Addiction” and an Etiological Model of Drug Addiction

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

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

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

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.

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

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).

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) that governmental policy structures, implemented in the years since the Rabittee report (Irish Government, 1996), have been a considerable achievement.

1 This risk is usually calculated on the basis of a number of positivistic indicators (e.g. high crime rates, high unemployment).

2 It is recognised that socio-economic factors are less prominent in this document. However, they are still highlighted.

10 However, whether one accepts the way this epidemiological evidence is interpreted or supports these policy developments, it is quite obvious that currently3 the number of people using drugs in Ireland, in ways they subjectively perceive to be problematic, and the level of overdoses (Lynn, 2016) have increased substantially in the last decade. For example, in Cork, the number of people presenting to treatment services, citing heroin as their drug of choice, has increased by over 600% in the period 2004-20164. Moreover, at seventy-one deaths per million citizens, Ireland has the fourth-highest overdose rate in Europe (over three times the EU average: see EMCDDA, 2017).

These statistics, at a minimum, indicate that there is a need to rethink how we view harmful drug use and collective responses in Ireland. Put bluntly, it has been over two decades since this research evidence has been accepted, and related policy structures developed, and though there have been some successes5 treated drug misuse continues to increase across the country, along with several other indicators of harm. The first, and most fundamental issue, which requires a rethink is the view typically assumed (Bradshaw, 1983 Comiskey, 1998), but sometimes explicitly stated (Butler, 2007), that harmful drug use simply presents to governmental, social and medical systems. These researchers have viewed harmful drug use as an actually existing problem that simply presents to social and legal systems (see O’Gorman, 2005), rather than something that is conditioned and constituted by these systems themselves. Indeed, this discussion mirrors a core ontological and epistemological concern of this thesis. While the thesis highlights that addiction is a widely contested positivistic construct, it is argued that it is real insofar as it is enacted in concrete political, economic, cultural, and social contexts.

3 Time of writing is early 2019.

4 See: www.drugsandalcohol.ie/tables/

5 For example, the total number of syringes given out by pharmacies, outreach workers and community- based syringe programs in Ireland in 2017 exceeded half a million: http://www.emcdda.europa.eu/countries/drug-reports/2019/ireland/harm-reduction_en. Specialist community level services also exist in some areas.

This thesis argues, therefore, that the Irish literature has failed to adequately engage with approaches which demonstrate how understandings of harmful drug use6 are socially and culturally constructed (see Levine, 1978; Reinarman, 2005; Seddon, 2010; Keane et al, 2014), and cannot be discussed as if they were problems which self- evidently exist “out there”. Indeed, O’Gorman (2005: 1) began her ethnographic study by “. . . interrogating the evidence for the uneven social and spatial location of problematic drug use - was this a 'real' or a socially constructed phenomenon relating to how drug use was defined in disadvantaged communities?”. Despite her claim to investigate this issue, she neither quotes nor engages with, the voluminous literature examining the social construction of concepts of addiction across time and place (Room, 1975; Levine, 1978; and Courtwright, 2001), and assumes that because there is an uneven social and spatial clustering of drug-related harm in disadvantaged communities, that the problem is real and not constructed.

However, it is quite clear that the use of various positivistic indicators is a way of framing the epidemiological evidence which is itself constructed7. For example, while the indicators of high crime rates and high levels of unemployment are indeed associated with drug-related harms, they are also linked to social deprivation in general (see

6 The term harmful drug use is preferred to “drug-related harm” when discussing the type of drug use which is typically associated with addiction. This is because “drug related harm” could refer to dental problems among ecstasy users, a fractured jaw as a result of a drunken fight, etc. Crucially, while these issues might be associated with “addiction”, they may be episodic harms, and therefore, are not the concern of this thesis. This thesis is concerned with drug use which has become harmful, and in which the person feels they have lost control. It is used non-judgementally. Finally, it should be mentioned that when I use other terminology this is because it is the chosen terminology of an author or body of literature I am engaging with.

7 Ontology and epistemology – The concept of addiction is a widely contested positivistic construct, which arguably has no objective meaning beyond being enacted in practice. This research argues that addiction is both constructed and real. It is constructed according to social, political and economic exigencies; but this construction is more likely to occur out of drug use in particular material contexts (e.g. deprived communities). Furthermore, once this constructed understanding is embodied it becomes “real”, in that it is experienced and enacted as real by participants. This approach to “addiction” ontology and epistemology is in line with new materialist approaches (Keane et al, 2014), and also Hacking’s (1999) “dynamic nominalism”.

12 O’Mahony, 2008). The decision to use these indicators to justify targeted counselling, educational, community development, and prevention resources at deprived communities, is representative of a pragmatic managerial decision intended to depoliticize contentious issues related to drug debates, as Butler correctly argues (2007). Indeed, it proceeds from the problematic (as this thesis will argue) assumption that progressive drug policy (e.g. community-level services, and viewing addiction as a healthcare rather than criminal justice problem) reform is sufficient to address drug- related harm, without the need for broader socio-cultural and political-economic restructuring of Irish society.

Crucially, it would be just as reasonable to assume that as unemployment, crime, and drug-related problems can plausibly be said to be increased by governmental decision making (see Hourigan, 20158), that they are symptoms of the harm caused by our current social and political arrangements in Ireland9. Such a view would posit that harmful drug use10, severe mental health issues, unemployment, and crime stem from the injuries that our current economic and political system commits against certain social groups. The result of this construction would be to challenge and change these political and economic structures and systems rather than advocating that those systems target resources at communities to assist them in the development of more progressive drug policy (and indeed social policy more generally). Ultimately, one view advocates for change within the system by rendering its functioning more benign, and the other argues for change by challenging the system itself.

8 E.g. Hourigan demonstrates how government social housing policy (e.g. the 5,000 pound surrender grant scheme) contributed to the residualisation of the social housing stock, and in turn, to an increase in unemployment and crime

9 O’Gorman (2016) has taken some account of this.

10 It should be mentioned that this thesis is only concerned with drug use which has become harmful. Why people use drugs in general (recreation, hedonism, religious reasons, boredom, etc.) is not the concern of this thesis.

In order to demonstrate the benefit of this type of social constructionist approach, the current thesis will conduct a genealogy of dominant addiction understandings across time in Ireland. Regrettably, this has been neglected in the Irish literature. The key question here is: why does “what we mean” by addiction differ today from the 1950s, for example? Why was alcoholism thought of as a disease of a minority of susceptible individuals in 1970s Ireland (Butler, 2010), yet now linked to total population consumption levels (Butler, 2010)? Following Foucault (1977), this research will focus on shifting “regimes of truth” in addiction causation. Foucault studied the processes and mechanisms by which it becomes possible to say that something “is true” rather than what is “the truth”.

Indeed, as Hacking (1999: 6-7) argues, social constructionism is a powerful tool in that when we show that something is socially constructed, it becomes clear that it could be constructed differently, and then we can start to demand changes in it. Importantly, however, demonstrating that understandings of drug-related harm are socially constructed, and therefore, could be constructed differently, does not address the question of what effect dominant understandings have already had on drug-using populations. To better comprehend this process, we turn to the work of Bacchi (1999). Bacchi (1999) has demonstrated that even if a concept’s epistemology is contingent, problematic, and lacks validity, its dominance nonetheless has real-world effects. Even if our dominant addiction theories are based on a shaky epistemological foundation and lack validity/usefulness, their dominance - and the particular way they frame the problem - virtually guarantee that they will impact drug-using populations and society more broadly.

Simply put, what we believe to be the case has real-world consequences irrespective of

14 where that belief came from or if it’s justified. Therefore, it will be argued that if one were to end the analysis with an account of how and why addiction understandings change over time, one would be studying “addiction without the addicts11”. Indeed, analyses of this kind study addiction as an ideology, or a set of ideas and propositions about what harmful drug use is, and how and why these change through time. It identifies, in other words, “the engines of change” – the scientific advances, technological developments, power struggles, socio-cultural and political-economic forces, and contingent events that drive change. However, as Bacchi (1999) has argued, though the structural forces mentioned create new problematized categorisations (the addict, or alcoholic), or ways to explain behaviour (addiction, alcoholism), this is no mere reporting of developments, it has real effects on people and institutions.

To study the impact of shifting addiction understandings across time this research will draw on Bacchi’s (1999) “what is the problem represented to be” (WPR) framework. This framework can examine the impact addiction categorisations have on addict populations. It is concerned with the fundamental assumptions, dichotomies, binaries, frames of analyses, silences, and implicit political persuasions of a given addiction categorization. This framework, it is argued, will enable the study of addiction “with the addicts”. It seeks to uncover and examine what “engines of discovery” drive shifting addiction understandings across time – the how and why – but also, what effect. It looks at not only how addiction understandings develop but how addicts are constituted as a group, as particular kinds of people with an identifiable condition (which has definite symptoms and characteristics), whether certain populations are

11 Note on terminology – The term addiction will be used when referring to concepts (i.e. disease model of addiction). Furthermore, I will use the term “addicted habitus” to denote that a socially constructed understanding of drug related harm (i.e. addiction), is now also “real”, in that it has been embodied and enacted in the form of the addicted habitus. Moreover, I will refer to participants as “addicts” in cases where I argue they have embodied this socially constructed understanding. Finally, in general when discussing another author’s work I will use their terminology.

15 more likely to be targeted, who targets them, and what purpose this serves. In short, if genealogy enables us to demonstrate that current addiction understandings could be constructed differently, Bacchi’s (1999) approach will demonstrate that they should be constructed differently.

Finally, there is a third issue that requires attention. That is, apart from problematizing the epistemological terrain of the addiction field and describing the effects particular representations of addiction have on drug-using populations, the issue of validity will need to be engaged with. Indeed, all knowledge formation is intimately influenced by social exigencies, and the idea that theories have effects, both intended and unintended, does not speak directly to the issue of validity. Furthermore, even if the concept of addiction has a problematic epistemology, and harms drug-using populations, the question of how to respond to the issue of harmful drug use will nonetheless remain. This issue demands we take seriously on their terms (i.e. on the grounds of scientific validity), the most dominant theories currently available. Chapter two and Chapter four will tackle this issue, demonstrating that the dominant theories are problematic both in terms of epistemology and validity/usefulness. The final aim then will be to advance an alternative view of addiction.

This research turns to qualitative interviews with individuals with lived experience of drug addiction to achieve this aim. It will be concerned with the contexts of social suffering (see Kleinman et al, 1997) which underpin people’s harmful drug use, their attempts to find meaning in this context, their understanding of addiction as both an ideology and a subjectivity, and finally, how they embody, resist and rearticulate addiction understandings in concrete contexts. Currently, there is a relative (in comparison to quantitative and policy-based research) shortage of research studies that have attempted to study addiction causation qualitatively in Ireland (see O’Gorman, 2005; Mayock, 2005;

16 and Woods, 2008 for exceptions). This research study will address this theoretical imbalance. Furthermore, the interviews were conducted in Cork City, to address the tendency of Irish researchers to conduct most of their research in Dublin, and generalize from these studies to the rest of the country.

Indeed, as mentioned, despite the spread of drug-related harm beyond Dublin the Irish literature remains overwhelmingly based on the experiences of drug users in the capital. Finally, combining a genealogical analysis of how and why addiction concepts change over time, with a philosophical investigation of how these understandings are constituted as subjectivities and what effect this has, and a qualitative analysis which seeks to explain how such ideologies become embodied and practised in everyday action is a novel approach to addiction causation never previously undertaken. Overall, the current research was guided by the following question:

What can the intersection between conceptions of self and conceptions of addiction tell us about the cause of drug addiction?

In other words, this thesis sought to examine the relationship between addiction as a social construct, and how this construct is embodied and enacted in concrete contexts. However, the overall question necessitated three research aims, and as they related to diverse literature it is perhaps helpful to list them below:

Examine the development of dominant addiction understandings across time in Ireland.

17 To investigate the effects that dominant addiction understandings have had on drug- using populations.

To rethink how we view addiction in Ireland, through the presentation of a novel approach to the study of drug addiction.

To achieve these aims we will draw on several conceptual tools. Firstly, as mentioned, Foucault’s genealogical method will be adopted to demonstrate that Ireland's dominant addiction understandings are socially constructed and track the country’s socio-cultural and political-economic development, as well as power-struggles and contingent events. This genealogy will enable us to argue that our understandings of drug-related harm can be conceptualized differently. Secondly, this thesis will draw on Carol Bacchi’s (1999) WPR framework to examine the effects of dominant addiction understandings on drug- using populations and to argue that we should construct different understandings. It will be argued that the way addiction has been constructed has caused identifiable harm to drug-using populations. In short, it has portrayed drug users and addiction as a corrupting influence in an otherwise well-functioning Irish society. It has also constructued drug users as a distinct problem population with undesirable characteristics, and finally, imposed a stigmatized subjectivity on them without including them in the process of constructing this subjectivity. Finally, an alternative approach to drug addiction will be advanced.

