THE DECONSTRUCTING ADDICTION PRIMER
The following piece includes a critique of the disease model in relation to addiction. It then goes on to describe how Narrative Practice can be utilized as an alternative to the disease discourse.
Authors’s note: It is not my intention to denounce any of the support systems that many of you might have found useful. Instead, my aim is to take into account the pitfalls of the disease model, so that the Deconstructing Addiction League doesn’t unwittingly recreate the same limitations. I understand that certain programs/practices might have saved your life and may still be of great value to you, hence, I do not want to diminish the potential contribution it has made to your life. Please keep this in mind while reading below. Since many of the people accessing this resource are currently relying on various disease models for support, myself included, I offer this critique as a way to reposition yourself in relation to the prevailing addiction approaches if need be. This way you can engage with any program, keeping your own terms in mind. One of our writings titled ‘Working With Existing Resources’ gives examples of how to do this.
The deconstructing addiction approach is informed by Narrative Practice and Post-Structuralist ideas. This provides an alternative therapeutic perspective, one that allows us to break from the disease model. Why is this important? The disease approach can be helpful in many ways, again, I want to acknowledge this, but as with any therapeutic model, it’s not without its potential hazards. For instance, when utilizing a disease model, you are working within a framework that assumes that there is something inherently wrong with you, that you have a flaw at the center of your personhood. This implies that you are different from the ‘normal’ people who don’t have this problem—different, inferior, and in some ways, sick. Since these and other negative identity descriptions are attributed to your personhood within a disease approach, you and the problem are understood as being one and the same—meaning you are the problem. Additionally, if a person takes up the identity of an ‘alcoholic’ or an ‘addict’, they are claiming a sickness to be who they are, thereby reducing themselves to a disease. Fortunately, not all people have the same meaning for these concepts, and in fact many individuals have found creative self-affirming ways of relating to ideas of pathology that don’t feel demeaning to them. Nevertheless, it is my understanding that it is more difficult to change under negative identity conceptions in general.
The disease discourse can be inadvertently subjugating of people and here’s how. When drug users are classified by our legal system as addicts or alcoholics, they fall under the jurisdiction of authoritative power—a form of disciplinary power that seeks to carefully manage and control them through moral instruction and/or punishment. This system of control sets the tone for a kind of intellectual posturing where district court judges, case managers, counselors, interventionists and even 12-step sponsors are apt to position themselves as experts in the lives of drug users, telling them how to live—making decisions for them often without any input from drug users at all. This arrangement of having to yield to authority and to ‘expert opinion’ elicits disempowerment, normalization and social control.
The disease discourse emerged from a tradition of thought known as structuralism. Within structuralist thought, action in life is understood to be the surface manifestation of an underlying essence or disorder that comes from the center of who we are. Historically speaking, addiction has been viewed within this framework as a disease of the will. Here are some of the drawbacks of positing the human will as the essence of a disease: when a person’s will is called into question, not only does this make everything a person does subject to the scrutiny of others, but it encourages a form of self-subjugation. People are taught that their thinking is bad, their motives are wrong, and that their ‘behaviors’ are inherently selfish and dishonest. People’s so-called deficiencies in these areas are understood to be a symptom of their disease when in fact it might not be the case at all. Since people’s will and their thinking is routinely considered maladjusted and in need of change, this gives license for a general molding of the person according to the group norms of whatever program they are in. This can be dangerous and scary.
I’d like to make clear that there are plenty of reasons why it’s important to think critically about drug use and to problematize one’s actions in relation to it. In fact, I highly recommend doing this as part of a deconstructing addiction practice. Unfortunately, though, limitations can arise when doing it within a disease model. In a context where so-called ‘addict behavior’ is viewed as an inevitable manifestation of some kind of underlying dysfunction, people are likely to have a suspicious outlook and a negative interpretation of their own actions and the actions of others. This can lead to being treated in a disrespectful and even humiliating fashion in therapeutic environments. When you are seen as innately dishonest and selfish, people often engage you with an extreme bias which can be patronizing, demeaning and undeserved.
Within a structuralist method of interpretation the ‘will to truth’ is paramount. The assumption therein is that if you can get to what is true about the alcoholic, i.e. that the nature of their disease is self-centeredness, then it can be corrected by prescribing certain norms for them to live by. The idea that universal truths can be discovered that we can then live in alignment with is fraught because it often provokes others to try and interpret your actions for you, to speak on your behalf, and to offer prescriptions (one-size-fits-all all solutions) on how you should live your life.
