Addiction” and an Etiological Model of Drug Addiction
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A socio-historical deconstruction of the term “addiction” and an etiological model of drug addiction A thesis submitted to the University of Manchester for the Degree of Doctor of Philosophy in the Faculty of Humanities Shane O’Mahony 2020 School of Law, Centre for Criminology and Criminal Justice CONTENTS Abstract P. 3 Declaration P. 4 Copyright P. 5 About the author P. 6 Acknowledgements P. 7 Part One Chapter one – Introduction P. 9 Chapter two – Literature Review P. 25 Chapter three – Methodology P. 63 Part Two Chapter four: “From shebeens to supervised injecting centres: The socio-historical P. 124 construction and portrayal of addiction in Ireland” Chapter five - “The addicted habitus in Cork City” P. 187 Chapter six - “A novel approach to drug addiction” P. 263 Part Three Chapter seven – Conclusion P. 296 1 References P. 313 Appendices P. 362 Appendix 1 – Topic Guide P. 362 Appendix 2 – Participant Information Sheet P. 384 Appendix 3 – Consent Form P. 394 Appendix 4 – Distress Protocol P. 397 Word Count: 90,000 2 ABSTRACT Over the past twenty years, treated drug misuse, drug overdoses, and the spread of infectious diseases linked to injecting drug use have all increased substantially in Ireland. To date, the consensus view in addiction research in Ireland is that drug-related harm is mainly explicable by reference to social deprivation. Furthermore, these approaches have largely represented the relationship between deprivation and drug-related harm by drawing on several positivistic indicators (high unemployment, low educational attainment, high crime rate). These approaches have failed to adequately engage with a large body of international literature on the social construction of concepts of “harmful” substance use across time and place. They have also tended to be disproportionately based on the experience of drug users in Dublin. The current thesis addresses these limitations by presenting a genealogy of dominant concepts of harmful drug use across time in Ireland, and a case study drawing on 12 in-depth interviews conducted with drug users in Cork. The thesis presents a novel approach to the study of drug addiction in Ireland, which argues that it is both constituted and real. The dominant understanding of drug-related harm in Ireland has been constituted over time according to the interests of powerful groups, political-economic and socio-cultural developments, and contingent events. Furthermore, the process by which this representation has achieved dominance has had a number of adverse effects on drug-using populations, including the view that they are a corrupting force in an otherwise well-functioning Ireland and the imposition of a stigmatized subjectivity. Alternatively, the current thesis argues that drug-using populations experience social suffering due to their lived experience of violent structures such as catholic institutionalization, patriarchal violence, alienation, and social bulimia. In this context, and when drug users meaning-making structures become undermined and treatment modalities deploy mechanisms of symbolic violence, their drug use becomes most harmful and they adopt the addicted habitus (i.e, become addicts). The thesis concludes with a discussion of this alternative model of addiction, and its implications for addiction research and policy. 3 Declaration I declare that no portion of the work referred to in the following thesis has been submitted in support of an application for another degree or qualification of this at any other university of other institute of learning. However, the research conducted for Chapter four has been used in an article published in the Irish Journal of Sociology. It can be found here: https://journals.sagepub.com/doi/abs/10.1177/0791603519835437 4 Copyright Statement The author of this thesis (including any appendices and/or schedules to this thesis) owns certain copyright or related rights in it (the “Copyright”) and s/he has given The University of Manchester certain rights to use such Copyright, including for administrative purposes. Copies of this thesis, either in full or in extracts and whether in hard or electronic copy, may be made only in accordance with the Copyright, Designs and Patents Act 1988 (as amended)and regulations issued under it or, where appropriate, in accordance with licensing agreements which the University has from time to time. This page must form part of any such copies made. The ownership of certain Copyright, patents, designs, trademarks and other intellectual property (the “Intellectual Property”) and any reproductions of copyright works in the thesis, for example graphs and tables (“Reproductions”), which may be described in this thesis, may not be owned by the author and may be owned by third parties. Such Intellectual Property and Reproductions cannot and must not be made available for use without the prior written permission of the owner(s) of the relevant Intellectual Property and/or Reproductions. Further information on the conditions under which disclosure, publication and commercialisation of this thesis, the Copyright and any Intellectual Property and/or Reproductions described in it may take place is available in the University IP Policy (see http://documents.manchester.ac.uk/DocuInfo.aspx?DocID=487), in any relevant Thesis restriction declarations deposited in the University Library, The University Library’s regulations (see http://www.manchester.ac.uk/library/aboutus/regulations) and in The University’s policy on Presentation of Theses. 5 About the Author Shane O’Mahony is a Criminologist interested in the relationship between drug addiction and broader socio-cultural, historical, discursive, and political-economic structures and systems. He holds a primary degree in History, as well as a master’s degree in Criminology. He has taught Criminology at the University of Manchester, and is currently a lecturer in Criminology at Bath Spa University. His primary research interests revolve around drug use and addiction. 6 Acknowledgements I would like to thank my supervisors Toby Seddon and Lisa Williams for all their help, support, and patience over the last three years. Your helpful comments on the many drafts I sent your way was of immeasurable help. I would like to thank my friends, both in Manchester and Cork, for providing support when I needed it most. I would like to thank my family without whom none of this would be possible. I would like to thank all of those who participated in this research. This study would not have been possible without your input, and I hope I have represented your views and experiences faithfully throughout. Finally, I would like to dedicate the study to the memory of my late uncle who had battled opiate addiction for over two decades, and had achieved recovery prior to his death 7 PART ONE Introduction Literature Review Methodology 8 Chapter one INTRODUCTION Addiction in Cork City (Ireland). “The Rabbittee report had an immediate and lasting effect [on Irish drug policy] . Appendix 3 simply used a color-coded map which provided graphic proof that treated drug misuse was not randomly distributed across Dublin, but instead clustered in areas designated as socially disadvantaged (Butler, 2007: pp.127/132)”. The above statement, made by Shane Butler on the 10th anniversary of the Irish Government’s acceptance of the link between social deprivation and the most severe drug-related problems (injecting use, drug use leading to treatment), represents the consensus view in the Irish research literature. Indeed, as Butler (2007) points out, the epidemiological evidence summarized in the maps dates back to community-level studies conducted in Dublin’s inner-city in the 1980s. These studies invariably found that drug problems clustered in the most disadvantaged communities in Dublin. Furthermore, these community-level studies are supported by data collected by the National Drug Treatment Reporting System (NDTRS), which has been the primary source of information on illicit drug use since the 1990s (see O’Hare and O’Brien 1992; O’Higgins, 1996). 9 Indeed, the profile of the typical drug user in treatment matches the community level and epidemiological research conducted in the 1980s. That is, they are typically male, single, from a disadvantaged socioeconomic background, with low educational achievement and poor employment records. Further support is provided by capture- recapture studies conducted by epidemiologists (Comiskey, 1998), as well as ethnographic research carried out by social scientists (see O’Gorman, 2005; Mayock, 2005). Moreover, since the Government’s embrace of these research findings, various structures have been established to target resources at areas deemed at risk1 of experiencing drug problems (e.g. local drugs task force). This orientation culminated in the Irish Government’s most recent drug policy document (Irish Government, 2017), which further committed to the view that drug-related harm could not be explained satisfactorily in individual terms2. This policy document also provided a legislative basis for the introduction of supervised injecting centers, as well as other harm reduction measures. The consensus view in the Irish literature then is that drug-related problems can largely be explained by reference to a set of positivistic indicators (high unemployment, high crime, poor educational attainment), which render specific communities vulnerable. Though there is some disagreement concerning appropriate policy responses, few authors would disagree with Butler (2007)