Interpellating recovery: The politics of ‘identity’ in recovery-focused treatment
Introduction
Sociological and psychological research on alcohol and other drug addiction tends to treat ‘recovery’ as a process of positive identity change and development. While the literature takes a range of approaches to identity, the term is generally used to mean a particular enduring sense of self. Early sociological studies of ‘natural recovery’ examined how people fashioned new ‘non-addict’ identities through participation in non-drug using social networks and activities. More recently, the ‘social identity’ approach has sought to illuminate the psychological and cognitive mechanisms of recovery by analysing how social relationships and participation in groups support the development of recovery identities. Although there are obvious differences between the two approaches, identity functions in both literatures as a conceptual vehicle for exploring continuities and changes in self-concept and drug-using practices, and the nexus between the individual and the social environment. In this article, we depart from this dominant approach by examining how the social and material practices of treatment are themselves active in the constitution of ‘recovery identity’. Using Judith Butler’s theorisation of interpellation and its recent mobilisation in science and technology studies, we examine the accounts of treatment experiences and practices provided in interviews conducted in Victoria, Australia with people who inject drugs. We argue that the ‘recovering addict’ is not a coherent psychological identity but rather a socially produced category. We consider the production of this category in relation to three dynamics identified in the data: (1) the tendency in therapeutic models of addiction to materialise treatment subjects as both disordered (because of unresolved trauma, unmanageable emotions or disease) and as ‘in control’ of these disorders; (2) the production of treatment subjects as enmeshed in suspect social relationships and therefore requiring surveillance as well as social support; and (3) treatment’s particular enactment of social context such that it erases stigmatisation and marginalisation and paradoxically performs individuals as entirely responsible for relinquishing drug use. As we will argue, these dynamics produce capacities and attributes often ascribed to identity but which are better understood as articulations of epistemological disorder in the state of knowledge about addiction, and its expression in treatment. By way of conclusion, we question the utility of ‘recovery identity’, conventionally defined, in providing a rationale for treatment.
Section snippets
Recovery-focused treatment in Victoria, Australia
In Australia, ‘recovery-oriented’ treatment approaches have a long unofficial history in residential services, therapeutic communities, and peer-based and self-help support services such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) (Ritter, Lancaster, Grech, & Reuter, 2011). In the UK and elsewhere, definitions of recovery have been the subject of ongoing debate, but in Australia recovery-oriented treatment usually refers to treatment practices and programs that promote and
Literature review
An interest in identity has long been central to sociological and scientific research on addiction recovery. Up until the last decade, much of the research had been located within the symbolic interactionist tradition (Nettleton, Neale, & Pickering, 2011). Here the dominant research focus was ‘natural recovery’ – drug use cessation without participation in formal treatment (e.g. Biernacki, 1986, Cloud and Granfield, 2001, Klingemann, 1992, Waldorf and Biernacki, 1981, Winick, 1962). This
Approach
One of the key contributions of poststructuralist feminist theory to the social sciences is its dismantling of the standard Enlightenment subject: the universal, unified and rational subject seen to underpin socio-material relations, practices and discourse (Fraser and Seear, 2013, Seear, 2014). For theorist Judith Butler, subjects are produced through iterative socio-material practices, and these are characterised by dynamics of inclusion and exclusion. As Butler explains, it is only through
Method
This article analyses material from in-depth, semi-structured interviews conducted in Melbourne in 2014 and 2015 by the first author (RF). The interviews were undertaken for a study on the emergence of ‘recovery’ in Australia. This study had two main aims: to identify how recovery-focused policy, scientific research and service provision problematise injecting drug use and people who inject drugs, and to understand how people who inject drugs adopt, accommodate, resist or otherwise engage with
Analysis
We begin our analysis of the data by considering how modes of ordering addiction materialise treatment subjects as both disordered and as ‘in control’. In the next section we consider the interpellative logics of social connection, the injunctions they produce and the ‘insecure’ and ‘hyper-vigilant’ subject positions they engender. Finally we examine how the simplistic mode of ordering ‘social context’ in treatment interpellates a responsibilised subject as entirely responsible for avoiding and
Conclusion
This article has critically examined the ontological politics of and rationale for recovery-focused research and treatment. Drawing on feminist theory and STS scholarship, we have identified three key dynamics at work in the ontological politics of recovery-oriented addiction treatment. First, we have shown how addiction treatment ‘modes of ordering’ enact disordered subjects yet simultaneously interpellate these devalued and stigmatised subjects as responsible for managing the many
Acknowledgements
The research on which the article is based was funded by a PhD scholarship from the Centre for Research Excellence into Injecting Drug Use (National Health and Medical Research Council Grant Number 1001144). Suzanne Fraser is funded by an Australian Research Council Future Fellowship (FT120100215). The National Drug Research Institute at Curtin University is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvement Grants Fund. The authors
References (68)
Articulating addiction in alcohol and other drug policy: A multiverse of habits
International Journal of Drug Policy
(2016)- et al.
