latter, it does not seem logical that the same blanket condemnation applies to the consumption (moderate or abusive) of all illicit substances, as their toxicities and effects vary enormously. [50]

16One year later, the Henrion report was published, a very important document in the history of changes in French drug policies. [51] On the one hand, the report marked the culmination of tense interdepartmental negotiations regarding the implementation of risk reduction policies. On the other, it also tangibly opened up public debate on the issue of decriminalising marijuana use by firmly advocating for this position. But the Henrion commission, which included no neurobiologists, still maintained a distant relationship with dopamine theory (referenced once) and the CCNE’s report (referenced twice). Above all, the stance it took in favour of decriminalisation was on the basis of a criticism of the 1970 law, pointing out that this law presented an obstacle to healthcare for addicts. Some addiction specialists made reference to both reports in their statements, and in subsequent reports, and as a result dopamine theory came to be more closely associated with this proposal for reform. Appropriation thus remained surface-deep, as the scientific jargon of neurobiology was largely incomprehensible to non-specialists. Nevertheless, a link began to be established between the anti-prohibitionist position and dopamine theory, to the extent that the latter now allowed the existing legal classifications to be called into question. Consequently, although the outline of the political issue at stake (decriminalisation) and its connections with the scholarly repertoire of neurobiology appeared to be relatively clear-cut, the indexing of the anti-prohibitionist cause to dopamine theory was not yet complete. In fact, although this theory allowed the existing categories to be challenged (i.e., the distinction between legal and illegal substances), it did not, however, establish a new classification as such, on the basis of which the legal status of different psychotropic drugs could be modified.

17Ultimately, a process of “de-confinement” [52] led dopamine to move between different arenas (from neurobiology, to the neurobiology of addictions (Inserm), to MIRE, MILDT, the CCNE, and ultimately to a public debate on drugs), thus causing it to become attached to a political objective with regard to drug policies (the decriminalisation of narcotics, and in particular marijuana). This first phase in dopamine’s political career was thus characterised by the fact that although it did circulate between the scholarly and politico-administrative fields, it was only weakly appropriated; not just because it only took root in peripheral and marginal regions of the drug policy world, but also because the inherent properties of dopamine theory did not immediately allow it to become a completely indispensable “reference point” for the anti-prohibitionist cause. The arrival of new actors and modifications to dopamine theory via new scientific expertise then changed the situation by shifting the “cognitive offer” to a “political demand”; that is to say, a concrete proposal for reform. [53]

Bernard Kouchner and decriminalisation: the appropriation of a political cause in search of scientific legitimacy

19We should first retrace Bernard Kouchner’s trajectory and his political relationship to drug and addiction issues in order to understood how he endorsed the anti-prohibitionist cause and why he needed to be able to draw upon a certain number of scientific reference points in order to legitimise his reform attempt and boost its chance of success. After undertaking several missions for the French Red Cross at the beginning of the 1970s, Kouchner helped to restructure the field of humanitarian medical aid by founding Médecins sans frontières (MSF – Doctors Without Borders), and then Médecins du monde (MDM – Doctors of the World) ten years later. Johanna Siméant describes Kouchner (and the whole generation of “French doctors” that surrounded him) as “an enlightened amateur”, capable of supporting causes with the necessary detachment, of publicly adopting a number of positions, and of choosing projects to be involved in based on the opportunities that they offered him. [54] This is likely what brought Kouchner to politics at the end of the 1980s, after having publicly supported the socialist candidate. He began to take an interest in drug and addiction matters when he became minister of health in 1992. Of course, he could hardly have avoided the question, since the issue of the transmission of AIDS among heroin addicts had become a major public controversy by that time. [55] But it was primarily his proximity to the world of humanitarian medical aid that would connect him to this political issue in a more permanent manner. MDM was in fact one of the first actors to promote risk reduction and, as an “enlightened amateur”, Kouchner quickly adopted its position in favour of the reform of existing drug policies. Throughout the 1990s, Kouchner regularly took part in drug policy debates, realising the significant political exposure these issues received and thus the potential gains to be made. We can see the extent to which ideas can be linked to interests (here, political ones): not only do the former shape perceptions of the latter, [56] but interests in turn encourage a cognitive framework that facilitates support for a specific set of beliefs. [57] Having been advised on these issues by a former MDM president, Patrick Aeberhard, who would be appointed to each of his future cabinets, Kouchner gradually developed a position with regard to narcotics legislation.