This model will draw on Galtung’s (1969) concept of structural violence, to argue that certain political-economic and social-cultural structures in Irish society, cause identifiable harm to drug-using populations. Structural violence is analytically broad as it brings together an assemblage of human problems that have their consequences in the devastating injuries that social forces can inflict on human experiences (Farmer et al,

18 2006). In this research, structural violence refers to the social arrangements and developments that put individuals and populations in harm’s way or demonstrably curtail their agency (Farmer et al, 2006). Such arrangements are structural because they are embedded in the political-economic and socio-cultural organization of the social world, and they are violent because they harm and impose limitations on people who, in general, are not responsible for perpetuating such inequalities (Farmer et al, 2006).

This harm manifests itself in a collective lived experience of social distress. This distress is what Kleinmann and colleagues (1997) have referred to as social suffering. At its most basic level, social suffering captures the lived experience of distress while exposing the often close linkages of personal problems with social problems, thereby challenging the problematic tendency in the social sciences of focusing solely on the individual (Kleinman et al, 1997). . However, it is only when our study participants “webs of significance” (Geertz, 1973) are shattered or significantly undermined, that drug use in the context of social suffering becomes harmful. In a now-famous quote, Geertz explains webs of significance as follows: “An individual is bound up in a series of symbolic or mythic representations – ‘man is an animal suspended in webs of significance he himself has spun’ – which serve to generate and maintain meaning” (Geertz, 1973: P. 2). Taken together these symbolic structures constitute our worldview and guide our actions.

They comprise a cohesive narrative of existence, a kind of mental text which functions, in much the same way as a geographical map, as a guide to the terrain of life. From them, we generate ideas, interact with people, and perform other activities we would be unable to do without a framework in which to interpret the world and make decisions. In a day to day context, this involves talking and listening to others, recounting stories, and eliciting responses (Geertz, 1973). This map produces a “daily interactive communicative process that reaffirms people’s

19 sense of themselves and gives meaning to their lives” (Inglis, 2014: P. 35). From here mechanisms of symbolic violence (Bourdieu, 1989) serve to individualise suffering and convince participants that this is their fault, natural or inevitable (misrecognition12), and primarily related to their drug use (condescension13). Finally, treatment regimens through a specific mechanism of symbolic violence (complicity/consent: Bourdieu, 1989), encourage participants to embody and enact dominant understandings (complicity/consent), thereby obscuring structural violence and reifying dominant theories of addiction. At this stage participants become addicts, and embody and enact the dominant addiction conception in the form of the addicted habitus14 (see Bourdieu, 1989). This is the alternative approach to drug addiction15 that this thesis will advance, however, as will be made clear in the methodology and conclusion chapters, no single study can ever conclusively “know” precisely why one person becomes addicted and another does not, and therefore can never fully know causation. We will now discuss how it will be structured and presented throughout each chapter.

12 Misrecognition is the process whereby power relations are perceived not for what they objectively are but in a form which renders them legitimate in the eyes of the beholder (Bourdieu and Passeron, 1977). For example, a working-class student perceiving his poor academic performance relative to a middle-class peer as a result of a lack of effort or intelligence, rather than a difference in social, economic and cultural capital.

13 It can be seen when a powerful individual or group temporarily suspends the power hierarchy between themselves and the dominated in an apparent attempt to help or assist, but in this apparent act of “reaching out” the dominant actually ends up reinforcing the hierarchy and obscuring structural violence – thus shoring up their position in the hierarchy (Bourdieu, 1993). An example of condescension can be seen when middle- class counsellors attempt to “cure” socially deprived addicts using models of therapy based on the individual.

14 Habitus is a set of embodied dispositions, perceptions and emotions. It is structured by experiences one has in the social world and then participates in restructuring the social world, in part, on the basis of those same experiences. This is why Bourdieu calls habitus a “structuring structure”

15 This approach this research takes to causation is in line with the new materialist (social science) and dynamic nominalist (philosophy). That is, social phenomena are socially constructed, but also real insofar as they are enacted and embodied in concrete contexts. However, as the methodology makes clear this approach to causation is tempered by Stinchcombe’s (2013) notion of ‘deepening analysis’, which is the view that no one study methodology can ever conclusively ‘know’ causation

20 Structure of the thesis

Given the novel and unorthodox way in which the argument of this thesis will be made, it requires some careful structuring. As such the thesis will proceed in the following manner:

Chapter two:

Chapter two will present the standard type of literature review that one would expect to find in a Ph.D. thesis. However, it will be divided into two separate sections analytically. This is deemed necessary as the thesis combines a critical historical inquiry about how and why addiction concepts change over time, and what effect this has, with a qualitative analysis that seeks to advance a novel approach to drug addiction. As these kinds of literature rarely interact explicitly with one another, it is deemed necessary to separate them.

Chapter two will argue that the international literature concerning shifting addiction understandings across time has been Anglo-American centric to the neglect of more peripheral jurisdictions and that this has led to an overt focus on the influence of structural developments, to a relative lack of attention being paid to politics, ideology, and contingent events. Furthermore, it has failed to adequately examine the effects of particular problem representations on vulnerable populations. The second section argues that addiction is not best viewed as a disease, disorder, pathology, direct result of social forces (deprivation, dislocation, etc.), or any other realist position. Finally, it is argued that the current

21 approach to conceptualizing, and responding to, harmful drug use in Ireland, has several limitations. The chapter closes by outlining the contribution to knowledge this thesis will make.

Chapter three:

Chapter three addresses all relevant methodological concerns. These include methods of data collection, ontological and epistemological considerations, data analysis, and ethical concerns. The chapter opens with a discussion of the research questions, their justification, and how they were addressed. Furthermore, it provides an instrumental account of the methods used (tools, techniques, and procedures), a philosophical justification for their use, and an account of to what end they were used.

Chapter four:

Chapter four will deal with the question of how and why the addiction concept has developed over time in Ireland, and what effect this has had. It will present a genealogy, or a “history of the present”, which seeks to understand how our present situation progressively came to be. It utilises historical material to trace the descent and emergence of a particular problematisation in the present. That problematisation is our contemporary conceptions of, and responses to drug addiction. The central aim is to demonstrate that the fundamental axioms of the drug addiction field are contingent, and that the way addiction is currently portrayed as a stigmatised subjectivity serves the interests of the powerful, and imposes a stigmatised subjectivity on powerless groups.

In order to achieve this, we will examine how the most powerful “claim-making groups” (medical profession, government, media, Catholic Church) have conceptualised addiction over time. This will follow Foucault’s notion of: “cutting off the king’s head”, or emphasising the diverse fields from which power operates, not simply restricting one’s analysis to the Government.

Chapter five:

This chapter will present the results of the qualitative interviews conducted in Cork City using empirical evidence to support the critical theoretical framework previously outlined (structural violence, social suffering, webs of significance, symbolic violence). In short, it is argued that there are certain social arrangements (socio-cultural and political-economic) in Ireland which cause significant harm to drug using populations, and that this harm is misrecognized due to treatment regimens successfully deploying mechanisms of symbolic violence through the language and practice of their treatment modalities16.

Furthermore, these mechanisms also lead to participants reducing much of their suffering to an effect of their drug use, and to embody and enact dominant addiction understandings in the form of the “addicted habitus”. However, it will also be argued that the theorists such as Bourdieu and Foucault take insufficient account of meaning- making, and how the dominant ideology is embodied, negotiated, enacted, and resisted

16 That is, while the 12 steps are beneficial for some, the language of 12-step recovery, and in particular, the Minnesota model tends to encourage an inward focus on the person’s character defects and mistaken beliefs, and lacks the language to successfully come to grips with the impact of structural violence.

23 in concrete everyday contexts. In short, the addiction as disease or disorder ideology is only ever imperfectly realized and rearticulated at the level of the embodied self.

Chapter six:

Chapter six will draw together the arguments and materials presented in the earlier three chapters, as well as an integration of the way the study participants have attempted to find meaning (webs of significance) in their addiction. This will enable a presentation of a novel approach to drug addiction as well as an elaboration of its significance in terms of theoretical and epistemological contributions to knowledge. This will be achieved in the form of four case studies, exploring participants’ individual life stories in greater depth.

Chapter Seven:

The final chapter will formally close the thesis by explicitly restating the exact nature of the claims made, outlining some principles through which change may be affected, engaging with the study’s limitations, and outlining suggestions for future research. It will also include some final thoughts on the research process, and some of the key lessons learned.

24 Chapter two

LITERATURE REVIEW

The international and domestic literatures – “What we know”

This chapter draws together literature from diverse fields to locate the current project within the broader scholarship. This is ultimately intended to provide the reader with a better understanding of the specific contributions to knowledge this thesis seeks to make. To this end, several arguments are presented. Firstly, concerning the international literature on shifting addiction understandings, the argument will be that the case of Ireland has the potential to provide unique insights, while also building on recent Cross- European research (Berridge et al, 2016), which has challenged the Anglo- American domination of that literature to date. Furthermore, while international research has successfully studied addiction at an ideological level and delineated the processes and mechanisms whereby addiction understandings shift over time, it has not focused as much on the effects a particular problem framing has on drug-using populations (see Keane et al, 2014 for recent exceptions). This will be referred to as studying “addiction without the addicts”.

The second section will examine theories of addiction causation in international literature. It will be argued that this literature contains two (at least) major failings.

25 Firstly, despite the emergence of more nuanced biopsychosocial models (see Borrell- Carrio et al, 2004), and the existence of debates within neuroscientific models (see Leshner, 1997; and Levy, 2013, for contrasting views), the dominant brain disease model of addiction (BDMA) problematically focuses on the internal workings of the “addicted brain”, to the near exclusion of other potential etiological influences. Secondly, more socially oriented researchers who have challenged this dominance, problematically present their models as universalistic “grand narrative” type theories (see Peele, 1985; Alexander, 2008; and Mate, 2008, for example). That is, they often claim that their models of addiction can explain addiction across all national, social, and cultural contexts.

The next two sections will outline and problematize the Irish literature concerning both “parts” of this thesis and how they relate to one another. It will be argued that there exists little research in an Irish context, which has examined shifting addiction understandings across time, and that the literature which does exist lacks a critical edge. In terms of causation, the tendency in the Irish literature has been to view addiction as either a disease (see Butler, 2016), or else largely explicable by reference to social deprivation (see O’Gorman, 1998). Both approaches will be engaged with critically. Finally, the conclusion and discussion section will specifically outline the unique contribution to knowledge that this thesis seeks to make17.

17 Before proceeding, see a list of academic databases consulted: ProQuest: Biological Sciences; Social Sciences Full Text: H. W. Wilson; Historical Abstracts; Sociological Abstracts; Humanities Full Text: H. W. Wilson; Academic Search Premier; Psychinfo; The Irish Health Research Boards “National Drugs Library”; and finally Google Scholar.

26 Shifting addiction understandings through time – International literature18

Perhaps the single unifying theme in the international literature is the problematisation of the notion that addiction as a disease or disorder can be seen as an objective scientific categorisation (Levine, 1978; Room, 2003; Reinarman, 2005; Seddon, 2010; Berridge, 2013). While authors differ on what we might call the “specified causal mechanisms” - that is what factors, processes, and dynamics, contribute to shifting conceptualisations of addiction there is practically universal agreement that addiction as a concept is at least partly socially constructed (Buchanan, 1992; Klaue, 1999). In terms of the mechanisms that drive these shifting conceptualizations, there is also broad agreement that they are in part driven by the social class who are addicted to and use a particular type of substance (Klaue, 1999; Courtwright, 2009; Berridge, 2013). This is most succinctly summed up in Courtwright’s argument that: “what we think about addiction very much depends on who is addicted” (Courtwright, 2001: P.4).

Courtwright gives the example of differing reactions to opiate use in America. In the 19th century and early 20th century, the typical addict was a middle-aged white female, of the middle or upper class, who sourced her opiates through her medical doctor. By 1935 this had changed thoroughly. Now the typical addict was a lower-class, African American male who sourced his opiates illegally. With this shift in the addict population, more punitive and stigmatising views and responses to addicts emerge (Courtwright, 2001). Berridge (2013) further points out that only when smoking during pregnancy was largely confined to the lower classes in England was it seen as a problem in popular discourse. She describes this opportunistic use of science as: “a fact waiting to happen” (p. 181).

18 This section refers to literature which has analysed addiction categories using social and historical methods.

27 The most famous, and certainly one of the earliest, explications of addiction's social construction can be seen in Harry Levine’s landmark paper (Levine, 1978). In the American colonial period, the puritans believed that social control was maintained by a hierarchical communal, relational structure (Levine, 1978). This in effect meant that through moral opprobrium the community could induce conformity in individuals who drank too much. However, in the 19th century with the advent of industrial capitalism, the locus of control shifted from the community to the individual. Levine argued that self- control became so important that its negation (e.g. “compulsive” alcohol use) had to be clearly defined and combated. With the advent of the enlightenment and increasing secularisation, this negation could no longer be defined in religious terms – i.e. as sin (Levine, 1978). According to Levine, this is the context within which the idea of addiction as a disease originates, and its defining feature is a loss of control over alcohol or drug use.