Not everybody responds well to being molded or being told how to live. If an individual challenges this system of thought, it can be viewed as ‘defensiveness’ and if you flat out disagree with it you can be seen as being in ‘denial’. Concepts like this rig the conversation in favor of the expert’s opinion and reinforce a paradigm of dominance and submission within the addictions field. This is a huge turn-off for many folks. By alienating people, it often makes them want to resist getting help which can be devastating. Conversely, it can turn many of the people who accept help into docile individuals who have been taught to forgo their own thinking in favor of more knowledgeable people’s opinions. In time, if they stay the course though, they too will be considered knowledgable and will achieve a sort of elite status that they will then be able to hold over others within various programs and institutions.
In light of these frequent power imbalances, the Deconstructing Addiction League goes to great lengths to question the taken-for-granted use of power in the shaping of people’s lives and to challenge the ethic of control that runs rampant in the addictions field. We do this because coercion confines people, hinders their chances of turning their lives around, and grooms them in a spiritless and standardized way. Alternatively, we have found that by taking a collaborative approach and giving people more of a say, they become fully engaged as active participants in the reshaping of their own lives. This is a welcomed alternative to being the passive recipients of expert knowledge within a structuralist model. Furthermore, by deconstructing expert knowledge we can create a non-hierarchical environment, which enables people to address problems in a more respectful and egalitarian way. This, I believe, creates a greater sense of personal agency.
Utilizing a slight shift in language
When people take for granted the disease discourse in relation to addiction, they are often unwittingly participating in a practice that limits them. Here’s how the use of language can contribute to this. If a person refers to the disease as something that is ‘theirs’ (something that belongs to them, i.e. something that they possess) then they are invoking an internal-state understanding. If they are talking about other people and they refer to the disease as ‘her’ disease or ‘their’ disease, they are again invoking an internal-state understanding. In Western culture, this internalizing way of talking about oneself (where we ‘possess’ personal qualities) is standard and usually harmless, but in therapeutic contexts, it can be problematic. Here’s how we can avoid it. When talking about the problem, it is more strategically beneficial to talk about it as ‘the problem’, or as ‘the disease’ or as ‘the addiction’, not as ‘your’ problem, not as ‘my’ disease and not as ‘their’ addiction. This way a person can see themselves as having a relationship to the problem and not as the source of the problem. Later I will discuss how to move away from using pathological terms like addiction and disease altogether, but for now, referring to these problems as being outside of you, and something that you are in relation to, is a huge leap forward. This will enable people to separate themselves and their identity from the problem, which will guard against subjugation.
In addition, since internal-state understandings limit the scope of the problem to the ascribed psychological structures of the mind, or simply within the mind/body/spirit relationship, it obscures the broader social and cultural context of problems. By construing this issue as solely an individual issue and not as a collective issue with individual components, difficulties can arise. For example, instead of seeing the person in relation to the social world, and discerning how the world shapes them; an internal-state understanding only sees the person in isolation i.e. in relation to their genetic, biological and psychological makeup. From this point of view, the world in which we live has nothing to do with the problem. It’s as if people are understood to be living in a vacuum, which is extremely short-sighted. This hugely ignores the fact that we live in a culture of consumption and everybody is potentially at risk of consuming substances in copious amounts. I’ll go out on a limb and say that excessive consumption and/or addiction is not just a problem that targets a special class of individuals known as addicts—it targets everyone. Luckily it doesn’t have its way with everyone. From a structuralist perspective, the problem begins and ends with you the individual. It is part of your nature. The deconstructing addiction perspective views the problem as being larger than just you and as such requires an individual as well as a collective response.
Externalizing
To circumvent the disease discourse more fully, we can employ a practice that externalizes the conversation about the problem. With conversations that internalize the understanding of the problem—the person is the problem. When you externalize the conversation about the problem, the problem is the problem. What does all this mean? It means rather than seeing the problem as being something that is part of one’s nature, we are able to see the problem as an external entity that we are in relation to. Not only does this give the person more clarity and distance in which to view the problem, but it also takes away the negative identity conclusions that people often internalize about themselves under the disease perspective. In this way we are able to take a position against the problem, and not a position against ourselves.
