Articulating addiction in alcohol and other drug policy: A multiverse of habits

Concepts of addiction differ across time and place. This article is based on an international research project currently exploring this variation and change in concepts of addiction, in particular in the field of alcohol and other drug (AOD) use. Taking AOD policy in Australia and Canada as its empirical focus, and in-depth interviews with policy makers, service providers and advocates in each country as its key method (N = 60), the article compares the addiction concepts articulated by professionals working in each setting. Drawing on Bruno Latour's theoretical work on the body and his proposal for a better science based on the 'articulation of differences', it explores the accounts of addiction offered across the Australian and Canadian project sites, identifying a shared dynamic in all: the juggling of difference and unity in discussions of the nature of addiction, its composite parts and how best to respond to it. The article maps two simultaneous trajectories in the data - one moving towards difference in participants' insistence on the multitude and diversity of factors that make up addiction problems and solutions, and the other towards unity in their tendency to return to narrow disease models of addiction in uncomfortable, sometimes dissonant, strategic choices. As I will argue, the AOD professionals interviewed for my project operate in two modes treated as distinct in Latour's proposal: in turning to reifying disease labels of addiction they take for granted, and work within, a 'universe of essences', but in articulating the multiplicity and diversity of addiction, they grope towards a vision of a 'multiverse of habits'. The article concludes by addressing this tension directly, scrutinising its practical implications for the development of policy and delivery of services in the future, asking how new thinking, and therefore new opportunities, might be allowed to emerge

The missing mass of morality: A new fitpack design for hepatitis C prevention in sexual partnerships

In the West, most hepatitis C transmission occurs through the sharing of equipment used for injecting drugs, and most sharing occurs between sexual partners. Despite this, little is known about how injecting practice, including equipment use, is managed in these partnerships. This article draws on science studies theorist Bruno Latour’s work on technology and ethics (2002), and preliminary data collected fora research project on sexual partners who inject together, to illuminate these issues. Responsibility for avoiding transmission has long been conceived individually, as have measures intended to aid individuals in fulfilling this responsibility, such as the distribution of sterile injecting equipment. This individualising tendency has been criticised for inequitably responsibilising disadvantaged people. This article aims to exceed this individualising approach by proposing a different understanding of agency and a new mode of prevention. Rather than treating hepatitis C in conventional terms, as a bounded, ontologically stable object that pre-exists its encounter with individuals and the material objects they use in injecting, it formulates it as made in its enfolding with other phenomena, including social relationships and technological objects. In turn it sees transmission in new terms; as a question of social relationships and of object design. The article goes on to discuss a new Australian research project that takes this approach as its starting point, aiming to develop two key prevention innovations: (1) new messages aimed at partnerships rather than individuals, and (2) a new injecting pack or ‘fitpack’ that treats the partnership a sa primary unit of resourcing. The article concludes by considering the politics of this shift to an ethics of technology, social relationships and objects

Junk: Overeating and obesity and the neuroscience of addiction

Over the past decade intense concern has developed in the West about what has been characterised as an obesity epidemic. This concern is producing a range of effects, including changing attitudes towards food. Some foods are no longer just foods; they are increasingly framed as illicit substances. At the same time, overeating is coming to be seen as a form of addictive behaviour. How do new concerns about junk food, health and overeating impact on notions of drug use and addiction? In this article, I explore food and obesity as a case study of changing ideas about addiction. Drawing on an analysis of scientific journal articles that link obesity and addiction, the article examines the assumptions that drive such linkages, and their implications and effects. Wherever obesity is linked to addiction, this link is increasingly explained via neuroscientific theories of behaviour. The brain's hedonic and reward systems are cited to frame ‘excessive’ eating as addictive behaviour, and ‘highly palatable’ or junk foods as akin to conventional drugs. In the process, a range of phenomena are enacted. In science studies theorist John Law's [(2011). Collateral realities. In P. Baert & F. Rubio (Eds.), The politics of knowledge (pp. 156–178). London and New York: Routledge] terms, numerous important ‘collateral realities’ are produced. ‘Drug addiction’ is referred to as though no controversy exists over its interpretation. Likewise, ‘drugs’ are produced as a homogeneous group with no differentiating features. The article concludes by considering the limitations of such accounts of food, the body, health and well-being, and their reciprocal effects on the field of drug addiction

The impact of training on the attitudes of mental health professionals toward borderline personality disorder

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The addict as victim: Producing the 'problem' of addiction in Australian victims of crime compensation laws

Background: Much academic scholarship has explored drug use and ‘addiction’ in the criminal justice system. Methods: This paper explores what happens when ‘addicts’ are victims, through an analysis of victims of crime compensation case law within the state of Victoria, Australia. Results: We argue that the law enacts a set of unexamined assumptions about the ‘problem’ of addiction, including the assumption that it is incompatible to be both addict and victim. However, courts reconcile this ‘dilemma’ by explaining addiction as an ‘effect’ of trauma, violence or abuse, a seemingly sympathetic rendering of addiction. Although this appears to represent a less stigmatising approach than found in the criminal law, we argue that these processes actually produce new challenges for people who use drugs and ‘addicts’, and that these may be counter to the stated aims and objectives of crimes compensation law. We argue that even legal systems with an explicitly remedial rationale have the potential to generate harms, creating those who use drugs and ‘addicts’ as pathological in certain ways and thereby undermining their claims to citizenship. Our analysis is underpinned by a critical approach to the constitution of social problems based on the work of Carol Bacchi. Conclusion: Although the focus is on Australian law, the arguments we develop in this paper are likely to resonate beyond the specific jurisdiction reviewed here, and raise questions about the mutually interdependent role of law and policy in compounding the stigmatisation and marginalisation of people who use drugs and drug ‘addicts’