20

So, when Kouchner was at the height of his position as Minister of Health, in 1992-93, he asked me to take care of this problem. At the time, he didn’t know much about it and little by little, he came to believe that this was a goal we had to attain [reforming the 1970 law] and that since he would be appointed minister, or at least secretary of state a number of times, he would try to help things progress each time. [58]

21In 1993, after the socialists were defeated in the legislative elections, Kouchner published an editorial in Le Monde. [59] In it, he argued that “we must consider the rights of drug users, who are full citizens. […] Let us not use the word decriminalisation, which suggests that we are soft on drug trafficking and drug traffickers. We should talk instead about necessary regulations for use.” He condemned the legislative framework as inappropriate “for young hash smokers”: “this law goes against the stated goal. It must be debated and then modified.” Back at the Health Ministry in 1997, he firmly intended to continue supporting this cause, which the reports published by the CCNE and the Henrion commission had made particularly visible to the public eye. But Kouchner also became aware of the complexity of the issue and realised that an institutional power struggle and political manœuvring would not necessarily play in his favour, and thus adjusted his hopes for reform to reflect their likely political viability. [60] For if drug policies had become a legitimate political issue, putting the anti-prohibitionist cause on the government’s agenda still remained a rather delicate affair – and developing a concrete reform project even more so. Although an “ideational process” was at work, during which ideas and other determining factors of public policy interacted (interests, institutions, electoral and partisan dimensions, etc.), this process was still far from reaching its conclusion. [61] Kouchner thus proceeded discreetly and, with his advisor, orchestrated a strategy which aimed to move his chess pieces into place slowly but surely.

22The first step in this strategy was organising the Rencontres nationales sur l’abus des drogues et la toxicomanie (National Meetings on Drug Abuse and Addiction) in December 1997 at the Ministry of Health. The goal was to bring together the addiction community around one project, but Aeberhard was careful to “not get trapped in a situation where we had to state that we were for or against decriminalisation so starkly. That wouldn’t help in any way.” [62] Kouchner went one step further: “That would mean that the debate was doomed from the start. Taking a position from the start means holding the entire debate hostage.” The revision of narcotics legislation required a great deal of political caution. The aim was to be able to reap the benefits of active reform without disqualifying oneself from the political game, where a position of outright support for decriminalisation was not tenable – at least in the absence of solid arguments that were not (solely) moral or ideological. At the time, dopamine theory did not yet provide a very useful “idea”. In fact, although the theory allowed the “political problematisation” of the anti-prohibitionist cause to be entertained, it did not yet ensure its conversion into legitimate technical solutions. [63] For if the concept of dopamine made all drugs comparable in theory, the actual comparison of these substances – in light of which a new regulatory framework could possibly be established – had still not been undertaken. It was thus not surprising that during these Rencontres nationales, the “coalition” [64] that began to form around Kouchner did not concretely mobilise the concept of dopamine. In fact, even if its political theorisations linked it (rather explicitly) to the question of decriminalisation, its inherent characteristics did not permit anti-prohibition activists to establish it as an indisputable reference point, on the basis of which they might develop viable technical solutions (i.e., concrete policy instruments to reform narcotics legislation). Dopamine theory thus needed to acquire additional properties to be fully appropriated by reformers and be capable of defining the content of a new public policy. In other words, it did not yet constitute a form of “government knowledge”. [65]

23Ultimately, although these national meetings presented a “moderate strategy”, [66] they were only the first step in a well-designed plan. The following phase was announced in the closing speech: Kouchner had just contacted the pharmacologist Bernard Roques so that the latter could prepare an expert report on the comparative dangers of various drugs. Until now advocates for decriminalisation had maintained a distant relationship with scientific expertise, whilst nevertheless keeping it discreetly in the background of this issue; an issue which science had done so much to bring to light, and which now mobilised properly political actors and arenas. With additional scientific attributes, dopamine theory would soon become a veritable “scholarly reference point” to help modify drug policies.

