Dissertations, Theses, and Capstone Projects

Date of Degree

5-2018

Document Type

Dissertation

Degree Name

Ph.D.

Program

Sociology

Advisor

Barbara Katz Rothman

Committee Members

Ric Curtis

David Brotherton

Rebecca Tiger

Jessie Daniels

Subject Categories

Medicine and Health | Social Control, Law, Crime, and Deviance | Sociology

Keywords

methadone maintenance treatment, recovery, harm reduction, addiction, disease model of addiction, criminalization

Abstract

Methadone Maintenance Treatment (MMT) has been undergoing a cultural and epistemological shift away from an approach that emphasized client stabilization and a reduction of social harms towards one grounded in values associated with the recovery movement. These changes include promoting a view of addiction grounded in the disease model as well as efforts to make abstinence and ancillary services such as recovery coaching/counseling, programs emphasizing proper citizenship, and concern for clients’ spirituality necessary parts of the program. As such, the increasing use of recovery as the dominant conceptual framework for MMT represents a change in how methadone, MMT, and those who use it are socially constructed. Recovery, which is based on theories of addiction-as-disease, is seen by some as a means to restore MMT to its rightful position as a medically-based treatment for addiction and a way to remove stigma from individuals on the program. Others believe that the shift will act as a form of social control by pathologizing drug use/users and obscuring the role of structural forces (criminalization) in the harms experienced by drug users. Moreover, by constructing PWUD’s choice to attend MMT as unrelated to the ways that they are oppressed under criminalization, the recovery discourse depoliticizes drug treatment issues, and, as such, implicitly supports the status quo criminalization of PWUD. This dissertation uses qualitative interviews and ethnographic methods to examine: how the shift towards recovery affects issues of agency and control among individuals on MMT; how it influences debates over methadone’s role as a form of drug treatment; and how addiction more generally is being constructed by the recovery discourse. Results demonstrate that despite MMT’s institutional focus on recovery, most participants linked their use of MMT to the structural-legal context of prohibition/criminalization rather than through the narrative of the recovery model. Responses also suggested the recovery model functions in part to obscure the role of criminalization in the harms PWUD experience in favor of a model based on individual pathology. Thus, in contrast to the recovery model, MMT cannot be understood outside of the structural context of criminalization and the War on Drugs which shape illegal drug use as a difficult and dangerous activity, and consequently position MMT as a way to moderate or escape from those harms.

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