The cities applied a range of harm reduction measures combined with systematic control strategies in order to tackle the problems. None of the cities succeeded by treatment and medical and social support measures alone. Provision of increased helping measures alone seems to have been unsuccessful and when provided within the open drug scenes, may even have increased their attraction. Equally, the provision of repressive methods alone has not been successful, even when an increase in control measures was combined with crisis intervention and coercive interventions. Only when the cities developed a comprehensive policy that integrated and coordinated treatment and helping measures with control measure were they able to successfully alleviate their situation. It might seem that the all have met the precondition of overcoming the controversy between prohibitionist and harm reduction ideologies.
The comprehensive and integrated policies share certain core features. One is that problematic substance use and dependence are defined as health care problems. At the same time, drug taking is seen as a social behaviour that is subject to ordinary social rules. The user has no right to be of nuisance to others, but the user has the same inborn right to integration in society and the same set of individual rights as others in the general population. Social stigmatization and isolation should be avoided. It is also accepted that mental health problems are often a key feature of problematic drug use and that these conditions should be diagnosed and treated effectively. Nevertheless, problematic behaviour should be controlled and prevented, and relevant measures have to be shared across different professions and service systems. Therefore shared responsibility should be accepted with a commitment to cooperation between the police, the social services and the health care services. This commitment has to be binding and anchored at a high political level.
Underlying these measures has been a basic acceptance of drug users including those who have been unable or unwilling to stop the use of illegal drugs, but this was combined with a policy not to permit the continuation of destructive behaviour in terms of public nuisance. The cities established policies of “no tolerance” for public nuisance but nevertheless developed appeasement, and found approaches to “coexistence” between society and users of illegal substances. This helped to end unfruitful controversies between liberal and conservative ideologies and policies.