The Roques report: indexing a reform strategy to scientific findings

24In the mission statement sent by Kouchner to Roques in January 1998, the latter was asked to develop, “based on [his] work and the existing international literature, a scientific analysis comparing the dangers posed by different toxins and psychotropic substances, including alcohol and tobacco, particularly with regard to the brain”. [67] Even without being explicitly cited, it was dopamine that allowed the gap between legal and illegal substances to be bridged. Neurobiological and neuro-pharmacological expertise was prominently represented in the group of experts (only Aeberhard, Kouchner’s technical advisor and a cardiologist, did not come from this discipline). Drafted over the course of a few months, the conclusions of the Roques report were crystal-clear:

25

If we are comparing their “dangerousness”, three groups [of psychotropic substances] can be identified. The first group includes heroin (and opiates), cocaine and alcohol; the second group, psychostimulants, hallucinogens, benzodiazepines and tobacco; and finally, and a long way behind, marijuana. [68]

26By relegating marijuana to a specific category – that of drugs that were not at all or hardly dangerous – the experts demonstrated their affinity with the political project of the report’s sponsor. Dopamine theory thus acquired attributes that would facilitate its circulation and appropriation in the field of drug policies. This expert report actually went beyond the idea that different drugs were relatively equivalent, and instead established a comparison and an effective hierarchy. Moreover, the strictly academic legitimacy of dopamine had been bolstered in the previous years by its expansion to disciplines beyond neurobiology and addiction studies (“general” neurobiology, pharmacology, psychiatry). Consequently its political uses, in particular by advocates for decriminalisation, were becoming increasingly evident. Several elements, both internalist (the inherent traits of dopamine theory and the the way the Roques report was written) and externalist (the context and conditions of its circulation in political and administrative spaces) can explain the successful indexing of the anti-prohibitionist cause to this scientific theory.

27First of all, considering the context in which the Roques report was published, scientific expertise was immediately associated with the anti-prohibitionist cause, of which the “French doctor” was the main media figure: “politically, it’s rather obvious, Bernard Kouchner seems to have tried to garner support for decriminalisation advocates”. [69] The health secretary’s cabinet strove to control the political agenda in order to orchestrate a “symbolic coup” with dopamine, [70] by highlighting marijuana’s non-dangerous nature when compared to other drugs at the very moment when a new president was appointed to the head of MILDT (see below). Decriminalisation advocates managed to accelerate the political career of dopamine by controlling the different phases of policy change. [71] Here, the “window of opportunity” [72] was not the result of factors exogenous to the policy process, but rather of direct and strategic orchestration by reformers, who managed to coordinate the phases of expertise (the availability of adequate scientific knowledge), the government’s agenda, and an institutional reorganisation that initially seemed favourable to their success. Consequently, although to understand the impact of ideas in politics it is necessary to differentiate analytically the processes that compete to shape the “cognitive offer” of those who are involved in establishing a “demand” for new kinds of knowledge, [73] we should not lose sight of the fact that these processes are often intricately intertwined.

28Second, the indexing of the anti-prohibitionist cause to dopamine theory was evident in the way the Roques report was written. In its introduction, and especially in the preface written by Kouchner himself, the report highlighted the incompatibility between the existing legal classifications and the current state of scientific knowledge. Although the term “decriminalisation” remained inconspicuous, it was clearly argued that the 1970 law had to be modified:

29

“We must not be the only country to remain ignorant of the facts, adopting ideological positions that stigmatise certain toxic substances without comparing them to others. [74] The division between legal and illegal drugs based on the criteria for risk of addiction has been challenged by the progress research has made regarding the mechanisms of how these substances act.” [75]

30Moreover, the Roques report spends the last few pages of its conclusion juxtaposing two separate tables that ensure the translation between the “political problematisation” and the “technical problematisation” [76] of the issue of drugs and addiction; in other words, establishing an equivalence between a political position and a scientific theory. The first table shows an overview of the drug classifications proposed by the Roques commission (the three categories of “dangerousness”), while the second compares different European legislation on the consumption and sale of narcotics, positioning French drug policies (as still governed by the 1970 law) among the most repressive. Here we can clearly see how a political effort was indexed to a scholarly construct, at the same time as neurobiology came to legitimise the anti-prohibitionist cause. Examining the processes of diffusion and appropriation in the politico-administrative circles in which the Roques report would later play a part (see below), it is evident that having recourse to dopamine theory was a necessary step and a “restrictive rhetorical chain” [77] for anyone wishing to take a stance on the decriminalisation of narcotics, including – and this is doubtless the most important point – for opponents of the anti-prohibitionist cause.