Dazzled by unity? Order and chaos in public discourse on illicit drug use
Social Science & Medicine
(2008) - et al.
The social model of cessation maintenance: Formulation and initial evidence
Addictive Behaviors
(2015) - et al.
Producing the ‘problem of drugs': A cross national-comparison of ‘recovery' discourse in two Australian and British reports
International Journal of Drug Policy
(2015) ‘Workers’, ‘clients’ and the struggle over needs: Understanding encounters between service providers and injecting drug users in an Australian city
Social Science & Medicine
(2009)- et al.
Putting at risk what we know: Reflecting on the drug-using subject in harm reduction and its political implications
Social Science and Medicine
(2006) Motherhood, pregnancy, and the negotiation of identity: The moral career of drug treatment
Social Science & Medicine
(2011)Ideology and ideological state apparatuses (notes towards an investigation)
Stories of change in drug treatment: A narrative analysis of ‘whats’ and ‘hows’ in institutional storytelling
Sociology of Health and Illness
(2015)Australian drug policy: Harm reduction and ‘new recovery’ (Discussion paper: draft for consultation)
(2012)
Identities under construction: Women hailed as addicts
Health
‘New recovery’, harm reduction & drug use policy statement
Predictors of flexibility in social identity among people entering a therapeutic community for substance abuse
Alcoholism Treatment Quarterly
The processes of reform in Victoria’s alcohol and other drug sector, 2011–2014
Overcoming alcohol and other drug addiction as a process of social identity transition: The social identity model of recovery (SIMOR)
Addiction Research & Theory
Social networks and recovery (SONAR): Characteristics of a longitudinal outcome study in five therapeutic communities in Australia
Therapeutic Communities: The International Journal of Therapeutic Communities
The recovery paradigm: A model of hope and change for alcohol and drug addiction
Australian Family Physician
Engaging with 12-step and other mutual aid groups during and after treatment: Addressing workers’ negative beliefs and attitudes through training
Alcoholism Treatment Quarterly
Pathways from heroin addiction: Recovery without treatment
Group membership and social identity in addiction recovery
Psychology of Addictive Behaviors
Bodies that matter: On the discursive limits of ‘sex’
Excitable speech: A politics of the performative
Natural recovery from substance dependency
Journal of Social Work Practice in the Addictions
Remaining a user while cutting down: The relationship between cannabis use and identity
Drugs: Education, Prevention, and Policy
The therapeutic community: Theory, model, and method
Encountering ‘triggers’: Drug-body-world entanglements of injecting drug use
Contemporary Drug Problems
Reducing the alcohol and drug toll Victoria’s plan 2013–17
Health identities: From expert patient to resisting consumer
Health
‘It’s Your Life!’: Injecting drug users, individual responsibility and hepatitis C prevention
Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
Habits: Remaking addiction
Making disease, making citizens: The politics of hepatitis C
‘Spoiled identity’ in hepatitis C infection: The binary logic of despair
Critical Public Health
Substance and substitution: Methadone subjects in liberal societies
Surviving heroin: Interviews with women in methadone clinics
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2022, International Journal of Drug PolicyCitation Excerpt :Previous studies have also established that how various addiction-related phenomena are made up in practice has far-ranging consequences for those affected. Examples include substance use problems (Lancaster, Duke & Ritter, 2015; Moore & Fraser, 2013; Savic, Ferguson, Manning, Bathish & Lubman, 2017), recovery (Fomiatti, Moore & Fraser, 2017 & 2019; Theodoropoulou, 2020), treatment (Rhodes, Azbel, Lancaster & Meyer, 2019; Valentine, 2007), and people who use substances (Dennis, 2017; Pienaar et al., 2017). Of particular interest to our study is critical research on claims made in addiction discourse to authorize and essentialize addiction-related phenomena as more or less undisputable scientific truths (see e.g., Fraser, 2015, 2016; Fraser & Ekendahl, 2018; Fraser, Valentine & Ekendahl, 2018; Pienaar et al., 2017).