Meanwhile, Seddon (2010) has conducted a critical analysis of British understandings of, and responses to, the “drug problem” over the last 200 years. Central to his argument is the notion that conceptions of freedom and the regulation of drugs are mediated by changing conceptions of the will under different manifestations of liberalism. That is, under laissez-faire liberalism there was minimal regulation or concern about addiction. With the advent of welfare-liberalism and the notion of the social citizen more restrictive and paternalistic responses were deployed. Finally, in the current neoliberal epoch strategies of responsibilisation in which citizens are governed through their own choices are most popular.

28 Previously, it has been mentioned that the debates within the literature are Anglo- American centric. However, recently this has been challenged by cross-European research (Berridge et al, 2016). This research spans numerous national contexts, so only the findings relevant to the current research will be mentioned. In short, this research demonstrates that taking peripheral jurisdictions into considerations highlights an array of influences on shifting addiction understandings beyond structural change. In the years 1860-1930, for example, while scientific explanations of alcoholism which stressed hereditary degeneration became more prevalent in Austria, they were unable to displace more local explanations which emphasized mental distress and passion and were rooted in local cultural and linguistic traditions. However, with the allied occupation in the post-World War Two period, more scientific theories, in line with British and American thinking became preeminent. We see here then the influence of politics, culture, linguistics, and specific historical events in conditioning addiction understandings.

Furthermore, this cross-European research (Berridge et al, 2016) also highlights the role of power-struggles in conditioning addiction understandings. For instance, in the 1970s and 1980s Polish alcohol policy was a reflection not only of the need to deal with alcohol, but was also rooted in the conflict between the state and the unions. As we shall see (Chapter four), the issue of particular groups battling for control over how to conceptualize alcohol and drug problems, as well as the influence of politics, culture, and specific historical events, also conditions addiction understandings in Ireland. Though the literature just surveyed has been indispensable in demonstrating that conceptions of addiction are socially constructed, there are at least two criticisms that are relevant to the current study. Firstly, this literature displays a lack of attention to how shifting portrayals of addiction as an actually existing condition19, has constituted addicts as a group sharply distinct from the rest of the population, a portrayal that facilitates the

19 This is in reference to a realist epistemology.

29 creation and imposition of an “addict subjectivity”. What is being suggested here is something along the lines of what Carol Bacchi (1999) has accomplished with her study of the effects of the “problematisation process” (on politics, institutions, and people).

So, while Seddon (2010), for example, successfully explicates the structural contexts within which certain understandings of addiction gain traction at an ideological level, he does not outline the micro and macro-level processes and strategies that constitute particular individuals and groups as addicts. That is, he outlines the ideological developments but not how the ideology operates in concrete contexts and comes to be applied to some groups rather than others, and the effects this has on drug-using populations. This tendency has been referred to as “studying addiction without the addicts’20”. Indeed, the current study’s contention that social constructionist approaches tend to study addiction without the addicts, mirrors the sustained criticisms of social constructionist approaches in general, which have emerged from feminist and science and technology studies (STS) scholars (see Keane et al, 2014).

In short, this critique argues that by giving the determining role in the construction of reality to culture and discourse, social science scholars were unable to engage with issues of embodiment, materiality or to adequately address the effects of the process of construction itself (see Keane et al, 2014). One way scholars have responded to the limitations of this social constructionist critique is to turn attention to addiction science's scientific and technical content. For example, Vrecko (2010) presents an analysis of how addiction was brought into being a brain disease by assembling material, political and social forces. Furthermore, he draws on the work of Ludwig Fleck to examine the scientific facts of addiction as historical

20 Crucially, the term “addiction without the addicts” is a criticism of social constructionist approaches which tend to give primacy to the task of tracing how language, culture and ideology shape addiction understandings, without paying adequate attention to the effect the construction process has on drug using populations. It is not a critique of the addiction literature in general which of course contains examples of studies drawing on ethnography and in- depth interviews, and which examine the lived experience of drug users

30 events that are brought into existence in concrete contexts, thus revealing the work that is done to produce and reproduce them.

For example, in his account of the rise of post-war US addiction science, Vrecko (2010) argues that a small group of neurobiologists interested in addiction was enrolled by the US Government who identified heroin addiction as a threat to the social order. Indeed, the funding and technical support this group received is posited as a key factor in the contemporary emphasis on receptors in contemporary discussions of addiction neuroscience. This study demonstrates that while a concept may be constructed, the work involved in the construction process can have identifiable effects (scientific focus on receptors) that are irreducible to language, culture, discourse or ideology. Similarly, as we will see in Chapter four, though addiction is socially constructed in Ireland, the work involved in construction produces identifiable effects (powerful groups portray addiction as a corrupting force in Irish society).

Another way scholars have responded to the limitations of social constructionism is by drawing on Annemarie Mol’s 1999) concept of ontological politics. The basic claim made in this body of work is that framing research evidence in a particular (and simplified) way necessarily constitutes a type of causality and creates a particular reality along the way. For example, Moore and Hart (2014) argue that the dominant public health approach to alcohol and alcohol effects is comprised of three propositions:

1. Alcohol is a stable agent that acts consistently to produce quantifiable effects

2. These effects may be amplified or diminished by social or other factors but not mediated in other ways

31 3. Alcohol effects observable at the population level are priorities for public health.

Furthermore, they argue that these propositions are predicated upon several simplifications and that these simplifications have political implications including the attribution of responsibility for health effects to a pharmacological substance, the deletion of other agentic forces that might share responsibility and a prioritization of simple over complex effects (Moore and Hart, 2014). Meanwhile, Frayne and Pienaar (2017) have drawn on the concept of ontological politics to argue that biographies produce normative ideas about addiction and those said to be experiencing it. Relatedly, Summerson-Carr’s (2011: 3) analysis of treatment programmes demonstrates that the aim of endowing people with “lasting sobriety” and self- sufficiency was primarily about reconstructing the client’s relationship to language and training them in a particular way to talk about the “self”. She calls this prescribed mode of speaking the

“ideology of inner reference” (Summerson-Carr, 2011: 4). Finally, the author concludes that the demand for “honest” inner reference produces the client’s subjectivity as a fundamental problem of self-deception, filtering out their social commentary and institutional critiques.

As we will see in more detail in the coming chapters, this literature has several implications for the current study. Firstly, More and Hart’s (2014) argument concerning alcohol policy is quite close to one of the main justifications for undertaking this research, that is, how evidence is framed influences policy responses, which in turn has political implications (i.e. epidemiological evidence relating to drug use and pragmatic managerialism: see page. 12). Furthermore, the work of Frayne and Pienaar (2017), Summerson-Carr (2011) and others (see Fraser and Ekendahl, 2018; Fraser, 2015; and Keane et al, 2014), which argues that how a person’s biography is managed (by treatment regimes) and narrated (by drug users themselves), produces ideas about what addiction is and also concerning who drug users are. As we will see, this line of argument has parallels with how the current thesis deploys Bourdieu’s (1989) concept of symbolic violence.

However, it should be mentioned that though this literature has drawn form, and built on the contributions from social constructionists, there are some limitations. That is, though these authors emphasize embodiment, the agentic properties of substances, and the materiality of the brain, they do not pay adequate attention to the material contexts in which harmful drug use develops. As we will see in Chapter five, there are real material contexts of social suffering which are as important as social constructionism, addiction biographies and which interact with these issues in important ways

Finally, as is probably obvious, the current literature concerning social constructionism and ontological politics21 is overtly Anglo-American centric. The current research, by focusing on Ireland, a country which has experienced colonisation, late industrialisation, and then rapid modernisation (Ferriter, 2004), can provide a useful counterpoint to this tendency. In this regard, the current thesis seeks to build on recent scholarship which has examined the Austrian, Italian, Polish, Scandinavian (See Berridge et al, 2016) and Australian contexts (Keane et al, 2014). Next, we will examine both the international and domestic literatures concerning the cause of drug addiction.

21 There is a strong emphasis on the Australian context in this research literature, and also some work in a Scandinavian context

33 Etiological models – international literature

Biological/neuroscientific models

Though there are internal differences most biological, neuroscientific, and genetic models, conceptualise drug addiction as a brain based disease, disorder, or pathology (Koob and Le Moal, 2001; Volkow and Morales, 2015). By far the most commonly utilised definition within these models defines drug addiction as: “a chronic relapsing brain disorder that is defined by a compulsion to take the drug with a narrowing of the behavioural repertoire toward the excessive intake, and a loss of control in limiting intake” (quoted in Koob and Le Moal, 2001: P. 97; for a virtually identical definition see Edwards and Koob, 2010). Though the models differ in terms of the particulars and exact mechanisms, in general it is argued that drugs in some way “hijack” the brain’s normal motivational circuits (Koob and Le Moal, 2001; Hyman, 2005; Kenny, 2011). Furthermore, it is argued that continued and prolonged use alters the brain’s structure and functioning so that drugs become the main object of motivation (Koob and Le Moal, 1997; 2001; Goldstein and Volkow, 2002). Drug addiction then is maintained due to brain dysregulation (Koob and Le Moal, 2001); a desire to avoid withdrawal symptoms, psychic or physical; and the overwhelming desire to obtain the positive reinforcing effects of the drug (Volkow and Morales, 2015).

Koob and Simon (2009) have argued, for example, that a key element of drug addiction is how the brain’s reward system changes throughout the development of addiction. Furthermore, Volkow et al (2010) stress the role of the dysregulation of the brain’s neuro-circuitry; however, they foreground the role played by dopamine. The main

34 argument offered in this model is that for natural reinforcers such as food or sex, dopamine signals triggered by the conditioned stimuli drive the motivation to get rewards, since with their repeated delivery dopamine cells will stop firing (Volkow et al 2010). It is argued that this is in sharp contrast to drugs which due to their pharmacological properties continue to increase dopamine released during their consumption (Volkow et al, 2010). Crucially, the vast majority of models identified within the biological literature, conceive of addiction as a brain based disease, disorder, or pathology, which results mainly from the hijacking of the brain’s motivational reward system and leads to long-term changes in the brain’s structure and functioning (Wise and Bozarth, 1987; Koob and Le Moal, 1997; 2001; and Volkow et al, 2010).

The concept of self, adopted in such research is axiomatically atomised and reduced to neurochemical processes. This is significant because this axiomatic adoption and reduction do not emerge from the scientific findings of neuroscience or any other academic discipline, but rather, direct the research agenda itself. It is therefore perfectly possible that all of the research findings coming out of neuroscience are perfectly valid, but that the presupposed theory of self is philosophically and theoretically untenable. This problematic cannot be overcome by asserting that all research needs to adopt axiomatic conceptions, and proceed from unjustified assumptions, this problem is rather more serious. Fundamentally, our conception of what a person consists of (the ontological self), and how they come to be that way, deeply influences the study of how people become addicted. This issue is so fundamental getting it wrong could be likened to pursuing a research agenda based on a geocentric universe22.

22 This refers to the impact of fundamental assumptions. That is, if one assumes a geocentric universe one can still produce valid findings (given the assumptions), but still be wrong about the fundamental assumptions.

It should be mentioned that while such models often posit social factors such as stressful environments or a lack of education (see Borrell-Carrio et al, 2004), and also sometimes genetic factors (Hyman, 2005, Kenny, 2011), these are incorporated into the neurochemical framework. In short, such models privilege neurons, and the chemical structure of the brain is seen as the site of the “self” and addiction. When social factors are taken into consideration it is usually only with how they impact on the brain’s structure and functioning. As such our attention is directed inward to the brain and away from potentially problematic aspects of the social world. A person’s biography, their internal psychological terrain, power relations, questions of whether the self’s capacity for reflexivity has origins in social interaction or is in some sense trans historical, fade into the background, much as they might in a discussion of diabetes or cancer. The addicted self, much as the depressed self (Rose, 2003), and indeed all selves, are the result of particular neural structures and functions in the brain, which can be functional or dysfunctional. This view is perhaps best summed up by LeDoux (2002: p. 2- 3):

“My notion of personality is pretty simple: it's that your 'self,' the essence of who you are, reflects patterns of interconnectivity between neurons in your brain. Connections between neurons, known as synapses, are the main channels of information flow and storage in the brain. […] Given the importance of synaptic transmission in brain function, it should be practically a truism to say that the self is synaptic”.

