Addiction and living in the shadow of death: impact of the body on agency and self-control

Abstract

Aims

To explore the lived experience of self-control by people with opioid and alcohol dependence.

Design

A longitudinal qualitative study.

Participants

The sample consisted of 69 persons with alcohol or opioid dependence, mostly from low socio-economic backgrounds in Sydney, Australia. People were recruited in both a detox facility and a maintenance treatment.

Measurements

Semi-structured interviews.

Findings

The bodily effects of substance dependence impact profoundly on the self-control of substance-dependent people. This change to self-control happens in two ways: by forcing substance users to take a local perspective on their lives, and by changing both their self-concept and their beliefs about what they can achieve. These bodily effects on self-control resemble other chronic diseases.

Conclusion

Understanding the role that the body plays in impairment of self-control in substance dependence can help to prevent these harms and contribute to overall recovery and well-being. Good quality health care, rendered by non-judgmental professionals, contributes immensely to the normative and diachronic agency of those struggling with addiction by minimizing somatic damage and damage to the self. Knowing how a loss of trust in one’s body can impair self-control may help health care professionals support people struggling with addiction in regaining trust in their body, future and self-control mechanisms.

Keywords:

• Self-control
• embodied agency
• diachronic agency
• disability bioethics
• opioid dependence
• alcohol dependence

Acknowledgments

A special thanks to the respondents who shared their stories, and to Hanna Pickard, Jeanette Kennett, Neil Levy, and Annie Bleeker for their valuable feedback. I would also like to thank Jai Galliott for his rigorous editing. Funding for this study was provided by the Australian Research Council (DP 1094144).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Sharing data from qualitative research, might endanger the anonymity of the research participants. Since they give very detailed accounts of their lives, and because they are such a highly stigmatized group, we decided not to make the data available.

Notes

1 Alcohol use is associated with more than 60 medical conditions (Rehm and Bondy 1998; Vaillant 2009; Lokkerbol et al. 2013; World Health Organization 2014). Several studies have outlined a high mortality rate amongst substance-dependent people (Vaillant 2009; Ericsson et al. 2013), some estimating a death rate as much as 50 to 100 times higher than the general population (Hser et al. 2001), depriving people of approximately 44 years of life, of which 29 are before the age of 65 (Degenhardt et al. 2014).

2 A literature search on the role of embodiment in addiction revealed a very limited use of this concept. Most literature can be found in the literature on symbolic interactionism, which looks at how the embodiment of addiction changes the relationships to others (Weinberg 2002; Duff 2007; Hellman 2012). There is another small stream of literature that focuses on addiction as an embodied custom (Schlimme 2010; Nettleton et al. 2011), but the emphasis is on addiction as a custom, rather than embodiment. A third stream of literature describes the addiction neuroscience as a turn to embodiment (Netherland 2011), but the neuroscientific literature focuses only on one part of the body: the brain.

Additional information

Funding

Funding for this study was provided by the Australian Research Council (DP 1094144). The funding sources had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.