31We can hence better understand how implicit political theorisations are formed: a process of indexation allows a “transcoding” [78] between the properties of a scientific reference point (dopamine) and those of a policy category (decriminalisation), which can in turn be mobilised by advocates for a specific cause or, as we shall see below, be “instrumentalised” via the production of specific governmental tools. Dopamine theory is in fact so polysemic – even polymetric – that it can become, thanks to the conditions of its circulation and appropriation in the field of drug policies, the “reference point” for changing public policies. The concept of dangerousness, at the core of the Roques report, played a key role: despite being defined in a medical sense, it was still burdened by the moral and political connotations that, in the nineteenth century, had made it a legal category serving to qualify certain crimes and criminals. [79] Emphasising the dangerousness of a substance is not merely passing a scientific judgement, but also launching a political operation (often set out in existing legislation) that seeks to disqualify the users of said substance. [80] Ultimately, dopamine theory as updated by the Roques report favoured a redefinition of the drug and addiction problem and allowed drug policy reform to be put on the political agenda. But although decriminalisation was the solution touted by anti-prohibitionists, the outline and effective scope of potential changes still had to be negotiated among all relevant stakeholders. The link between problematisation and instrumentation depends on the conditions of circulation and appropriation of a given reference point within political and administrative circles. And even if this reference point may contain, thanks to its implicit political theorisations, a potentially significant impact for reform, it is not always certain that this impact will be fully expressed in the concrete process of policy formulation. Next, we shall see how dopamine’s political implications were tamed during its instrumentation phase.

The challenge of instrumentalising dopamine

32Debates surrounding decriminalisation reached their apex in the summer of 1998, following the publication of the Roques report. Once the government announced that it would prepare amendments to existing narcotics legislation, a new phase in dopamine’s political career began, now more clearly framed by the institutional and political constraints of public action. Dopamine theory began to circulate in new spaces (the governmental sphere) and was appropriated by new actors. The uses of dopamine started to extricate themselves from the anti-prohibitionist cause in an attempt to graft neurobiological knowledge onto less radical reform solutions, allowing for balance and compromise between the different sides. The modalities of dopamine’s indexation were thus transformed within the drug policy sphere: the relative failure of anti-prohibitionist attempts at reform did not lead political and administrative actors to abandon the neurobiological theory, but it became embedded in more nuanced forms of problematisation and instrumentalisation. We shall see how instrumentalisation operations, considered as a new way to index an idea in politics (depending, evidently, on the conditions of its circulation and appropriation), shape political theorisations – for which the reference point is an essential conduit – and thus exacerbate or mitigate the potential effects suggested by that reference point’s inherent properties.

33First, a political context allowed for the anti-prohibitionist cause to be “absorbed” by the institutional landscape of drug policy. In other words, although reforming the legal framework of the fight against drug addiction was not completely out of the question, decriminalisation was far from being the chosen solution. Nevertheless, the three main actors in these negotiations (MILDT, the Ministry of the Interior and the Ministry of Justice) were quick to appropriate certain scientific categories to defend their position with regard to the question of prohibition, and to establish some kind of compromise with their institutional partners and adversaries.

“Arbitration”: when a political initiative must adapt to an institutional configuration

34The same day that the Roques report was published, Nicole Maestracci was appointed president of MILDT. [81] The position had been offered to her by Kouchner, who had met her six months earlier during the Rencontres nationales sur l’abus des drogues et la toxicomanie. But although since 1997 MILDT had been operating under the state secretariat of health, the prime minister’s cabinet then presented a bill proposing that the interdepartmental structure be returned to its administrative supervision, [82] a clear sign that Lionel Jospin had decided to take the reins on this sensitive issue. Matignon’s position with regard to the political implications of dopamine was a result of a process of political framing conducted well before Maestracci’s nomination. Informal meetings had taken place between the prime minister and a number of other relevant ministers in order to determine the orientation of the public policy that the latter would have to elaborate. This is where the “need for reform” was stipulated: [83] in other words where the political viability of different technical solutions was evaluated. Though the necessity of adapting the legal system to the new insights of neurobiology was agreed, the range of possibilities was still too wide for the prime minister to grant his ministers full latitude to determine the terms of the public policy. The goal was to avoid the drug and addiction problem culminating in a political crisis, such as the sector had seen a few years earlier when risk reduction policies had been implemented. [84] It was consequently during these meetings that the decriminalisation option was formally eliminated and it was decided that the legal response to violations of narcotic legislation should nevertheless favour public health measures rather than punitive ones.