A pertinent example of this is type of reduction can be seen in trauma research. The ACE study, for example, demonstrates how adverse childhood experiences render certain individuals more susceptible to experiencing addiction, or other socio-emotional

36 problems, such as mental illness (see Mate, 2008). While it would be plausible to interpret this research from a Marxist or broader political-economy perspective – given research demonstrating that addiction is more prevalent in socially deprived communities (see Adams, 2016 for example) – this does not occur. This is due to biological models privileging the brain and viewing the self as an individualised entity, which fundamentally relate to the brain and are at base neurochemical. It should be pointed out that the current researcher is not making the point that one framework is superior to the other. Crucially, the point is that the implicit concept of self at the heart of biological and neuroscientific models interprets, organises, and analyses findings only in terms of their effect on the brain. The experiences people have and their biography are certainly seen as important but ultimately only in terms of how they affect the brains structure and functioning in the short, medium, and long-term. The task then in such models is to explain how the brains of certain people with certain life experiences and genetic structures become susceptible to being ‘hijacked’ by drugs. In short, people are indistinguishable from their brains, and drugs have the potential to hijack the brains of certain people with certain susceptibilities.

Another example is seen in neuroscience research which claims that neuroimaging scans, which demonstrate structural and functional brain changes in the regions of the addict’s brain associated with impulse control and motivation (Koob and Le Moal, 2001; Koob and Simon, 2009), are the result of excessive drug use. It is certainly true that once the term excessive is operationalised these studies do indeed demonstrate what they claim to demonstrate. However, the initial act of defining what exactly counts as “excessive” is one that is philosophical, ethical, and culturally bound; and certainly, not objective and unproblematic, or value free. Indeed, similar changes in the brain occur in problem gamblers (Cocks et al, 2017) and other “non-substance addictions” (e.g. Voon et al, 2014). However, these cannot be non-problematically incorporated into a model which views addiction as a disease or disorder, at least not without a degree of philosophical

37 debate and discussion. Furthermore, the current author is unaware of any study which demonstrates the ability of neuroscientists to differentiate between different addictions (say gambling and heroin), or indeed addicts and non-addicts, without at least some prior knowledge of who is who, simply by looking at neuroimaging scans. Ultimately, the issues unproblematic due to this inward focus which is facilitated by the adoption of a neurochemical conception of self. Finally, drawing on the work of Lewis (2015) it seems that the disease model is even untenable at the level of neurochemistry. The structural and functional changes associated with addiction are not representative of a brain dysfunction, but rather are representative of a process of deep learning, which occurs in any activity one engages in regularly. Indeed, similar brain changes (and indeed negative consequences!) occur in the brains of people who fall in love (Song et al, 2015), join a religious cult (Owen et al, 2011), and become London taxi drivers (Maguire et al, 2000).

Psychological models

There are four main Psychological models of addiction: (1) psychodynamic, (2) behavioural, (3) cognitive, and (4) personality. Like biological models the focus in all of these is primarily on the “self” as an individualised entity. The assumption underlying all of these models is that there are some identifiable cluster(s) of cognitions, behaviours, personality traits, or unconscious processes in the individual’s psyche (in behavioural models such clusters cause the behaviour) which represents “what addiction is”. The task then is to identify what exactly this cluster(s) consists of and what causes it to occur. Cue conditioning theory, for example, is a behavioural model which posits that external cues are vital in the development and maintenance of addictive behaviour (Childress et al, 1999; Tiffany, 2002). Thus, a cue which was present at times when the individual previously administered drugs will be much more likely to elicit a conditioned response leading to the resumption of drug taking behaviour (Greeley et al, 1990). This is posited as an explanation for the phenomenon of craving and why a person, who has been

38 abstinent for many years or decades, may experience intense craving (Greeley et al, 1990). Similar to how a bell can cause a dog to salivate (Pavlov, 2010), these models argue that certain cues have a powerful effect on “addicted people”, often resulting in the development and maintenance of addiction due to the brain linking the cue to the addictive substance(s).

In short, the more cues that are linked to the substance the stronger the addiction will be and the harder it will be to cease drug taking. The concept of “self” implicit in such models is largely the same as in biological models. In short, the self is also atomised, but in this model reduced to some psychological rather than neurological process. Furthermore, external factors such as cues are similarly only discussed in terms of the ability to elicit a conditioned response from the addicted agent. If biological models are only interested in trauma, for example, insofar as it can render the organic brain susceptible to addiction, cue conditioning models are only interested in external cues (someone’s home neighbourhood say) insofar as they can elicit the conditioned response. No attempt is made to uncover the historical phenomenological basis of meaning, or to theorize why a particular cue is meaningful in any comprehensive sense. Instead, meaning is reduced to an unmediated situational process. For example, a person’s home neighbourhood could be seen as an external cue. However, no analysis would be undertaken to uncover what it is about concepts of “home”, “belonging”, etc. which give that particular cue its power. This is because such models do not posit a reflexive appraising self. The self here is inherently situational and prone (in some individuals) to being overwhelmed by particular cues and conditioned responses.

Before we move on to cognitive models, an influential variant of behavioural models should be mentioned – “choice theories” (see Heyman, 2009; Heather, 2017). Though these models differ slightly in terms of particulars they all view addiction as some sort of “disorder of choice”.

Addiction here is a failure of self-regulation, a failure to make consistent choices over time. In short, addicts choose to take drugs because they provide more value in the short term. However, the sum of these optimal short-term choices becomes suboptimal in the long term. Basically, the optimal short-term choices accrue to produce a sub-optimal addict lifestyle, as the drug effects become less pronounced (tolerance), and other reinforces (relationships, hobbies, family) are either lost, or become of secondary importance to the drug. So, while choosing to abstain is not optimal in the short-term, due to contextual factors, it is optimal in the long run as it leads to an optimal non-drug using lifestyle.

The contextual factors range from living in a poor neighbourhood to things like drug availability and an inability to self-regulate. While the self here is more complex in that it has “extended agency”, it is still individualised. This is because contextual factors are viewed as person specific and the notion that addicts as a population may be subjected to structural forces above their individual abilities to make rational choices, optimal or suboptimal, short or long term is not considered. Finally, it assumes to a certain extent that individuals are not subjected to non-rational, non-individual, and contextual variables that may make drug use optimal in both the short and long term. For example, if one comes from an extremely marginal and stigmatised community where job and other prospects deemed socially and culturally desirable, are extremely hard to come by, and one’s peer group and family are drug users, then it may be optimal in both the short and long-term to use drugs. Meanwhile, cognitive models of drug addiction focus on how an individual’s interpretation of situations influences their subsequent feelings and behaviours, and posits that these interpretations are shaped from core beliefs which are developed during early childhood (see Diaz and Fruhauf, 1991; Miller and Brown, 1991; Brandon et al, 2004; and Kouimtsidis, 2010). These models typically propose that

40 individuals develop addictive beliefs (I need alcohol to relax) alongside beliefs about the self (I am powerless and hopeless). This is seen as a reflexive learning process by which core beliefs about the “self” and addicted beliefs combine with memory associations, drug effects, and cues to produce a cognitive vulnerability to drug addiction (see Kouimtsidis, 2010; and Hill and Harris, 2016). It seems then that cognitive models are quite similar to biological models in that they posit a dysfunctional cognitive (as opposed to neuronal) process which causes addiction. However, the self in this model is also reflexive and “negative” views about the self are seen as equally as important as dysfunctional cognitive processes in addiction causation.

The concept of self, inherent in such models, is more complex than in biological models. In biological models, it would not matter whether a person considers themselves to be powerless, powerful, hopeless, or optimistic. Ultimately if the person’s brain has been subjected to certain genetic and environmental influences it will be susceptible to the power of drugs and become addicted if drugs are administered often enough. The concept of self is similar in behavioural models based on cue conditioning. Rather than a neuronal process rendering people susceptible to addiction, it is a conditioned response brought on by environmental cues and repeated drug administration. In both models the concept of self is atomised and reduced to some internal individual process. Cognitive models add to this framework reflexive appraisal.

They posit cognitive processes in place of neuronal processes and conditioned response but ultimately the agent can reflect on themselves and their lives (Brandon et al, 2004; Kouimtsidis, 2010; and Hill and Harris, 2016). The self is not simply a series of neuronal processes and structures or conditioned responses, but can reflect and their beliefs are as important to addiction causation. Most importantly, such models claim that certain beliefs about self and certain cognitive processes are intrinsically problematic and likely

41 to cause addiction. The implicit concept of self then is that “selves” are comprised of self-beliefs (developed during childhood), and related beliefs about various things in the social world (drugs say). These self-beliefs and beliefs about things in the world are what people are comprised of and ultimately these can be functional of dysfunctional. However, no analysis, philosophical or otherwise, is undertaken whereby the parameters of what exactly counts as functional or dysfunctional are delineated. This is again due to the inward focus, this time on cognitions rather than neuronal processes. While the social world is not considered unproblematic in quite the same way, categories of perception (functional and dysfunctional) are treated as if they are unproblematic.

Personality models of addiction contend that there exists a set of personality characteristics or traits that make a particular individual uniquely vulnerable to developing an addiction (Lang, 1983). Typically, these traits are said to be identifiable experimentally (Lang, 1983). The cause of this personality vulnerability is addressed by reference to biological mechanisms (Loewen, 2016), psychological mechanisms (Miles, 1985; Zuckerman, 2012), or environmental mechanisms (ACE study: referenced in Mate, 2008) – typically to do with childhood trauma – or a combination of all three, as in biopsychosocial models (Griffiths, 2005). The type of personality traits or characteristics that have been identified as predisposing an individual to addiction are many and varied ranging from negative affect, impulsivity, and low conscientiousness (Terracciano et al, 2008), to neuroticism and extraversion (Dubey et al, 2010), as well as introversion (Tarnai and Young, 1983). In short, every personality characteristic has been linked to addiction at one time or another.

Personality models contain a concept of self which consists of clusters of personality traits which are either innate or develop through the influence of

42 environmental or psychological processes. This conception of self leads to the search for addiction causation in the commonalities between addicts’ personality characteristics or traits. Ultimately this model posits a concept of self, identical to biological models and behavioural models. Instead of conditioned responses or neuronal processes, personality is posited. Though psychodynamic models of drug addiction stretch as far back as at least the early/mid 1900s (Abraham, 1908, Savitt, 1954, Rado, 1957), the focus will be on the most recent outputs. These accounts stress that a major reason that people become addicted to drugs is because they enable them to overcome anxieties in adolescence which were caused by the fear of facing adult role expectations with inadequate preparation and poor prospects. Such conflicts, it is argued, leave some adolescents vulnerable to anxiety, depression and in some situations drugs provide (at least initially) a way to resolve these conflicts (Weider and Kaplan, 1969). Basically, drug addiction provides an adaptive functional means of guarding against feelings of hurt, shame, and from poor prospects, and a lack of individual resources to deal with this situation (Wurmser, 1972; 1974; Zinberg, 1975).

These models, as should be clear, are very similar to behavioural and biological models, in terms of conceptions of self. Ultimately, they posit psychodynamic processes over neuronal processes or conditioned responses. These psychodynamic processes are seen as being produced by certain social factors - stress, lack of social support, isolation – but ultimately causation can be found within psychodynamic processes. In a similar vein to these models the self is seen as an atomised, psychological reductionist, and internalised entity.

43 Taken as a whole, psychological models are very similar to biological/neuroscientific models in terms of their conception of self. Firstly, and most importantly, the frame of analysis is firmly placed on the individual. While environmental and social factors are considered, they are only seen as important in terms of how they impact on the individual. For example, in cognitive models, self-beliefs are seen as equally as important as beliefs about the addictive substance. While such beliefs are seen as originating in early childhood, the social world is rendered unproblematic. So, while biological models may accept that stress and trauma render the brain susceptible to addiction, they are unlikely to examine the social and historical processes and structures which render particular individuals and populations more susceptible to experiencing stress and trauma. Similarly, psychological models would examine how social factors render individuals susceptible to developing problematic cognitions, psychodynamic structures, conditioned responses, and behaviours, but again would not place such susceptibilities in a social or historical context.

Adams (2016) provides a good analogy to better understand this conception of self. He argues that the self is commonly viewed as an individual object. In terms of biological models the person is made up of bones, muscles, fluids, neural networks, and hormonal system (Adams, 2016). Psychological models add to this thoughts, memories, emotions, beliefs, motivations, and attitudes. However, both models reduce the self to a neurological or psychological entity (sometimes with reflexivity), that resides in the individual’s body and mind. When the social world is considered it is only insofar as this particle self is projected onto other people – seen as autonomous units, self-contained within their bodies and minds (Adams, 2016). In short, these particles move around within the environment, connect and disconnect like balls bouncing off each other on a snooker table (Adams, 2016). What both models ultimately have in common is a commitment to discovering the site of addiction in the autonomous

44 individual self. This theory of self renders the social world unproblematic; particularly in political terms. As we will see this is in fundamental opposition to social approaches.

