The Making of the Chronic Addict

Abstract

Inspired by social problems theory, this article analyzes the “formula story” of harm reduction in a Danish addiction-treatment context. In Denmark, very few opiate addicts are in drug-free therapeutic treatment. Instead, they are offered methadone (often on a permanent basis) accompanied by practical help in tackling the negative social, economic, and health-related consequences of their drug use. The aim of this article is to show how the formula story of harm reduction—and first and foremost the idea that opiate addiction is an incurable condition—tends to work as a self-fulfilling prophesy. Opiate addicts entering the treatment system risk being “made up” as chronic addicts regardless of how they themselves look upon their own addiction problem and notwithstanding that many of them have not given up their hope of becoming drug-free. The article is based on two types of data: (1) file records (gathered in 2007) describing the addiction problems and treatment careers of clients enrolled at outpatient treatment centers in Copenhagen, and (2) qualitative interviews (conducted in 2006) with 30 methadone-program participants at the centers. The analysis is qualitative and the empirical results cannot necessarily be generalized to other methadone-maintenance programs. Yet the theoretical message of the article is applicable to all treatment institutions and social problems work in general. Definitions and categorizations of clients are not innocent, and naming people and their problems is the same as changing them.

Keywords:

• formula story
• institutional identities
• harm reduction
• chronic addicts
• institutional matrix
• looping effects
• self-determination

Notes

¹The price for 1 month's residential treatment ranges from DKK (Danish krone) 30.000 to 50.000 (US£ 63.00 to 10.500) (Center for Rusmiddelforskning, 2008: 252). Drug-free, residential treatment is the costliest form of treatment in Denmark (Pedersen, 2007).

²In all 198 randomly chosen files of opiate addicts were analyzed at two different ambulatory-treatment centers in Copenhagen in 2007. For the most part, we registered quantitative information (about the development in the participants' living conditions, recorded criminality, frequency of contacts with the treatment system, etc.). When gathering this (and many other types of) information, however, we simultaneously took qualitative notes from a number of files, especially in cases when the files contained information pertinent to the formula story of harm reduction. It is the latter type of notes that the present analysis is based upon.

³Both the interviewers were females, 26 years and 30 years old respectively. Both had a B.A. in sociology from the University of Copenhagen.

⁴Despite this information, however, some participants may have hoped that the interviewers could help them with realizing different types of plans (for instance coming into drug-free treatment if that was what they wished), which the interviewers could not, and this was also explained to participants who brought up this issue. This fact—that the participants took part in the study without being likely to be benefitted directly from their participation—is an important ethical issue in studies like the present one (see Kleinig & Einstein, 2006).