The Trouble with Morality: The Effects of 12-Step Discourse on Addicts’ Decision-Making

Abstract

Since its development in the 1960s, researchers have extensively scrutinized methadone maintenance treatment (MMT) as a medical response to heroin addiction. Studies consistently find that MMT is more successful than other treatment models in the reduction of opiate/opioid misuse, the transmission of diseases like HIV/AIDS and hepatitis C, and criminal arrest and conviction rates. Nonetheless, a significant portion of active and former heroin addicts view MMT negatively and—perhaps as a result—MMT is vastly underused. This study examines the effects of 12-Step discourses on the opinions and treatment decisions of active heroin addicts, addicts in MMT, and addicts in 12-Step treatment programs. The study finds the abstinence/morality based discourse of drug addiction and treatment is pervasive among addicts and their non-drug using relations and peers alike; moreover, addicts have internalized this narrative, oftentimes despite their own knowledge of MMT's success and positive personal experiences. The findings suggest that the dominance of abstinence/morality narratives contributes to MMT's poor reputation among, and low use rate by current and former heroin addicts and that the power of the dominant discourse is such that it produces a desire to buy into its values and tenets even when it is against the individual's interests to do so.

Keywords:

• abstinence
• decisions
• methadone
• morality
• stigma
• treatment

Notes

1.Opiates refer to alkaloids extracted from poppy pods and their semisynthetic counterparts which bind to the opioid receptors, while opiod is used to refer to any drug which binds to receptors in central nervous system (CNS) including synthesized drugs like methadone. However, this study uses the terms interchangeably.

2.The abstinence/morality discourse refers to the previously described discourse that currently dominates mainstream conceptions of drug addiction, treatment and recovery, and is exemplified by 12-Step organizations such as NA.

3.To some extent, addict's negative perceptions regarding methadone-based treatment are due to structural issues such as the cost of treatment or inconvenience of the clinic system. However, their descriptions of the stigma experienced from family, friends, and society in general suggests that patients are experiencing sociocultural difficulties beyond the structural problems associated with the clinic system (D'Aunno & Pollack 2002; Sheridan 2008; Zule & Desmond 1998).

4.Cause and implied treatment can be distinct. The experience of trauma does change brain chemistry (there is ample evidence of this), creating a medical reality that can be treated medically. Thus, stating something has an environmental cause does not preclude seeking a medical cure.