Sociological models

Social or sociological approaches take as their unit of analysis populations of addicts as opposed to individuals. In labelling theory, for example, this would involve a move beyond searching for the cause of drug addiction in the individual brain or psyche toward an analysis of the processes by which a person is labelled an “addict” (Becker, 1963). Take for example Becker’s seminal work on marijuana smokers in “Outsiders’: Studies in the Sociology of deviance”. Though Becker is focused on marijuana use, his framework is equally as applicable to addiction. He argues that: “nobody becomes a user without (1) learning to smoke the drug in a way which will produce real effects; (2) learning to recognise the effects and connect them with drug use (learning in other words, to get high); and (3) learning to enjoy the sensations he perceives” (Becker, 1973: 58). Replace the word “use” with “addict” and the phrase “Learning to enjoy the sensations he perceives” with “being censured for use and coming to associate use with negative feelings, emotions, and events”; and one can see how applicable Becker’s work is to addiction23. Central to labelling theory is the idea that deviant labels are arbitrary and are placed on the dominated by the dominant, a process which is inherently interactional, and serves frequently to amplify the deviance (Goffman, 1963).

This involves taking from social interaction the perspective of the other, and coming to view oneself as a deviant (e.g. drug addict), as a result Crucially, the concept of self here is reflexive, social, and interactional. It is reflexive in that one has to connect the effects

23 Just as all users in Becker’s study learned to recognise the effects of the drug, and this process was transferrable across drugs, all “addicts” can be said to learn to associate their use with negative consequences, experiences, and cravings; and this is transferrable across addictions.

45 of the drug with the drug use itself. This mirrors Lindesmith’s (1938) famous research studies which view craving not simply as an unmediated physiological response (as in neuroscientific models) to the absence of the drug, but crucially, as the recognition and proper identification of the withdrawal distress given the fact of physical dependence. In other words, if an opiate addict ceases to take opiates they will experience physiological withdrawal symptoms. However, this will only result in craving if the person comes to associate the physiological response with absence of the drug (as opposed to the symptoms of some other illness).

The social and interactional aspects of self can be seen in comparison to neuroscientific/biological models. These models are interested only in how drugs alter a susceptible (genetically or otherwise) individua’ls brain. In contrast, labelling theorists would be uninterested in these neurochemical processes and instead look at the interactional and social processes by which one is labelled an addict. Thus, upon viewing a group of marijuana addicts the neuroscientist would ask: “what are the commonalities between these various people’s brains which would explain their addictive drug use?” If the neuroscientist was attuned to the inter-disciplinary literature on addiction he/she may look for traumatic environmental influences or a genetic susceptibility, but always on an individual basis. In contrast, a labelling theorist would ask: “by what processes are groups of people labelled as addicts?” “Who has the power to label them such?” and “Why are they labelled this way? Etc.

Ultimately, the neuroscientist accepts such categories (addiction) as objective a priori conjectures and turns his attention inward to the brain. In contrast, the labelling theorist views such categorisations as interactional, and produced by the dominant to label certain problematic (for the established social order) groups as deviant. Crucially, these different conceptions of “self” lead to the selection and emphasising of different facts

46 and arguments, the acceptance or problematisation of pre-existing categories, and to the advancement of arguments which proceed from radically different assumptions and ontological presuppositions.

It should be pointed out that not all sociological models problematize the addiction category. Bruce Alexander (2008), for example, offers a perspective on addiction causation that while not accepting the addiction category a priori, nonetheless operates from a definition of addiction very similar to biological and psychological models. In short, while Alexander doesn’t view addiction as a disease or disorder he accepts that it involves a loss of control and progressivity, notions central to most biological and psychological models. The key difference is that Alexander shifts the focus of his analysis from the individual level to the social level. Thus, addicts are taken as a population or a unified whole as opposed to discrete individual actors. First, however, it is necessary to outline Alexander’s model in a little more detail.

The model contains three basic claims. Firstly, psychosocial integration is necessary for human well-being (Alexander, 2008). The basic idea here is that people require real and meaningful connections with family members, friends, their community, and need to feel as though they are part of, and meaningfully contributing to, society at large (Alexander, 2008). Alexander’s second claim is that free-market society fragments communities and cultures of every sort, breaking the social links that give people a sense of belonging, meaning and identity (Alexander, 2008). Thirdly, these conditions lead to more and more people being unable to achieve psychosocial integration, which leads to dislocation. Dislocation denotes a separation from a person’s society and is experienced as a profound feeling of despair and lack of identity (Alexander, 2008). Crucially, Alexander argues that addiction is a way of adapting to dislocation (Alexander,

47 2008). While people can sustain moderate and short-lived dislocation, persistent and enduring dislocation is unbearable, which can lead to addiction (Alexander, 2008).

The self in Alexander’s model is viewed through a social lens. Basically, people’s conceptions of self, come from their relationships, social interactions, and the meaning they come to attach to particular experiences within these social interactions. Furthermore, the “free- market” is seen as ordering and conditioning all relationships and social interactions in an all- encompassing and pervasive way. Fundamentally, the self cannot be understood or theorized unless it is understood as being intimately connected to other selves. Rather than operating like a ball on a pool table (as in individualized models) it operates more like a circuit on a switch board. This conceptualization of self leads to an examination of how the free-market creates populations of addicted selves. It seeks to understand how the market makes psychosocial integration more difficult to achieve. Thus, the site of addiction is to be found in the processes and mechanisms which disrupt this interdependence.

There are several problems with Alexander’s model. Firstly, at the beginning of his book “The Globalisation of Addiction” (Alexander, 2008), he engages in a brief etymology of the term “addiction”. However, Alexander completely ignores the large body of socio- historical research concerning shifting conceptions of addiction across time and place (see Levine, 1978; Courtwright, 2001; Seddon, 2008). Such accounts have consistently demonstrated that what we mean by the term addiction is in large part constituted by wider social, historical, and political processes. Alexander (2008), however, presents an argument which ignores this research and asserts that the “traditional” (meaning pre 19th century) dictionary definition of addiction is the “correct” definition, which overtime has become obscured due to the myth that drugs are particularly dangerous and addiction-inducing.”. Secondly, Alexander seems to axiomatically assume a “realist” position about “nature” of addiction. However, he never explicitly takes this stance –

48 instead his body of work simply ignores the philosophical debate between realists and nominalists (see Hacking, 2007; for a brief overview).

Theorists of “late”, “post”, and “liquid” modernity have tackled the issue of addiction as it relates to the self, most explicitly. Anthony Giddens, for example, sees addiction as a symptom of the individualism of the post- traditional culture (Giddens, 1991). He argues that addiction can only be understood in terms of a society in which tradition has been swept away and in which the reflexive project of self correspondingly assumes a special importance (Giddens, 1991). In a post-traditional social world, the “self” has to be continuously reworked and brought into line with lifestyle practices. In other words, today the “self” is defined by the types of consumption practices and life style choices a person undertakes.

According to Giddens (1991), addiction can be seen as a negative index, a type of dysfunctional consumption, of the degree to which the reflexive project of self moves to centre stage in late modernity. An addiction is an inability to colonize the future and as such transgresses the need to constantly reproduce and rework the self through consumption practices and lifestyle choices. Ultimately addiction is seen as a refuge, a desperate type of self-defensive reaction against the ontological insecurity inherent in the constant need to reinvent oneself through consumption, and within a context of the breakdown of the solid “anchors” of the past – family, community, lifelong careers, and stable social relationships based on institutionalized solidarity (Giddens, 1991). Meanwhile, Cushman (1990) has argued that the self in the contemporary era has become empty due to a loss of community and a general sense of alienation. People attempt to abate these feelings of loss and alienation by adopting “lifestyle solutions” whereby the self is constructed through purchasing and consuming products. Addiction then is seen as an exaggerated and extreme form of the consumption practices advocated by the society at large. There are several problems with such approaches.

49 For one thing, they are too structurally deterministic, taking insufficient account of resistance, counter-currents, distinct cultural contexts, or politics. Furthermore, these types of epochal analyses tend to be overly ambitious. In short, capitalism and capitalist societies are too dynamic, fluid, and flexible to be characterized according to a single over-arching conceptualization.

What all of these approaches have in common is a social model of self. The cause of addiction is to be found in some problematic aspect of the social world. The social approach then proceeds from radically different ontological, and epistemological presuppositions to either biological/neuroscientific or psychological approaches. In terms of ontology biological models view the self as a neurochemical phenomenon. This leads to the search for knowledge about how one can lose control over drug use in neurochemical processes and structures. In psychological models ontology and epistemology are similar except the site of both the self and addiction is seen as residing in the psyche as opposed to the organic brain. A social approach views the self as an intersection point in a radiating network of social interactions (Adams, 2016), sometimes conditioned by an over-arching societal process or structure. This leads to the search for addiction within these networks, interactions, processes or structures.

Finally, as this research advances a novel approach to drug addiction, it will be necessary to review the sociological literature pertaining to the structure/agency debate in drugs and alcohol research. While in the 1980s (see Parker et al, 1988) there was a tendency to highlight the influence of structural determinants, and the 1990s witnessed a focus on rational consumers making cost-benefit analyses (see Sihiner and Measham, 2009), recently researchers have focused more on finding a balance between structure and agency. For example, Shiner has developed an approach based

50 on the notion of “situated choice”, while Measham has looked to the concept of “structured action” in balancing the structural inequalities people experience with the life choices they face and make (see Measham and Shiner, 2009 for overview). Both approaches are based on Giddens (1991) theory of structuration which emphasizes the links between structure and agency, so that social structures are said to make social action possible, yet are themselves reproduced through social action.

Though the current thesis shares the view that social structure as such has no reality apart from its instantiation through the actions of human beings, it differs from approaches based on Giddens (1991) in terms of the importance given to conscious intention in the reproduction of the social structure. For Giddens (1991) actors are reflexive, and this capacity to reflect is an integral aspect of social action, and is potentially transformative. However, following Bourdieu (1989) this thesis will argue that though conscious reflection on one’s habitus is a possibility, it is not a usual part of social process. In short, this thesis follows Bourdieu (1989) in placing more emphasis on social structure, in contrast to work based on Giddens (1991) which places more emphasis on reflexive action24.

Addiction understandings through time: the Irish literature

To date, no Irish researcher has analysed the issue of shifting addiction understandings across time directly. However, there are some studies that have approached the issue indirectly. The historian Diarmuid Ferriter (1999), for example, has conducted a comprehensive historical analysis of the Pioneer movement in Ireland over the last 200 years (in its various incarnations). Prior to independence, the movement tended to link drinking problems to the British colonial context, thereafter they continually stressed the

24 In chapter six, Geertz’ notion of webs of significance will be drawn upon to highlight the role of agency in the current model. This is intended to overcome Bourdieu’s (1989) tendency to be vague in relation to how exactly agency operates in his approach.

51 volitional nature of drinking. That is, people drank and got drunk because they wanted to, not because they had to. Furthermore, people could cease drinking if they wanted to, by praying, joining the pioneers, going to mass, or asking for God’s help (Ferriter, 1999). Regardless, from the 1950s onwards the pioneers went into terminal decline and this conceptualisation of alcohol problems ceased to have much influence.

Shane Butler (2010) has analysed the history of Alcoholics Anonymous (AA) in Ireland. While his main aim was to unravel the puzzle of how an organisation so obviously steeped in Protestantism could gain traction in a country devoted to Catholic social teaching25, he does touch on the issue of addiction, specifically alcoholism. In short, he argues that AA’s concept of alcoholism (disease) was initially met with suspicion and hostility by both the medical profession and the Catholic Church. However, due to the organisational and theological nous of their early chairperson, coupled with the Government’s eagerness to adopt the disease concept to pursue a liberalisation agenda (of pub licensing laws for example), the disease concept became enshrined in Irish policy (see Chapter four).

The final article that should be mentioned is Butler’s (2016) analysis of the historical development of Coolmine Therapeutic Community. Initially (late 1960s/early 70s) Coolmine, and indeed much of official Ireland, viewed drug problems as an issue of individual psychopathology. Its treatment then consisted of breaking down the person and reconstructing them through impulse control strategies. This view of addiction was challenged by epidemiological work in the 1980s which examined Dublin’s emerging “opiate epidemic” and found that heroin problems were mainly confined to areas of extreme social deprivation. In response to this, Coolmine seemed to double

25 An organising principle in Catholic’s social teaching that matters ought to be handled at the lowest possible level and central authorities should as far as possible stay out of intimate affairs

52 down. Indeed, they shifted their allegiance from a relatively moderate abstinence only group in London (Phoenix House) to an extremely fundamentalist American group (Daytop). We see then that at this juncture, theories of addiction in Ireland were divided between those who adhered to fundamentalist disease and psychopathology theories and those epidemiologists who advocated harm reduction measures based on their findings. Indeed, it seems that this division remains in Ireland to this day.