Addiction veridiction: gendering agency in legal mobilisations of addiction discourse

This paper explores the question of whether and in what ways the law and legal processes work to stabilise addiction as a health problem or ‘disease’. In undertaking this analysis, we also explore the associated gender implications of these practices and the means through which legal processes that stabilise addiction simultaneously stabilise gender. Using the work of science and technologies scholar Bruno Latour, in particular his anthropological analysis of scientific and legal ‘modes of existence’, we explore legal processes of what he calls ‘veridiction’ – or the specific processes by which law distinguishes truth from falsity – associated with addiction. We focus on processes that are largely hidden from public view and as such receive little scrutiny, but through which the meaning of addiction as a disease is secured. Our aim is to consider the role of legal negotiations in establishing agreed facts, and to explore lawyers’ understanding of these processes. We argue that although in public discourse judges are ascribed the status of the law’s key decision-making figures, lawyers’ accounts do not necessarily support this view. Instead, their accounts of the judicial process foreground their own and other lawyers’ role in decisions about addiction, despite an absence of training or education in the area. We also note that lawyers’ accounts suggest little independent oversight – even from judges – of the work lawyers do in stabilising addiction ‘facts’. Based on these observations, we consider the ways such processes of stabilisation impact on women in the legal system whose lives are in some way affected by discourses of addiction as a disease. We argue that legal practices of veridiction are centrally implicated in the making of both gender and health and that elements of these processes, which are not often publicly visible or subjected to scrutiny, require more analysis

Hepatitis C prevention and convenience: why do people who inject drugs in sexual partnerships ‘run out’ of sterile equipment?

Rates of hepatitis C virus transmission among people who inject drugs in Australia remain high despite decades of prevention education. A key site of transmission is the sharing of injecting equipment within sexual partnerships. Responsibility for avoiding transmission has long been understood individually, as have the measures designed to help individuals fulfil this responsibility, such as the distribution of sterile injecting equipment. This individualising tendency has been criticised for placing an unfair level of responsibility on poorly resourced, marginalised people and ignoring the social nature of injecting drug use and related health care. Likewise, although research has demonstrated that injecting drug use is gendered, gender and sexual partnerships remain marginal to health promotion efforts. In this article, we address these weaknesses, drawing on a qualitative, interview-based project that explored equipment sharing within (hetero)sexual partnerships. In conducting our analysis, we explore a key theme that emerged in discussions about accessing and sharing injecting equipment, that of convenience, using critical marketing theory to understand this theme. In particular, we investigate the issues of convenience that affect the use of sterile injecting equipment, the many factors that shape convenience itself, and the aspects of equipment use that go beyond convenience and into the realm of intimacy and meaning. We conclude that injecting equipment needs to be both meaningful and convenient if sharing within partnerships is to be reduced further

Emergent publics of alcohol and other drug policymaking

Alcohol and other drug (AOD) policy is developed within complex networks of social, economic, and political forces. One of the key ideas informing this development is that of the ‘public’ of AOD problems and policy solutions. To date, however, little scholarly attention has been paid to notions of the public in AOD policymaking. Precisely how are publics articulated by those tasked with policy development and implementation? In this article, we explore this question in detail. We analyze 60 qualitative interviews with Australian and Canadian AOD policymakers and service providers, arguing that publics figure in these interviews as pre-existing groups that must be managed – contained or educated – to allow policy to proceed. Drawing on Michael Warner’s work, we argue that publics should be understood instead as made in policy processes rather than as preceding them, and we conclude by reframing publics as emergent collectivities of interest. In closing, we briefly scrutinize the widely accepted model of good policy development, that of ‘consultation,’ arguing that, if publics are to be understood as emergent, and therefore policy’s opportunities as more open than is often suggested, a different figure – here that of ‘conference’ is tentatively suggested – may be required

Food, fat and family: Thinking fathers through mothers' words

In targeting parenting and the family with advice on healthy eating and exercise, contemporary childhood obesity discourse draws attention to mothers as primary carers. In the process, fathers' roles and responsibilities in promoting healthy lifestyles and in family food work are neglected or silenced. This article addresses the silence surrounding fathers' participation in the feeding of their families. To do so we draw on qualitative data from an Australian Research Council-funded study investigating the impact of childhood obesity-related health messages on families. Using Carol Gilligan's (1982) notion of the ethics of care and Ann Phoenix's (2010) concept of ‘intertextuality’ and silence in the qualitative research process, we offer an ‘intertextual’ reading of mothers' presentations of fathers' involvement in family food provisioning. Mothers' accounts reveal how gender is relationally produced in the context of parental food work, with descriptions of maternal expertise, altruism and commitment to health being contrasted with stories of paternal authority, complacency and selfishness