Research paper
Addiction stigma and the biopolitics of liberal modernity: A qualitative analysis

https://doi.org/10.1016/j.drugpo.2017.02.005Get rights and content

Abstract

Definitions of addiction have never been more hotly contested. The advance of neuroscientific accounts has not only placed into public awareness a highly controversial explanatory approach, it has also shed new light on the absence of agreement among the many experts who contest it. Proponents argue that calling addiction a ‘brain disease’ is important because it is destigmatising. Many critics of the neuroscientific approach also agree on this point. Considered from the point of view of the sociology of health and illness, the idea that labelling something a disease will alleviate stigma is a surprising one. Disease, as demonstrated in that field of research, is routinely stigmatised. In this article we take up the issue of stigma as it plays out in relation to addiction, seeking to clarify and challenge the claims made about the progress associated with disease models. To do so, we draw on Erving Goffman’s classic work on stigma, reconsidering it in light of more recent, process oriented, theoretical resources, and posing stigmatisation as a performative biopolitical process. Analysing recently collected interviews conducted with 60 people in Australia who consider themselves to have an alcohol or other drug addiction, dependence or habit, we explore their accounts of stigma, finding experiences of stigma to be common, multiple and strikingly diverse. We argue that by treating stigma as politically productive – as a contingent biopolitically performative process rather than as a stable marker of some kind of anterior difference – we can better understand what it achieves. This allows us to consider not simply how the ‘disease’ of addiction can be destigmatised, or even whether the ‘diseasing’ of addiction is itself stigmatising (although this would seem a key question), but whether the very problematisation of ‘addiction’ in the first place constitutes a stigma process.

Introduction

Definitions of addiction have never been more hotly contested. The advance of neuroscientific accounts has not only placed into public awareness a highly controversial explanatory approach, it has also shed new light on the absence of agreement among the many experts who contest it. Key neuroscience proponent Nora Volkow (Director of NIDA) argues that the approach allows us to understand that addiction is a ‘brain disease’ and that this disease approach is important because it is destigmatising. The conviction that disease labels destigmatise addiction is also evident among many of NIDA’s critics, although the disease models they use do not emphasise the ‘brain’ in the same way. Considered from the point of view of the sociology of health and illness, the idea that labelling something a disease will alleviate stigma is a surprising one. Disease, as demonstrated in that field of research, is routinely stigmatised (see, for example, Jutel, 2011; for stigma and medical diagnosis). In this article we take up the issue of stigma as it plays out in relation to addiction, seeking to clarify and challenge the claims made about the progress associated with disease models. To do so, we revisit the conceptual terrain established in Goffman’s classic work on stigma, reconsidering it in light of more recent, process oriented, theoretical resources, and posing stigmatisation as a performative biopolitical process. Analysing recently collected interviews conducted with 60 people in Australia who consider themselves to have an alcohol or other drug addiction, dependence or habit, we explore their accounts of stigma, finding experiences of stigma to be common, multiple and strikingly diverse. Stigma, it seems, emerges in and through countless activities, relationships and circumstances and plays out in an almost infinite range of ways. This reach and ubiquity invites analysis, especially from the point of view of process given its constant presence. What are the operations of addiction stigma in these instances? What, since it is hardly rare, does it achieve politically? Taking the accounts together, what does it say about drug use per se in Western liberal democratic settings? By treating stigma as politically productive – as a contingent biopolitically performative process rather than as a stable marker of some kind of anterior difference – we can better understand what it achieves. In turn this allows us to consider not simply how the ‘disease’ of addiction can be destigmatised, or even whether the ‘diseasing’ of addiction is itself stigmatising (although this would seem a key question), but whether the very problematisation of ‘addiction’ in the first place constitutes a stigma process—a process that for specific biopolitical reasons in need of further, ongoing, examination, remains indispensable to contemporary liberal societies.

Section snippets

Background

Definitions of addiction and views on the best ways to respond to it have varied significantly over time, and remain multiple and contested. The social science literature on the history and contemporary trajectory of the concept is extensive and has diversified over time to acknowledge the rather different articulations of addiction that occur depending upon the substance under discussion, other issues such as race and gender, and political and cultural variation across time and place

Literature review

Research that takes in experiences and practices of stigma in relation to drug use is extensive and diverse. Along with differences in disciplinary and methodological approaches, there are differences in scale and specificity. In this latter respect the literature takes two main forms (although see, for example, Room, 2005). One form comprises highly specific studies on stigmatising practices in particular settings such as drug treatment services, hospitals and workplaces, on how individuals

Approach

According to Goffman (1973 [1963]), stigma exists where a personal attribute is viewed negatively in society, and where the affected individual is marked by that attribute in such a way that she or he is aware of the potential or actual negative judgements of others. In this sense the individual feels a sense of being either already ‘discredited’ by the attribute, or else potentially ‘discreditable’ in that negative judgement would follow the discovery by others of the attribute in question. In

Method

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

Analysis

As we have noted, many participants described experiences of addiction-related stigmatisation. They talked at length about the impact of stigma on their everyday lives, including how it shapes their experiences of healthcare, their relationships with family, friends and their work. The sections that follow break up kinds of stigma according to context to allow us to focus on the variety of settings within which participants describe encountering stigma. Importantly, however, such experiences

Conclusions

In the analysis presented here we have spelt out the many experiences of stigma reported by the participants in our study. In doing so we have highlighted the persistence of addiction stigma in a context where disease models, most influentially right now the brain disease model, ought if expectations are correct to be reducing such experiences, and we have raised the need for new approaches that better understand the role of stigma. In response to this need we have elaborated the performative

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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