As is clear, though there has been some innovative research which has approached the issue indirectly, there are clear gaps in the Irish literature. Firstly, and most importantly, this question has never been directly addressed in any form. Secondly, no attempt has been made to examine shifting addiction understandings in terms of border structural change or ideological developments, over a substantial time-span. Thirdly, the literature that does exist, focus on a narrow range of interest groups and the state. Foucault (1977) has demonstrated that power is diffuse, and flows from numerous channels. If this is the case we will need to go beyond an examination of the state, the medical profession, and some special interest groups (Coolmine and the Pioneers). Furthermore, we will have to do so over longer period of time than has previously been attempted. More fundamentally, however, the literature highlighted takes a conventional archival approach to the study of history. It looks for the emergence of a phenomenon and analyses how it came to be in terms of power struggles between different institutions, actors, and groups. While this is undoubtedly fruitful, it lacks a critical edge through which to problematize the present and explicitly link historically conditioned understandings of addiction to addiction causation.

53 Etiological – Irish literature

While the 1960s and 1970s witnessed the first formal governmental discussions and responses regarding drug use in Ireland (see Butler, 1991), the 1980s represents something of a watershed in Irish history. In 1979, a growing trend in opiates' use was brought to government attention by health and community workers in Dublin. Indeed, in the five years between 1979 and 1983 the numbers presenting to the city’s drug treatment centre increased from 182 to 1,028 (O’Gorman, 2005). However, as Shane Butler (1991; 1996) has argued, up until the 1980s, the dominant view was that a personality defect caused addiction, and recovery from drugs necessitated the confrontation and elimination of said defects. This view was the established view in virtually every treatment centre which opened in the state from the 1970s until the emergence of alternative approaches in the 1990s (e.g. harm reduction and community based programs). Though some of the more moralistic and punitive elements have given way to more psychological interventions, a substantial number treatment providers in Ireland today view addiction as an individual disease or disorder (see Ivers and Barry, 201823). In terms of the formal academic literature, epidemiologists and religious orders have paid the most attention to the issue of addiction causation.

Beginning in the early 1980s, numerous research studies (usually conducted by research teams consisting of both priests and academic researchers) emerged which linked drug addiction to the deprivation and marginalisation of certain communities in Dublin (see Bradshaw et al, 1983; Power, 1984; O’Kelly et al, 1988; and O’Gorman, 1998). The central claim of the literature is that addiction in Ireland is primarily related to heroin use, mainly a Dublin problem, and for the most part confined to disadvantaged communities in Dublin. In one of the first studies of the period Bradshaw et al (1983) link addiction specifically to social deprivation. They argue that addiction is

54 overwhelmingly concentrated in deprived areas, with high unemployment rates and social settings in which drug taking, crime, and alcohol abuse were common. This finding is replicated in numerous research findings, both in the 1980s, and in the decades since (see O’Gorman, 1998 for an overview).

As mentioned in the introductory chapter, this research is supporting by the National Drug Treatment Reporting System’s (NDTRS) data (see O’Hare and O’Brien 1992; O’Higgins, 1996), capture-recapture studies (see: Comiskey, 1998), and ethnographic research which examines drug use in deprived communities (for example: Mayock, 2005; O’Gorman, 2005). These ethnographic approaches tend to draw on Rhodes (2002) concept of the risk environment, and social exclusion to theorize the lived experience of drug users in social and spatial environments deemed “risky” in terms of their potential for drug-related harm. For example, O’Gorman (2005) analyses quantitative socio- economic data as well as the lived experience of heroin users, to argue that components of social exclusion (poverty, educational, disadvantage, chronic unemployment) are not just cumulative but mutually reinforce each other when experienced in the same risky socio-spatial environment.

While this research successfully demonstrates that there is a relationship between deprivation and drug-related harm, there are a number of limitations. Firstly, some research studies which posit social deprivation unjustifiably exclude identified groups of middle class opiate addicts from their sample (see Bradshaw, 1983 for example).

Furthermore, this research evidence has primarily been used as a means of

55 justifying targeted counselling, educational, community development (e.g. local drug task force), and prevention resources at deprived communities. It is representative of a pragmatic managerial decision intended to depoliticize contentious issues relating to drug debates. As critical addiction researchers have pointed out (see Frayne and Pienaar, 2017 for example), propositions and evidence concerning drug use are never neutral, they always have political implications. In this case, the tendency of Irish addiction researchers to overly rely on positivistic indicators has led to drug policy responses being limited to pragmatic administrative measures, and to measures intended to help marginalized communities develop resilience.

Indeed, it has also meant that broader economic and political power structures that harm marginalized communities (see Allen, 2007) have been neglected by addiction researchers26 . In short, this has meant that addiction researchers have largely focused on progressive reform of drug policy as a means of responding to drug-related harm, without sufficient consideration of the need for broader structural change27. Finally, as O’Gorman’s (2005; 2016) work most explicitly attempts to provide a critical sociological framework through which to interpret this research evidence, we will need to engage with it here. O’Gorman (2005) has successfully elucidated the contextual and interpersonal dynamics within which heroin careers develop in environments characterized by social exclusion. This combination of qualitative lived experience and quantitative

27 For example, the political issue of imposing austerity on marginalised communities while giving tax breaks to multi-national corporations, is a power imbalance that certainly contributes to increased marginalisation (and thus harmful drug use). However, discussions of austerity in addiction research tend to focus on its impact on drug policy (see O’Gorman, 2016), as opposed to its broader impact. This is partly because the pragmatic managerial approach is largely concerned with keeping change within narrow bureaucratic limits, or helping communities develop resilience to these social forces and political/power imbalances. In short, while drug policy may become more progressive by creating person-centered community responses which recognize the impact of deprivation, this will need to be accompanied by structural change which fundamentally addresses the power imbalances in the socio-cultural and political-economic structure of Irish society.

56 socio-economic data, has contributed to an increased knowledge of the mutually reinforcing relationship between social and structural processes in the development of local drug problems in risk environments characterized by social exclusion. More recently, O’Gorman (2016) has demonstrated the policy-related harms and structural violence experienced in deprived areas, as a result of government policies that have reduced welfare payments and imposed other austerity measures on vulnerable populations.

The current study recognizes the vital contribution of O’Gorman’s (2005; 2016) work to the study of the lived experience of harmful drug use, and to progressive drug policy reform which stresses the importance of experiences of harm and structural violence. The current study intends to build on this research by addressing the unresolved tension (see O’Gorman, 2005) between the social and spatial clustering of drug-related harm, and the social construction of concepts of drug-related harm across time. Furthermore, the current thesis will argue that though progressive drug policy which stresses the harm of structural violence within the policy process is a helpful development, progressive developments in drug policy alone are not ebough to address harmful drug use. These progressive developments, will need to be accompanied by wider political-economic and socio-cultural restructuring of society.

In relation to the point concerning unresolved tensions (see above), Insofar as O’Gorman (2005) attempts to adjudicate between the social constructionist and realist positions, it seems that she views drug-related harm as real as it has a social and spatial clustering. However, this social and spatial clustering though real, needs to be interpreted, and it therefore seems that a dynamic nominalist (Hacking, 1999) approach to the ontological issue at hand is more appropriate.

57 This would involve seeing this clustering as both real and constructed. This approach can account for both the Irish research evidence demonstrating a social and spatial clustering and the voluminous literature that demonstrates that understandings of drug-related harm are socially and culturally constructed (Levine, 1978; Courtwright, 2001), as this thesis will demonstrate

Finally, though O’Gorman’s (2005) analysis of the cumulative and reinforcing impact of indicators of deprivation in risk environments has some similarities to the current study’s concept of “cascading intersections of alienation” (see Chapter five), it fails to explicitly trace the wider historical and structural conditions which go beyond drug policy debates, and influence experiences of social suffering more generally. Indeed, these limitations are also evident in the more critical approaches to studying addiction in Ireland (Mayock, 2005). As will be demonstrated, the critical sociological framework offered in this research, can build on this work, and overcome some of its limitations, by addressing the tension between social contructionist and realist approaches, and expanding the study of structural violence beyond drug policy and the policy process in general, to an analysis of the political-economic and socio-cultural structure of Irish society.

Conclusion and discussion

It is now necessary to explicitly place the current research within the broader literature to demonstrate its potential to make a substantial contribution to knowledge. It has been noted that the current international literature on shifting addiction understandings, is Anglo-American centric, to the neglect of more peripheral jurisdictions. By examining the Irish context, this research seeks to build on recent cross-European research (Berridge et

58 al, 2016) which has challenged this domination. Indeed, as mentioned previously, there are many reasons to be confident that the Catholic Church's unique influence and the particular configuration of the political field in Ireland may challenge the overt focus on structural influences in the international literature. The central point of this review, however, is that the separation of these (critical socio-historical and etiological) literatures has limited the study of addiction causation.

While a genealogy of the addiction concept may have little direct relevance to causation, the problematisation process outlined by Bacchi (1999), quite clearly does. That is, the effect of portraying addiction as an actually existing problem of pathological individuals or communities has several effects on drug using populations. These include the identification of definite and fixed “addict” characteristics, the delineation of rigid categories (sharp distinction between addicts and non-addicts), and the creation of techniques of normalisation through which to change the addict’s very sense of self (e.g. drug treatment). Therefore, combining a genealogical analysis with a study of the problematisation process, according to the WPR framework's precepts, has the potential to overcome the problematic tendency to treat, separately, issues of causation and shifting understandings over time.

Furthermore, a genealogy of dominant addiction understandings can highlight structural developments, power struggles, and contingent events that condition contemporary addiction understandings. By demonstrating that our current understanding is not the result of the slow accretion of scientific evidence, or objectively correct, necessarily, the space can be opened to challenge the model’s epistemological foundation, and to understand suffering28 and harmful substance use

28 For example, Rose (2003) has noted a contemporary tendency to understand almost all versions of human suffering as the result of individualised neurochemical imbalances (think depression, bipolar, etc.)

59 in different ways. This has the potential to challenge biologically and socially deterministic models of addiction, which are historically conditioned and power- infused, and create new and emancipatory ways for people to be. However, social conditions and individual life circumstances do indeed create contexts of suffering and harmful drug use, as social models of addiction highlight, despite categories intimately influencing our understanding of this. Thus, the current research will also pay attention to that level of analysis, keeping in mind the philosophical issues and cultural contextual factors, the relative ignorance of which have been considered justifiable grounds on which to criticise some social researchers.

The current thesis then will seek to make a number of distinct contributions to the current literature. Firstly, it will be the first study to explicitly examine shifting understandings of addiction across time in Ireland. Secondly, it will adopt a genealogy in order to add a critical edge to the investigation, the aim of which is to problematize current understandings of, and responses to, addiction. Thirdly, it will counter the tendency within the relevant literature to study “addiction without the addicts”. That is, it will not only study how and why addiction understandings change over time, i.e. addiction at an ideological level, but also addiction as a subjectivity, along the lines suggested in Bacchi’s (1999) work. This will enable an examination of how shifting addiction understandings (ideological level) create new and elaborate ways for people to be (subjectivities) which has real effects on populations of addicts.

However, we will not just be interested with subjectivities and the effects their creation may have on populations of addicts, but also how individuals embody, rearticulate, and resist subjectivities. For this, we will turn to Bourdieu’s (1989) concept of symbolic violence (see Chapter five).

Symbolic violence will enable us to articulate the mechanisms through which people misrecognise the objective structures which cause them harm and limit their agency, how they come to view their suffering as natural or inevitable, and almost entirely caused by their drug use. Finally, it will demonstrate how powerless addicts come to “do the work of the dominant” by coming to embody and rearticulate dominant addiction understandings, to varying degrees. The next contribution this thesis seeks to make is to link the conceptual, ideological, subjectivist and embodied understandings just outlined, with actually existing social conditions which cause people to suffer and limit their agency. For this, we will draw on Johan Galtung’s (1969) concept of structural violence, and Kleinman et al (1997) and Farmers (2009) concept of social suffering (see Chapter five).

Social suffering and structural violence are analytically broad as they bring together an assemblage of human problems that have their origins and consequences in the devastating injuries that social forces can inflict on human experiences. This is beneficial to the current research as it counteracts the tendency in the Irish literature, and indeed the international literature, to posit either social deprivation (too narrow to explain the impact of all violent structures and forms of suffering), or disease models. Finally, both concepts provide an analytical scaffolding that can be applied across national contexts, while remaining sufficiently non-prescriptive to allow adaptation to the particular historical, socio-cultural, and political-economic configuration of a particular society.