Other ways to utilize non-pathologizing language include substituting terms like heroin lifestyle for heroin addiction and alcohol lifestyle for alcoholism. Also, instead of using the term recovery which implies recovering from an illness, I prefer to invoke the rite of passage metaphor which is a journey metaphor. This way, instead of being ‘in recovery’, you can think of yourself as being on a journey or a migration of identity. Other helpful ways to deconstruct the disease discourse is to refer to your journey as changing lifestyles, or breaking from addiction, or revising your relationship to substances. In addition, I prefer not to say ‘substance misuse’, as it implies that there is a quantifiable right and a wrong way to use substances. Likewise, ‘overconsumption’ implies that there is a level of consumption that is an acceptable norm and a level that isn’t. Further, you don’t need to say ‘substance abuse’ or ‘substance use disorders’ which implies disease, rather you can say substance use dilemmas if you prefer. And this field of work can be called the field of substance use revision instead of the addictions field.
A note on the league’s terminology. It is not our intention to police people’s language. We offer tips that we hope will create a new discourse, however in doing so it is not our prerogative to shame or judge people for using pathological terminology, or to coerce people into using the ‘right’ terminology. In addition, granting an elite status to people who use the ‘correct’ language and referring to people who skillfully employ the new discourse as the people who ‘get it’ is also problematic as it would reinforce normalizing judgment and a hierarchical configuration within the groups. This would actually be considered more problematic than people using language that reiterates pathology. We are in no way trying to establish a new moral authority here, as it would become divisive, reinforce expert opinion and incite power imbalances within the groups. Instead, we offer useful insights and ways to strategically step outside of the concepts that reinforce the problem. Our new discourse is offered as an invitation to you—it is not a requirement.
Further deconstruction of the ‘addiction’ discourse
As discussed earlier, there are ways to externalize the disease terminology which allows us to strategically use the given terms of the disease discourse without taking on the negative associations. However, we are not simply limited to this. We have the opportunity to break from the disease terminology entirely if you like. This is done when a person creates an experience-based definition of the problem, one that is near to their own personal experience. Addiction and alcoholism are global terms (universal terms) that are considered to be experience-distant. In other words, experience-distant terms are far from one’s personal experience. I recommend coming up with your own name that describes the unique way that the substance or substances are affecting you; a name that reflects the particularity of your very specific relationship to the problem of excessive consumption. These are known as experience-near definitions of problems. Experience-near definitions will hopefully have more resonance than an umbrella (experience-distant) term like addiction. Not only is this more tailored to one’s experience, but it enables people to personify the problems affecting them. When people personify the problem, it gives them an enhanced ability to see the entire range of the problem and to take action against it. For instance, when talking about one’s experience grappling with a particularly duplicitous drug craving, people have invented their own names for these problems like “The Sleeping Dragon”, the “Sexy Whisperer” or the “Tractor Beam”. These names hone in on how the problem operates in their life and how it upends them. The sleeping dragon catches the person off guard. The sexy whisperer acts as an instigator who tries to seduce the person into using drugs. The tractor beam is a force that keeps the person coming back for more drugs despite severe consequences. These particular understandings allow people to respond more specifically to the problem as it affects them.
On another note, the umbrella term that we can use instead of alcoholism or addiction, one that doesn’t imply pathology is excessive consumption. Excessive consumption (no matter how extreme) refers to the activity that is problematic, not to a disease that resides within. And to be clear, I am not talking about excessive consumption as a lesser degree of problematic use that sits on the lower end of a spectrum just below addiction. From a deconstructing addiction standpoint, excessive consumption refers to all forms of complicated use no matter how much or how little.
Insider experience
The people who are revising their relationship to substances are known as insiders—the people most affected by the problem. Insiders rely on what we call local knowledge or insider knowledge to support one another. Local knowledge is not derived from the expert knowledge of the professional disciplines, it is a folk knowledge. This folk understanding contains useful knowledges of life and skills of living that are excavated from our collective insider experiences to solve problems. This enables us to remain independent of the expert knowledge traditions that oftentimes impose an ‘all-knowing’ position of authority over us. Insiders, as a whole, are ultimately in a much better position to know what’s best for themselves. This is important, as the league doesn’t believe in anyone (group members included) positioning themselves as experts who claim to know what’s best for anyone else. Once group members have incorporated skills in discernment, and have support to throw off the powerful influence of the cravings, they can be counted on to make reliable life-preserving decisions.