35

“We laid down a few political markers around the subject in advance, and we had one or two debates in open, rather unstructured informal meetings, in the Prime Minister’s office, and we framed the issue, decriminalisation or no decriminalisation, and where do we draw the line. […]. I mention these two meetings because the political framework was set out there, it was the first thing we had to take care of, it was our responsibility [the four technical advisors], to establish a shared political line that was defended by all the ministers, and the same one, so that there was no cacophony, this was the starting point. And after, once this framework was established, we entered into the traditional governmental decision-making process.” [85]

36Thus, even though anti-prohibition advocates had managed to put the reform of existing narcotics legislation on the political agenda with the help of dopamine theory, the option favoured by this group – decriminalisation – was still too radical, given the institutional and political equilibrium among all drug policy actors. Although the government had committed to preparing a new action plan against drugs and addiction, it nevertheless also wished to find a solution that was more appropriate for the existing power structure. Dopamine’s political career was certainly part of the movement pushing for a focus on health within drug policies, but this movement was nonetheless tempered by the institutional equilibrium of existing political and administrative forces, whose configuration did not allow for decriminalisation to become the consensus outside of anti-prohibitionist circles. This episode thus illustrates the fact that it is not always so easy to dissociate the phases of confinement and de-confinement of public problems, just as it is not easy to separate the operations of problematisation and instrumentalisation of ideas in politics. Dopamine entered into a new phase that could be called semi-public and semi-private, its forms of appropriation henceforth unfolding in intermediary politico-administrative spaces (in terms of confinement). The uses of dopamine were discussed in ministerial cabinets and at the highest levels of central directorates (the political dimension), but in the technical language of the law and of neurobiology, accompanied by little publicity (no parliamentary debates or consultations with civil society partners). It was thus in these unique arenas, on the border between the political and the administrative, [86] that a double indexing operation occurred – both political and technical – of the theory of dopamine to the content of a public policy, that of its instrumentation.

37At the outcome of this political framing operation – the nomination of Maestracci marking its beginning – MILDT once again took charge of the “drugs and addiction” dossier, instead of the State Secretary of Health (despite the latter having been one of the main architects of dopamine’s inclusion on the political agenda). This moment sounded the death knell for Kouchner’s ambitions. Even though he had never explicitly stated his support for decriminalisation, Kouchner ultimately had no choice but to align himself with the government’s stance:

38

“I do not seek decriminalisation, and not only because the prime minister is opposed to it, even if that’s a good reason, since I’m part of the government, a government that communicates.” [87]

39On an institutional level, Kouchner was taken out of the game by MILDT’s return to the prime minister’s supervision, at the same time as he lost a strictly political battle regarding the definition of the drug and addiction problem. He thus withdrew from the process of public policy-making, while the anti-prohibitionist cause essentially disappeared from the political and administrative landscape of the drug policy field. A new phase of “sub-politicisation” was then launched, [88] in other words a return to more euphemistic forms of problematisation and instrumentation, which coincided with the debate’s shift to new arenas and the introduction of new actors. But the narcotics legislation problem had been constructed by anti-prohibitionist advocates (by indexing it to dopamine theory) in such a way that its new owners would not be able to ignore its previous definitions. [89] These actors would thus have to learn how to handle the scholarly definitions of drug addiction and adapt their positions accordingly with regard to the legal framework of drug policies.

40The diffusion of neurobiological theories in the central spheres of the drug policy field (the Ministry of the Interior, the Ministry of Justice, and MILDT – rather than the Ministry of Health) also meant the redefinition of their implications in terms of public policy, to the extent that these three actors would need to produce regulatory instruments for drug usage that referred, at least in part, to dopamine theory, while simultaneously rejecting the option proposed by its first advocates. We will likewise see how the “reform configuration” [90] in which a scientific reference point circulates ultimately shapes the conditions of its appropriation by politico-administrative actors. In this case, it was in fact the retreat of dopamine’s primary political champion that allowed the drug’s career to experience a new phase. This is proof that “veto players” [91] are not necessarily the opponents of an idea, whose institutional position allows it to be blocked. In fact, the supporters of a scientific reference point can also curb the expansion of its arena of circulation and appropriation, and thus its potential impact on the elaboration of public policies – especially when their involvement is such that it tends to monopolise the indexing of the new reference point to policy measures that are radical or lacking in consensus (in this case, decriminalisation).