This thesis also seeks to overcome the lack of attention to meaning-making in Bourdieusian and

61 Foucauldian approaches (Inglis, 2014). For this, we will draw on Geert’z concept of webs of significance (Chapter six). This will provide us with a mechanism that can resolve issues related to the structure/agency debate. Thus, webs of significance (the symbolic narrative structure which gives life meaning), spun around family, friends, hobbies, communities, and work can help us understand why some people suffer and use drugs harmfully, become classified as addicts, and embody this subjectivity (imperfectly). To conclude then, the current thesis seeks to make a novel and comprehensive contribution to knowledge through addressing the following research question, and addressing the following research aims:

Research question:

What can the intersection between conceptions of self and conceptions of addiction tell us about the cause of drug addiction?

Research aims:

Examine the development of dominant addiction understandings across time in Ireland.

To investigate the effects that dominant addiction understandings have had on drug- using populations

To rethink how we view addiction in Ireland, through the presentation of a novel approach to the study of drug addiction.

62 Chapter Three

METHODOLOGY

The research paradigm – ontology, epistemology, methodology, and methods.

As argued in the previous chapter, current theories of drug addiction are either biologically, psychologically, or socially reductionist, and also in an Irish context, they tend to represent addiction in overtly positivistic fashion and axiomatically assume a realist position. Furthermore, as argued, there is an urgent need to combine an epistemological deconstruction of the drug addiction field, with a new approach to addiction causation which addresses these limitations and provides an alternative and emancipatory framework. This is the gap in knowledge the current study seeks to fill.

The following will deal with all of the methodological concerns of the research. It will engage with issues concerning research aims and justifications, the project’s ontological and epistemological underpinnings, the practice of data collection, the form and process of data analysis, and the ethical issues relevant to all of the above. Crucially, this chapter will outline the approach to qualitative interviews that was adopted during the study, as well as the genealogical method adopted when analysing and collecting the historical materials.

Furthermore, a discussion of how both of these methods related to one another, the study’s philosophical underpinnings, and how all of this evolved throughout the study,

63 will be discussed. This chapter will also deal with the two “parts” of the research separately. That is, firstly, a socio-historical deconstruction (specifically a Foucauldian genealogy) of the term addiction and then an etiological model of drug addiction. This is deemed necessary as different methods will be used in attempting to address both issues.

Importantly, in this chapter I will justify the adoption of my chosen methodology and methods and their suitability for the current research. Furthermore, I will outline in detail the approach to data collection adopted and the research strategy. Finally, I will engage with issues to do with reliability, validity, and generalisability. Firstly, however, I will outline the research questions, rationale, and also the research paradigm.

Methodology: The research rationale, questions, and paradigm

In the opening chapter to this thesis, I gave many reasons for undertaking the current research. To recap, the core motivation was a deep dissatisfaction with current approaches to addiction in light of an increase in harmful drug use29 and overdoses (see Lynn and Lyons, 2019) - particularly in Cork City. To this, we could add Reinarman’s (2005) assertion that the field of addiction is in conceptual chaos, as well as the patent failure of current approaches in an Irish context to make any significant positive impact on the current crisis (though there have been some successes). The current research represents an attempt to return to the fundamentals of the addiction field to take a fresh look at these issues. As mentioned in the introductory chapter, it seemed that the nature of addiction and the nature of people who become addicted seemed to be the two most

29 See: https://www.drugsandalcohol.ie/tables/

64 fundamental issues at hand here. These considerations led to the central research question:

What can the intersection between conceptions of the self and conceptions of addiction tell us about the cause of drug addiction?

However, this central question led to ancillary research aims that needed to be treated separately initially. For example, the issue of changes in our understanding of addiction over time necessitated a specific set of ancillary questions and methods, as did the issue of what affect the portrayal of addiction as a particular kind of condition has on drug- using populations. Finally, the issue of how addiction understandings intersect with a drug user’s sense of self and life experiences also necessitated ancillary questions and research methods. Before turning to address these issues, however, it is necessary to foreground the current study’s ontological and epistemological underpinnings.

Ontology and epistemology

A relational ontology and epistemology inform this thesis. This will be outlined in contrast to a radically different research paradigm in the social sciences – abstractionism. Ontological abstractionism is a philosophical worldview that defines all that is real as self- contained and isolated (Richardson and Slife, 2005). Therefore, “things in the world” are best thought of as detached from other things, and especially from the context in which they occur. Ontological abstractionists then would argue that all things, including the self and the addicted self, are most readily comprehendible when they are separated from the situations in which they occur (Slife, 2005). From this perspective, each factor of addiction – genetics, environment, social context, culture – is conceived of as being

65 detached from each other, from context, and from how our understandings of addiction are represented, and how this changes over time. Ontological relationality, on the other hand, asserts that individuals can only be understood in relation to the contexts in which the individual exists, or the behaviours occur. Thus, it is the issue of primacy that is vital here. Both abstractionism and relationality assume that relationships are vital in the study of phenomena; however, one assumes a relationship based on weak relations and the other based on strong relations. This distinction is best captured by Slife (2005):

“From this weak relational perspective [abstractionism], persons, places, and things begin and end as self-contained individualities... Relationships... in this weak sense are reciprocal exchanges of information among essentially self-contained organisms [or entities]. The term ―interaction often connotes this weak form of relationality because members of the interaction ―act on each other... In all cases, the identity of these entities stems from what is ultimately ―inside and within them, even if some of what is inside might have originated from the outside... Strong relationality, by contrast, is an ontological relationality. Relationships are not just the interactions of what was originally non- relational; relationships are relational ―all the way down. Things are not first self-contained entities and then interactive. Each thing, [including addiction], is first and always a nexus of relations”. (p. 3- 4).

In short, abstractionist accounts would view the addict’s self as a prelude to their participation in and interaction with the rest of the world. Conversely, relationality assumes that the rest of the world is a prelude to the emergence of the addict’s self, and their individuality is both secondary to, and in part dependent on, that world. The addicted self in this study is seen as an intersection point in a radiating network of meaningful social connections (Adams, 2016).

66 Furthermore, if we are to understand how a person becomes “an addict”, epistemologically, we must analyse multiple levels in order to uncover clues that may render this puzzle understandable and meaningful.

Firstly, how people come to be the way they are in general. Secondly, our understanding of such a process and how it is historically contingent. Thirdly, the structures, systems and ideologies which propel and constrain, under what context they do so and the role of meaning-making in this process. Fourthly, how and why addiction understandings shift across time, what impact this has on people labelled as addicts; and finally, the interdependence and inseparability of all these levels of analysis. Crucially, though addiction understandings (and addicts) are constructed over time, addiction is real in so far as it is enacted through social action in concrete contexts. Furthermore, the contribution to knowledge that this thesis will make; and the level of understanding this study can obtain, will be limited relative to the overall phenomenon (addiction). This approach to epistemology was best summed up by Stinchcombe (2013) who argues that the task is not to develop a single theory that explains all aspects of a phenomenon but to proceed by “deepening analysis” between various aspects of an overall phenomenon and relevant models, and other comparable instances.

Crucially, just as ontological relationality holds that things are not self- contained at base, epistemological relationality holds that knowledge cannot be meaningfully or validly captured in its entirety in any one theory, model, or research study. Therefore, it is only through the intersection of diverse academic contributions that comprehensive and insightful knowledge claims can be advanced. In summation, the approach this thesis adopts towards ontology, epistemology, and causation is in line new materialist approaches (see Keane et al, 2014), and also Hacking’s (1999) ‘dynamic nominalism’. The approach to causation, however, is tempered by a methodological commitment to

67 Stinchcombe’s (2013) notion of “deepening analysis” – that is – this thesis is based on a view of causation supported by the material presented, yet accepts that one study can never fully “know” causation. Finally, as the current study combines different data sets from different sources and epistemologies, a discussion of the difficulties associated with triangulation is warranted. In the social sciences, triangulation refers to the application of a combination of several research methods (e.g. genealogy, WPR approach, in-depth interviews) in the study of the same phenomenon (Bogden and Bilken, 2000).

Social scientists have highlighted several potential problems associated with triangulation. These include: (1) triangulated research may run the risk of taking on too many unfocused questions all at once unless it has a precise sequence; (2) some combinations of methods may not be appropriate due to fundamental differences in ontological and epistemological presuppositions; and finally, (3) triangulation may lead to the collection of inconsistent of contradictory data. The first issue in relation to unfocused questions was not an issue in the current research. Indeed, as outlined in the research aims (Chapter one and two), each of the areas of focus is specific and related sequentially to the others.

That is, the first aim was to explore whether concepts of addiction in Ireland are socially constructed, and if so, could they be constructed differently. The second aim was to explore the effects of this process of construction itself, on drug-using populations. Finally, in conjunction with the critical sociological framework, the in-depth interviews are intended to contribute to a new approach to the study of drug addiction. In relation to the second criticism of triangulation, this was not an issue in the current research. Typically, this issue emerges in mixed methods research, which draws from both quantitative and qualitative approaches and has to reconcile positivist and interpretivist

68 paradigms. As the research paradigm was consistent throughout this study (relational ontology and epistemology), this did not present any issues30.

Finally, as the three research aims were concerned with how different groups had understood and enacted understandings of addiction, where contradictory data emerged, this enabled rich reflection and more comprehensive understandings and was certainly not seen as a limitation. For example, the way in which two participants, Roisin and Collette, ambiguously engaged with the dominant disease models demonstrated that socially constructed understandings are only ever imperfectly embodied and enacted in an individual’s life. I will now turn to a discussion of the specific methods utilized.

Methods

Genealogy

As previously mentioned, there is a distinct lack of research that has examined the issue of shifting addiction understandings across time in Ireland. Furthermore, the available literature quite strongly suggests that addiction understandings do not develop according to objective scientific evidence. For example, the initial rise to dominance of the disease theory is explicable by reference to specific governmental policy interests (specifically economic), broader socio-cultural and political-economic developments, as well as the interests of a whole host of powerful groups in Irish society (Butler, 2010). This contradicts standard histories of the addiction concept, which argue that it develops according to objective evidence-based science (see for

30 It might be claimed that Foucault’s epistemological commitments would preclude the construction of a novel approach to addiction. However, Foucault (see Seddon, 2010: p. 3) urged researchers to view his work as a “conceptual tool box”, and the use of genealogy in this research is in line with Foucault’s suggestion here.

69 example Matano and Wanat, 2000). These issues, as well as those raised in the literature review, at the very least call into question the epistemological underpinnings of addiction research in Ireland, suggesting that non-epistemic interests play a more significant role in conditioning addiction understandings than has hitherto been acknowledged.

The genealogical method (see Foucault, 1977) was adopted to provide a critical edge through which to problematize present addiction understandings in Ireland. This concern arose directly from an engagement with available etiological models of addiction both internationally, and in an Irish context. While the literature review outlined criticisms of both biological and social models of addiction, there is no doubt that, at least in an Irish context, understandings of this nature are dominant. A Foucauldian genealogy then is uniquely placed to account for the dominance of such understandings despite the many criticisms that can be levelled against them. As Dreyfus and Rabinow (1983) argue, the genealogical method can explicate the current state of knowledge through examining the history that has contributed to legitimising a present discourse or practice. This method can move beyond viewing dominant understandings as “incorrect” in any straightforward sense, to an appreciation of the complex unfolding over time, and the multitude of power-struggles, socio-cultural and political-economic developments, and contingent events, which provide the context within which dominant understandings come to be accepted and viewed as “true”.

David Garland has pointed out that successful genealogy depends on identifying the:

“Dispositive” and upon a prior critical account that establishes the problem to be explained which points the way to its most likely solutions (Garland, 2014).

Furthermore, Foucault describes the “dispositive” as follows :

“What I am trying to pick out with this term is a thoroughly heterogeneous ensemble consisting of discourses, institutions, architectural forms, regulatory decisions, laws, administrative measures, scientific statements, philosophical, moral, and philanthropic propositions – in short, the said as much as the unsaid…” (quoted in Garland, 2014: p. 378).

To give a practical example of what a dispositive would look like here is how Foucaul describes it concerning our “present day” experience of sex:

“Sexuality – is the name that can be given to a historical construct not a furtive reality that is difficult to grasp, but a great surface network in which the stimulation of bodies, the intensification of pleasures, the incitement to discourse, the formation of special knowledge’s, the strengthening of controls and resistance, are linked to one another, in accordance with a few major strategies of knowledge and power” (Foucault, 1978: 105-106).

To be quite specific, the problem to be addressed was: How is it that in contemporary Irish society, using alcohol and drugs in ways which cause individual and collective suffering has come to be seen as a medical problem? How has medical, and to a lesser extent, moral and psychological, knowledge come to be privileged as the deepest reservoir of truth in terms of this type of substance use? This will be discussed further in the introduction to Chapter four; however, it is now necessary to say something about

71 the sources from which the genealogy will be undertaken. It is argued following Rudy and Orcutt, (2003), that the most appropriate way to trace the emergence and descent of a particular conceptualisation is through an examination of how it has been represented by society’s most powerful groups across time. While such an approach cannot claim to capture “the homogenous” view of any of the groups (indeed there is often a diversity of views) through representations in published texts, it is argued that by collecting a wealth of historical and contemporary materials the dispositive can be “picked out” (see Foucault, 1978) and traced across time. The groups selected are in no particular order of importance: (1) The medical profession; religious organisations, particularly, the Catholic Church and temperance organisations;m, Irish Government; and (4) the media. We will now turn to this issue of sampling.

