Commentary
Salutogenesis: Contextualising place and space in the policies and politics of recovery from drug dependence

https://doi.org/10.1016/j.drugpo.2015.10.002Get rights and content

Highlights

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    Links between agency, drug use and places of consumption are well-established.

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    Places of drug use generate the production/exchange of various forms of capital.

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    UK policy favours structurally-led approaches to drug treatment options.

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    Structure and agency collide in the State's interpretation of recovery capital.

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    Salutogenesis may synthesise structure and agency within enabling environments.

Abstract

This commentary seeks to make a contribution to applied and academic debates concerning recovery from drug dependence. This involves a discussion of various commonalities relating to the places and spaces of substance use/treatment; the identification of various tensions relating to ‘structure and agency’ in current service provision and the way in which environmentally disparate settings may be synthesised to establish enabling environments of recovery. At the centre of this discussion is Aaron Antonovsky's (1984) model of ‘salutogenesis’ (and ‘salutogenic environments’) and how this conceptual framework may be considered and/or applied in the field of recovery from dependent substance use.

Whereas public health, clinical intervention and epidemiology each attempt to identify the underlying causation of illness and ill health, salutogenesis is an agency-led concept that seeks to identify the factors and mechanisms that foster good health and the principles of ‘keeping well’. It is suggested that a salutogenic approach to recovery options would draw upon the guiding principles of the framework towards advancing, individual level, recovery capital. These principles being (i) the development of social/cultural capital within socially-constructed environments; in which (ii) individual action (or agency) seeks to (iii) manage ill health; recognise the challenges underlying illness and identify the resources that are available to improve health. The author suggests that opportunities for a more ‘salutogenic approach’ to recovery may be noted within a grassroots model burgeoning throughout parts of the UK (and known as Recovery Cafés). This design is in stark contrast to the State's more structurally-focused treatment options that may not fully appreciate the influence of agency (and the role of place) in attempts to garner recovery capital.

In order to demonstrate the academic and applied value of the proposed salutogenic framework to the issue of recovery from dependence (including the centrality of space and place in debate surrounding substance use/treatment), the author draws upon empirical research as well as theoretical and hypothetical frameworks from the discipline of sociology to illustrate throughout.

Section snippets

Place, space and substance use

The sentiment underlying Harvey's (1996, 316) observation that ‘places are constructed and experienced as material ecological artefacts and intricate networks of social relations’ has been increasingly recognised throughout the social sciences during the last two decades (see Fitzpatrick & LaGory, 2000). This recognition is particularly notable within a large body of, mainly qualitative, research that focuses upon the relationship between places and spaces associated with various forms of

Sociological theory and places of substance use

Other researchers (Bourgois & Schonberg, 2009Neale, 2002, Rhodes, 2002) have considered the spatial qualities (including associated capital) of drug-using environments from theoretical positions that prioritise the dialectic of ‘structure’ and ‘agency’ (the two way relationship between individual action and structural influences). Similarly, Parkin, 2013, Parkin, 2014 presents an empirical assessment of Pierre Bourdieu's theories concerning habitus in the context of street-based injecting

The emergence of capital in UK drug policy

It is currently en vogue for politicians and policy-makers (on a global scale) to respond to issues of drug dependence with terms of sociological-grounding such as ‘recovery capital’1.

For example, interest in this particular ideal is made explicit throughout the UK Government's most recent Drug Strategy document (HM Government, 2010) in which the Home Secretary explains:

A fundamental difference between this

Places of recovery and productivity?

Various conditions attached to the treatment of drug dependence (such as high intensity, long duration and interruption) have raised divisive opinions relating to the overall efficacy of OST, especially for “high severity’ populations, throughout the UK (see McKeganey, 2011). Indeed, polarised discussions at an applied level has perhaps characterised policy-related debate of this topic in the UK for over a decade (McKeganey, 2011). Similarly, theoretically-grounded critiques (Bourgois, 2000,

Salutogenesis: A synthesis of place, capital and public health politics?

Thus far this commentary has highlighted the centrality of place relating to drug-using environments and the way in which place facilitates substance use and the production of street-level capital. In addition, an overview of the way in which drug policy has attempted to engage sociological approaches to drug treatment and recovery from dependence has highlighted the applied value of theory (relating to capital). A third highlight relates to structural attempts to reproduce an alternative form

Conflict of interest statement

There is no conflict of interest.

Acknowledgement / Disclaimer

The views, opinions and academic content within in this paper are those of the author. These views, opinions and interpretations should not necessarily be associated with any previous/current body/people associated with the research described throughout this text. In addition, these views and opinions are not necessarily shared or held by any institution to which the author has been previously or currently attached (especially those associated with the author's current position at the

References (57)

  • G. Stimson

    Blair declares war: The unhealthy state of British drug policy

    International Journal of Drug Policy

    (2000)
  • ACMD

    What recovery outcomes does the evidence tell us we can expect?

    Second report of the recovery committee

    (2013)
  • A. Antonovsky

    Health, stress and coping

    (1979)
  • A. Antonovsky

    Unravelling the mystery of health

    (1987)
  • A. Antonovsky

    The salutogenic model as a theory to guide health promotion

    Health Promotion International

    (1996)
  • M. Ashton

    The new abstentionists

    Druglink Special Insert

    (2008)
  • D. Best et al.

    The potential of recovery capital

    (2010)
  • P. Bourdieu

    Distinction: A social critique of the judgement of taste

    (1984)
  • P. Bourgois

    Disciplining addictions: The bio-politics of methadone and heroin in the United States

    Culture, Medicine and Psychiatry

    (2000)
  • P. Bourgois et al.

    Righteous dopefiend

    (2009)
  • D. Briggs

    Crack cocaine users: High society and low life in South London

    (2011)
  • R.G. Carlson

    Shooting galleries, dope houses and injection doctors: Examining the social ecology of HIV risk behaviours among drug injectors in Dayton, Ohio

    Human Organization

    (2000)
  • M. de Certeau

    The practice of everyday life

    (1984)
  • J. Conahan et al.

    Responding to the needs of homeless substance abusers: A social business model

    International Journal of Interdisciplinary Social Sciences

    (2012)
  • K. Duke et al.

    Substitution treatment in the era of “Recovery”: An analysis of stakeholder roles and policy windows in Britain

    Substance Use and Misuse

    (2013)
  • M. Ferres et al.

    The social, health and wellbeing benefits of allotments: Five societies in Newcastle

    Electronic working paper 47

    (2012)
  • K. Fitzpatrick et al.

    Unhealthy Places: The ecology of risk in the urban landscape

    (2000)
  • R. Granfield et al.

    Coming clean: Overcoming addiction without treatment

    (1999)

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