Domesticating dopamine

41In this new configuration, MILDT was the actor that was most familiar with the scientific discoveries of neurobiology and which, after a fashion, ended up replacing the health secretariat in the work of indexing public policy to dopamine theory. Maestracci was in fact quite familiar with the “drugs and drug addiction” dossier, which she had encountered several times before in her career as a magistrate: in the office of the Minister of Justice (1988-1992), where she observed the first attempts to run needle exchange programmes; then as a sentence enforcement judge in Melun’s Court of First Instance (1992-1996), where she was confronted with the legal treatment of drug addiction while the implementation of risk reduction policies was in full swing. Once appointed to MILDT, she quickly familiarised herself with the state of neurobiological research (interviews, conferences, reading), and, moreover, appointed J.-P. Tassin as head of the interdepartmental scientific council. In general terms, her vision of drug policies made reference to the various different scientific categories which were available to her. During her presidency, MILDT became the nerve centre for the definition of French drug policies and represented the gateway via which neurobiological and addiction reference points entered the politico-administrative space. [92] Maestracci helped to distribute the crucial table from the Roques report (which classified drugs according to their dangerousness) in exchanges with her institutional partners (via mail, telex, etc.). This table thus became the main vector for circulation of dopamine theory in the world of drug policy. By distancing herself from Kouchner’s earlier positions, however, in particular by linking the aforementioned table with other elements of the Roques report, Maestracci allowed dopamine theory to be mobilised by other politico-administrative actors, and to be separated from the anti-prohibitionist cause and its primary solution of decriminalisation. More than adherence to a belief, what we can observe here is in fact the appropriation of a scientific reference point (in both senses: taking ownership and converting its properties).

42This does not mean, however, that making political use of dopamine theory was an easy task for all new players. The Minister of the Interior was especially hard-pressed to accept the forms of problematisation and instrumentation that were implied by neurobiological references, given in particular how anti-prohibitionist advocates had previously used them. For reasons that were both cultural and institutional, police management was essentially associated with the criminalisation of narcotics usage, which gave the police a way to fight against drug trafficking (with, in particular, the possibility of remanding drug users in police custody). [93] In his exchanges with MILDT, the representative from the Ministry of the Interior first began by challenging the indexation of public policy to the scientific research in neurobiology and addiction studies:

43

“This approach is based on a behavioural doctrine which, despite being the most recent approach, does not as such justify it being allowed to define a public policy exclusively. Although it may be appropriate with regard to legal and cultural drugs such as alcohol and tobacco, it is much more difficult to apply it to illegal products […] even if, of course, everyone is aware of the idealism of a drug-free society.” [94]

44Although the Minister of the Interior’s prohibitionist position was clearly apparent, and would be reiterated many times, we can nonetheless see a concession being made when he admitted that the goal of eradicating drugs entirely was a utopian fantasy – an argument that was dear to Maestracci. [95] Prior political arbitration (the rejection of decriminalisation) here played a role of “sub-politicisation” by eliminating conflict from the policy-making process. [96] Representatives from the police administration would even go so far as to appropriate the biomedical repertoire to better influence its transposition into law. With regard to the texts being prepared by MILDT, police representatives proposed the potential indexing of narcotics legislation to scientific categories:

45

“[fearing] that an approach to dependence that was overly focused on public health and behavioural problems would place issues of public safety on the back burner, and ultimately help to make the use of narcotics seem banal, [97] […] [the minister] suggests that at the very least, developments regarding the reaffirmation of the objectives and principles of criminal policy concerning drug users should be inserted into the chapter about prevention.” [98]

