Research paper
Challenging the addiction/health binary with assemblage thinking: An analysis of consumer accounts

https://doi.org/10.1016/j.drugpo.2017.01.013Get rights and content

Abstract

Critical analyses of drug use and ‘addiction’ have identified a series of binary oppositions between addiction and free will, independence, self-control, responsibility, productivity and autonomy. This critical work has also examined how science, policy and popular discourses frequently characterise addiction as antithetical to health and well-being. Furthermore, those diagnosed with addiction are often understood as indifferent to health and well-being, or as lacking the knowledge or desire required to maintain them. In this article, we draw on data from 60 qualitative interviews with people who self-identify as living with an ‘addiction’, ‘dependence’ or ‘habit’, to argue that the binary opposition between addiction and health struggles to attend to their rich and varied health perspectives and experiences. We explore three themes in the interview data: reinscribing the binary opposition between addiction and health/well-being; strategies for maintaining health and well-being alongside addiction; and alcohol and other drug consumption as aiding health and well-being. Perhaps because addiction and health have been so thoroughly understood as antithetical, such perspectives and experiences have received surprisingly little research and policy attention. Yet they offer fertile ground for rethinking the strengths and capacities of those who self-identity as living with an addiction, dependence or habit, as well as untapped resources for responding to the harm sometimes associated with alcohol and other drug use.

Introduction

An extensive body of sociological research has identified the political, ideological and symbolic role of health in the management of contemporary societies as well as the governing obligation of modern citizens to embrace and pursue health. These issues have informed critical analyses of drug use and ‘addiction’, which have identified a series of binary oppositions between addiction and free will, independence, self-control, responsibility, productivity and autonomy. This critical work has also examined how science, policy and popular discourses frequently characterise addiction as antithetical to health and well-being. Furthermore, those diagnosed with addiction are often understood as indifferent to health and well-being, or as lacking the knowledge or desire required to maintain them. In this article, we draw on data from 60 qualitative interviews with people who self-identify as living with an ‘addiction’, ‘dependence’ or ‘habit’, to argue that the binary opposition between addiction and health struggles to attend to their rich and varied health perspectives and experiences. We explore three themes in the interview data: reinscribing the binary opposition between addiction and health/well-being; strategies for maintaining health and well-being alongside addiction; and consumption as aiding health and well-being. Perhaps because addiction and health have been so thoroughly understood as antithetical, such perspectives and experiences have received surprisingly little research and policy attention. Yet they offer fertile ground for rethinking the strengths and capacities of those who self-identity as living with an addiction, dependence or habit, as well as untapped resources for responding to the harm sometimes associated with alcohol and other drug use. In the next sections, we review critical literature that attends to the binary between addiction and health evident in science, policy and popular discourses; outline our theoretical approach; and detail our interview methods. We then analyse the qualitative material generated by the in-depth interviews and discuss the implications of our analysis for future policy.

Section snippets

Background

The political, ideological and symbolic role of health in the governing of contemporary societies and citizens has been the subject of sustained sociological analysis (e.g. Crawford, 1977, Crawford, 1994, Crawford, 2006). Poststructuralist accounts have analysed how the promotion of health in policy and practice has become the basis for ‘technologies of the self’ in neo-liberal societies, creating obligations on the part of individuals to lead ‘healthy’ lifestyles (e.g. Burrows, Nettleton, &

Approach

The approach to ‘addiction’ and ‘health’ we adopt in this article draws on the critical literature cited above. In this respect (as well as others), it differs from the accounts conventionally offered by neuroscience and psychology, which treat addiction ‘as a more or less established medical fact, and like all medical facts, it is understood as pre-existing its “discovery” by medical science’ (Fraser & Moore, 2011: 6). Rather than understanding addiction as a unified anterior object located

Method

The qualitative research project on which this article is based involved a collaboration with Healthtalk Australia (http://healthtalkaustralia.org), an Australian research consortium that conducts qualitative research into personal experiences of health and illness, and was designed to gather personal accounts of drug use for editing and collecting in a web-based resource on addiction (www.livesofsubstance.org). Healthtalk Australia collaborative projects use a research methodology developed by

Reinscribing the binary opposition

Some participants articulated the relationship between addiction, health and well-being in terms strikingly reminiscent of the binary opposition documented in existing sociological analyses of science, policy and public discourses: that addiction is antithetical to health. For example, Renee (F, 35, works in hospitality) was, at the time of her interview, living in a residential treatment unit after completing a custodial sentence. Describing herself as now ‘in recovery’, she said her past

Strategies for maintaining health and well-being

Many participants described strategies for maintaining health and well-being while continuing to use drugs in ways that they themselves understood in terms of addiction, dependence or habit. We draw attention to the ways in which these accounts include addiction and health within the same assemblage. For example, Scarlett (F, 29, works in finance) had previously taken crystal methamphetamine at work and on weekends but now limited herself to injecting the drug on weekends with her partner. She

Alcohol and other drug use as aiding health and well-being

In the previous section, we considered accounts in which participants describe their strategies for managing or supporting their physical and mental health alongside their use of alcohol and other drugs. In this section, we consider participant accounts in which consumption is constituted in the assemblage as a force active in the maintenance of health and well-being. Our first example is provided by Zadie (F, 33, works in health), who had prior experience of detoxification for heroin use and

‘Real addicts’?

One possible response to the data and analysis we present, already expressed to us following public presentations on material from this project, is that the participants we interviewed are not ‘real addicts’. As we noted earlier, participants were carefully screened to ensure that they met the criteria for a diagnosis of ‘substance use disorder’ or ‘dependence syndrome’. But what, we also ask, is a ‘real addict’? The definition of addiction and the tools used in its diagnosis cover an

Conclusion

In this article, we have explored the relationship between addiction, health and well-being in the accounts offered by participants self-identifying as experiencing an addiction, dependence or habit. Whereas some participant descriptions of the relationship between addiction, health and well-being reinscribe the binary opposition found in science, policy and popular assemblages of addiction, others offer more complex accounts in which addiction, health and well-being are assembled together.

Acknowledgements

The research reported in this article was conducted in the Social Studies of Addiction Concepts (SSAC) Research Program, based in the National Drug Research Institute, Faculty of Health Sciences, Curtin University, in collaboration with Healthtalk Australia, Monash University, the University of New South Wales’ Centre for Social Research in Health and the Hunter New England Local Health District. The research was funded by the Australian Research Council (Discovery Project DP140100996). Suzanne

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