46In short, even if we should be careful not to downplay the divergences between MILDT and the Ministry of the Interior, it is nevertheless true that these two players were able to establish a relative consensus thanks to new forms of the appropriation of dopamine theory, ultimately making possible a calmer “reform configuration” (by ousting the State Secretary of Health). It was, however, in the context of the relationship that MILDT had with the Ministry of Justice that the instrumentation, and more specifically the “domestication” [99] of dopamine theory were concretely conducted. The Chancellery prepared a circular on criminal policy that sought to redefine how the 1970 law was applied by public prosecutors. This document marked both the compromise reached between all governmental drug policy actors and the culmination of dopamine’s political career: the reference to dopamine theory demonstrated definitively how the latter had been able to embed itself in the policy-making process and thus influence certain political theorisations. Although decriminalisation was no longer on the table, the neurobiological theory nevertheless favoured an increased focus on public health issues within narcotics legislation. The compromise was largely achieved by Maestracci, but also because the Chancellery had spent several years striving to promote public health instruments within legal proceedings, [100] and this occasion allowed it to reaffirm its central position in (drug) policy-making:

47

“In terms of narcotics use, public prosecutors have been made aware, over the past few years, of the problems regarding alternative responses to judicial proceedings, and of the diversification of these responses. […] It seems essential to me to recognise this gain.” [101]

48Once again, we can see how indexing a political idea depends on the interactions between cognitive, institutional and strategic factors. [102] The circular was at pains to distinguish different kinds of psychotropic substances – despite all being classified as narcotics – according to current neurobiological expertise regarding their dangerousness or the risk of addiction depending on mode of consumption:

49

“The offence of the use and possession of narcotics can apply to many extremely different situations. There is no comparison between, for example, someone in possession of a few milligrams of hash and someone caught with large quantities of heroin. And yet they are charged with the same infraction. […] Making the distinction between occasional drug use, drug abuse, or drug dependence should help us choose between different legal options.” [103]

50Legal practices were thus adapted to drug classifications and definitions of addiction as informed by dopamine theory: the circular proposed instruments such as “procedure with warning”, especially for occasional marijuana users, and “procedure with counselling”, for dependent users. It was on the basis of the comparative dangerousness of drugs that a circular of criminal policy could thus permit itself to promote differentiated treatment of individuals and psychotropic substances, despite the former all legally belonging to the same category of “narcotics users”, as defined by the 1970 law.

51Ultimately, although the anti-prohibitionist cause did not find favour due to a political context that excluded the option of decriminalisation, by the time its political career reached an end, dopamine had nevertheless succeeded in becoming the established “scientific reference point” of drug policy, transformed into an “idea” that was diffused well beyond its original scientific scope. The circular was in fact a policy instrument appropriated to this end, to the extent that it constituted a relatively flexible form of regulation, one that could be adapted to varied local situations and which would allow previous practices to be maintained while simultaneously taking new norms into account. [104] Since it was not possibly to simply reject the neurobiological categories that had become a central element for defining the problems of drugs and drug addiction, it was necessary for a new indexing process to be conducted between the content of the public policy and dopamine theory: one that would allow actors to master its implicit political implications, so that these implications would be compatible with both the institutional and political equilibrium of the drug policy world. In a certain sense, instrumentation also meant “domestication”, in that the conditions of circulation and especially of appropriation (in both meanings of the term) of an idea in a politico-administrative space shape the theorisations that it will be able to express, thus determining how the idea will become “politically viable”. [105]

52* * *

53At the end of our journey alongside dopamine, we can see more clearly how ideas can impact public policy. The problem is certainly vast and has been variously and frequently interrogated in the existing literature; this article is far from claiming to have addressed all of these lines of investigation. Looking at the “prime” areas of research identified in recent studies, I believe that the case presented above offers several fruitful avenues for reflection. The main task of the current aggiornamento is to clarify the link between problematisation and instrumentation of ideas within policies. Behind this ambition lies the desire to connect work on the construction of public problems and agenda-setting with research stemming from new historical institutionalism, which is more (state-) centred concerning the concrete basis of public policies. At least two elements discussed here seem to fall directly within this perspective.

54First of all, this article has demonstrated the value in empirically re-connecting processes and operations which have generally been analytically separate in the past. On the one hand, the “supply” and “demand” of ideas in politics are correlated phenomena: an academic body of knowledge circulates in a politico-administrative space because its purveyors not only see an interest, but also an opportunity, in mobilising it. It is only by examining this dynamic that we can understand the potential effects of an idea on the definition of a public problem or policy. As presented in the Roques report, dopamine perfectly illustrates this two-fold movement, which simultaneously benefited from new neurobiological theories and the placement on the political agenda of the anti-prohibitionist cause. Ultimately, this is what the notion of indexing expresses. On the other hand, the forms of technical and political problematisation, often relegated to the confinement/de-confinement dichotomy of public policies and problems, merit being examined side-by-side. In fact, the processes of politicisation, played out in public arenas and relating to properly political objectives, are nevertheless based on the technical properties of the categories they exploit. Dopamine theory could only be fully exploited by decriminalisation advocates in its second version (found in the Roques report): that is to say, when it not only asserted that all drugs utilised the same neural pathways, but also that some psychotropic substances were, from this point of view, more harmful than others. From this perspective, the concepts of over- and sub-politicisation have the merit of distinguishing the different forms of problematisation and instrumentation by degree rather than by nature.

55This leads to the second point of the article: the importance of not side-stepping analysis of the inherent categories of a scientific reference point or a form of public policy (without, of course, falling into the functionalism trap). We should in fact consider the two facets of appropriation, and what they owe to circulation, in order to reveal the way in which implicit political theorisations are formed and expressed. If we seek to comprehend the link between the political and technical treatment of an idea, between its problematisation and its instrumentation, we must examine how it becomes a reference point. By conducting “process tracing” on dopamine, this article has thus identified three forms of indexing in the field of drug policies, each one characterised by the specific processes of circulation and appropriation that fashion the political theorisations (and thus the effects) that this category encompassed: first of all, attachment, which saw dopamine associated in a fairly loose and probably reversible manner to a goal (decriminalisation); then, mobilisation, which allowed it to be anchored more firmly when it was pressed into the service of a political endeavour (the anti-prohibitionist cause); and finally, instrumentation, which saw dopamine grafted onto the content of a specific public policy, which marked the domestication of its potential effects. At the end of its trajectory, dopamine was finally established as a “theory” with properties that were relatively flexible, capable of influencing both the strictly scientific appropriation of drug consumption and the content of a public policy. Thanks to the notion of “reference”, and by striving more specifically to describe these indexing operations, this article has thus attempted to open the black box of “implicit political theorisations” and emphasise the contingent nature of ideas in politics. In other words, the effects of ideas on public action are linked to the conditions of their circulation and appropriation. As the case of dopamine has shown, a single scientific category can bestow different political theorisations on the (technical) solutions of public action, and consequently orient public policy in an alternative fashion. In fact, although dopamine was rapidly exploited by the anti-prohibitionist cause, which promoted such instruments as the decriminalisation of narcotics, it was ultimately limited to promoting a focus on health measures within drug policies – a process which had already been underway, thanks to legal tools which granted more weight to a medical, rather than criminal, approach to drug addiction.

56I believe that these elements for reflection may contribute to the problematic of change in public policy, which constitutes the overlapping core of the different trends and traditions within political science research as presented in this article. Once more, far from claiming to discuss the many theoretical models that exist, [106] and even less presenting a new one, [107] this article merely seekds to elucidate what a close examination of a particular case study may bring to the debate. Here again, the debate is primarily structured around broad oppositions, such as between change and status quo, or between different types of change (incremental, paradigmatic, etc.). [108] And yet dopamine’s political career specifically highlights the overlap between different characteristics that the existing literature has tended to separate. For when the emergence of a new scholarly theory – which had led many to believe that a profound break would occur (decriminalisation) – in fact culminates in an ultimately marginal adjustment of public policy, but nevertheless moves in the direction of a long-term trend (public health measures), what are we to conclude? Doubtless we should admit that the constitutive elements of the “three orders of change” [109] (to use Peter Hall’s terms) can co-exist in a single public policy. Or that between change and the status quo, we should perhaps also interrogate the conditions for “continuity”; that is to say, that reconfigurations may occur as part of a trend, and that micro-transformations can occur within these very processes, whose dynamic they fundamentally maintain. This perspective raises in particular the notion of the interdependence between the different temporalities of change – a line of research recently suggested [110] and which I believe merits further investigation. In this case, this would mean re-contextualising dopamine’s (relatively short) political career within the history (both long and mid-term) of French drug policies. In the end, I argue that the value of the “systematic process tracing” method, at least in its “historical” version, [111] lies not in validating or invalidating theoretical models via a series of successive tests, [112] but rather in connecting them in a painstaking attempt at “empirical operationalisation” [113] which would allow new areas of research to emerge. [114]