Sampling

The genealogy upon which part of this study was based, adopted a purposive sampling strategy. That is, as mentioned, following Rudy and Orcutt (2003), the most powerful groups in Irish society were selected. It is, of course, recognised that other groups such as the alcohol industry (particularly the Vintners Federation of Ireland) and the Irish Farmers’ Association (Bryan, 2013) had been involved in debates and discussions regarding alcohol and drug-related issues. However, given that genealogy was not a central focus in this research, there are a number of reasons for their exclusion. Firstly, historical documents and publications by the alcohol industry, in general, would likely prove extremely difficult to access, and given the limitations imposed by a Ph.D. Thesis, this would prove too labour intensive. Secondly, given that the alcohol industry would not likely be overly concerned with drug use, and the justifications which will be provided for the inclusion of the other groups, it seems that this omission is not a serious limitation. Finally, while representatives of the Irish Farmers’ Association have argued against specific alcohol policies (particularly regarding restrictions on alcohol consumption and sports sponsorship: see Bryan, 2013), in general their interest in these issues has been sporadic.

In any case, as mentioned, I will argue that there are several justifications for the inclusion of the groups selected. It should be mentioned that the genealogy covers the period from the foundation of the modern Irish state (1922) to the present (2019). These dates were chosen to give the study enough breadth to conduct a comprehensive genealogy, while also being feasible within the timeframe of a Ph.D. thesis. Furthermore, most historians agree that the foundation of the modern Irish state represents a watershed in Irish history (see Lee, 1989; and Ferriter, 2004). I will now discuss sampling in some more detail (also see Table 1). There were two main justifications for my selection of what I broadly term “the medical profession”. Firstly, “The Irish Medical Journal” and the “Irish Journal of Medical Science”, have been in publication for over 150 years and are the longest running journals in Ireland. Furthermore, both journals and the third examined “The Irish Journal of Psychological Medicine”, contain more articles that address the issue of addiction than any other Irish medical journal. More importantly, researchers are largely in agreement that the opinions and views of the profession have been extremely influential in shaping popular and governmental opinions on a wide variety of issues over the last two centuries (Harvey, 2007; Ferriter, 2004). Given the sheer volume of literature, it was necessary to include “search criteria” (see Table 1).

There are several justifications for the inclusion of the various religious groupings. Firstly, religion has been perhaps the single most influential force in shaping Irish culture and society – rivalled perhaps only by Ireland’s colonial relationship with Britain (Ferriter, 2004). In terms of religion then, this research analysed sources pertaining to the “Pioneer Total Abstinence Association”, and the Catholic Church’s seminary journal The Furrow. Given its sheer size, and that its raison d’etre was to combat alcohol consumption and drunkenness, and that historians (Ferriter, 1999) argue that it was one of the largest social movements in Irish history, the inclusion of The Pioneer movement was deemed

73 highly appropriate. Furthermore, The Furrow is the Irish Catholic Church’s seminary journal and is concerned with examining social problems from a Catholic perspective. This was deemed more appropriate for the current research than a journal such as The Irish Theological quarterly which is primarily concerned with abstract theological issues.

In the case of the pioneer movement, there is a detailed secondary historical literature that was consulted. This takes the form of a comprehensive historical analysis conducted by Ferriter (1999), as well as authors such as Butler (2010) and Butler and Fagan (2011). These studies drew on the historical papers (1839-1996) of the pioneer movement, which are available at the University College Dublin’s archives. I also consulted these papers, with the assistance of an archivist who was made aware of my project, to determine whether there was anything significant that the other authors had missed. As it transpired, I was unable to find anything of further value, and thus my analysis of the movement is based on the work of the aforementioned authors. To conceptualise governmental attitudes, Irish governmental policy documents, legislative acts, and “Dáil Debates” (debates in Irish house of parliament) were analysed. The justification for using Dáil Debates in relation to governmental conceptualisations is that a focus on legislation alone can obscure the debate and critique, which is integral to the process through which legislation is crafted. Furthermore, all stages of legislation and Bills are debated fully in the Oireachtas (upper and lower Irish houses of parliament) and are therefore included in Dáil Debates.

Finally, to gain a sense of the media’s conceptualisations of addiction, the “Irish Newspaper Archives”, were examined. This depository contains all Irish newspaper publications over the last 200 years, and as such, was an incredibly valuable resource to the current research. In terms of the media, all newspapers in the online archives have been consulted, and the inclusion/exclusion criteria was that only the first, last, and a

74 middle year in each decade (1920s, 1930s, 1940s etc.) will be examined (see Table 1). Relatedly, in every year included, only the first and last 50 articles were included and examined to keep the dataset manageable (over 10,000 hits per year: see Table 1). This was also justified on the basis there seemed to be no particular reason why any important difference in conceptualisations would emerge in the middle of the year as opposed to the beginning or the end. Given that no previous research of shifting addiction understandings across this sort of time span has previously been undertaken in Ireland, an appeal to the division of academic labour (see Garland, 2001) will need to be made.

If another scholar were to pick fifty articles from the middle of each year and uncover completely different conceptualisations (there seems to be no reason why this would happen though), then this would only enrich our understanding, by demonstrating the seasonal influence on addiction understandings, and thereby making a crucial contribution to the literature. Of course, it is recognized that this could have been done differently. For example, I could have focused on a smaller number of major newspapers, rending the dataset more manageable. However, this approach was rejected on the basis that it would simply reinforce the Dublin centric focus of much Irish addiction research. Another approach would be to narrow the date range in order to render the dataset more manageable. This is unsuitable as genealogy is concerned with large shifts in discourse over time, and demands a long historical view. Indeed, given that Foucault’s (1977) genealogies sometimes spanned centuries, it seemed that the timeline the current study adopted could even have been longer31. It is argued that the decision to select the first and final 50 articles in the years specified, was superior for the reasons given and also on the basis that it was most suited to examining shifting understandings across a lengthy historical period (and provided geographically diverse

31 This was of course unfeasible given the scope of the study. Furthermore, given that genealogy wasn’t the only aim, it is argued that the current time scale is appropriate

75 newspaper articles). Ultimately, it is hoped that this necessary methodological limitation will be corrected by future researchers picking up where I have left off.

In terms of search terms, it is recognized that relatively few terms were used given the scope of the study. However, it is argued that this was justified given the genealogical approach adopted. That is, the decision to exclude terms such as “substance use”, “substance use disorder”, “substance abuse”, and “drug-related harm” was due to these terms having a relatively recent history. In short, the search terms included have been in usage for well over a century (in some form and with different meanings), and are, therefore, more suited to analysing large shifts in understandings across time. While more search terms may have identified a wider range of material, given arguments that medical discourse has colonized understandings of addiction (particularly with the expanding power of the WHO – see Berridge, 2013) since the latter part of the 20th century, it was feared that the alternative terms mentioned would have disproportionately focused the study on contemporary medical terminology, which goes against the purpose of genealogical research.

Finally, some consideration should be given to the decision to include both alcohol and drugs within the addiction category. Indeed, many authors have highlighted the different ways in which alcohol and drug use are constructed across time and place (e.g. Room, 2002). However, as Weinberg (2011) points out, there is a stark contrast between this literature which provides detailed descriptions of the cultural meaning of drug and alcohol use, its function as a medicalized or pathologised discourse, and the stigmatization of users and other works which have specifically addressed the issue of addiction. He argues that the relative lack of focus on addiction has been due to its colonization by medical and therapeutic discourses. Ultimately, it is argued that a study which focuses on the commonalities in how addiction is constructed can help

76 contribute towards decolonization of the addiction concept, and perhaps even a critical sociological analysis of addiction which many authors have argued is overdue (see Weinberg, 2011; and Keane et al, 2014). I will now turn to a discussion of the use of Bacchi’s (1999) problematizing approach

Table 1: Name of Sources used Key Words Date Sampling Group Ranges The Irish (1) Dáil Debates – Available at: Addiction, 1922- Only debates 2019 Gov. oireachtasdebates. oireachtas.ie drug which directly addiction, related to the alcoholism, issue of drunkard, addiction or alcohol, problematised drugs substance use in some form were included32 The (1) Irish Journal of Medical Science Addiction, 1922- All articles 2019 Medical (https://www.springer.com/journal/11845) drug which Profession (2) Irish Medical Journal (www.imj.ie) addiction, matched the (3) Irish Journal of Psychological medicine alcoholism, keywords (www.cambridge.org) drunkard, were alcohol, examined (70 drugs. articles)

32 This was due to issues of relevance to the current paper and that in the region of 10,000hits were generated . The debates which were excluded, however (over half), contained no reference to harmful substance use; typically, they focused on taxation and other strictly financial matters

78 Catholic (1) The Furrow (www.thefurrow.ie) Addiction, 1922- All articles 2019 Church (2)The papers of the Pioneer Total drug and literature

Abstinence Association (UCD Archives) addiction, which

alcoholism, matched the

drunkard, keywords

alcohol, were included

drugs. and examined 1922- The (1) Irish Newspaper Archives Addiction, First, last, and 2019 Media (www.irishnewspaperarchive.ie) drug a middle year addiction, in each alcoholism, decade only drunkard, only, and then alcohol, only the first drugs. and last 50 articles33

33 This was deemed necessary as each search word would generate hundreds of hits per year (see text for further details.).

79 The effect of problem representations

Importantly, the portrayal of addiction as an actually existing problem of individual or community pathology has had real effects on drug-using populations. To investigate these effects, it was necessary to draw on the “WPR” framework, outlined and elucidated by Bacchi (1999). This framework challenges the view that governments and other powerful groups simply respond to “problems” that exist “out there”. It draws attention to how particular issues are given a shape, which in turn affects what will be done or not done. For example, identifying drug addiction as the problem of a pathological individual or community keeps change within narrow limits, protecting specific interests, stigmatizes, and imposes subjectivities on individuals, or communities, who are deemed to be “the problem”.

The aim therefore, was to move beyond an examination of how addiction became named and shaped as a problem, to an examination of the impact of that problematisation process. Crucially, this framework assumes that some problematisations benefit some groups at the expense of others. It is committed to identifying the discourses and processes which impose subjectivities on groups of drug users, as well as frames of interpretation on complex social phenomena, in ways that support the status quo. Bacchi’s (1999) approach provides a conceptual “checklist” that guided the analytical process, using a set of six questions to probe how problems are represented. The six questions are as follows:

What is the problem represented to be in a particular field?

80 What presuppositions or assumptions underpin this representation of the problem?

How has this representation of the problem come about?

What is left unproblematic in this problem representation? Where are the silences?

Can “the problem” be thought about differently? What effects are produced by this representation of the problem?

How/where has this representation of the “problem” been produced, disseminated, and defended? How has it been (or could it be) questioned, disrupted, and replaced?

Therefore, Bacchi’s framework was utilised to account for how the addiction ideology became a subjectivity, and how this problematisation process created and affected “the addict”. It should be clearly stated that Bacchi’s framework was only applied to the historical data, as it has typically been used in critical policy analysis, or in analyses which critically analyse how powerful groups represent certain problems and the effect of this process (see Bacchi, 1999). It is, therefore, not suited to an examination of how individuals embody and negotiate dominant representations. The next section will provide an introduction to the study setting - Cork City.

81 Cork City

Cork is a regional port city, a status it shares with other European cities such as Glasgow, Liverpool, Barcelona, and Amsterdam (Keohane, 2006). Historically, the city was little more than a large town until population growth (1930s in particular) led to the clearing of the city slums and the construction of social housing estates on the Northside, and to a much lesser extent the Southside, of the city (Jefferies, 2010). From the 1960s onwards with the decline of agriculture and the growth of industry, further population growth driven by those from rural Cork coming to the city for work led to the construction of sprawling suburban estates in old villages several kilometres outside of the city (Jefferies, 2010). This process intensified from the 1980s onwards, and currently, the population of Cork City is 126,00034.

Like much of the country, Cork developed a large industrial economy from the 1960s onwards, centred on the port of Cork. Like the rest of the country, this industry saw a sharp decline from the mid-1980s, which led to unemployment and all the attendant social problems. Today, a process of globalisation beginning in the 1990s has led to Cork becoming a world base for pharmaceuticals and Information technology (Jefferies, 2010).Indeed, Apple INC’s European base is located on the Northside of Cork City. However, this positioning is telling as the multinational giant overlooks council housing estates suffering from addiction, crime, high unemployment, and precarious low waged work.

Meanwhile, the lower middle-classes living in the suburban housing estates, having attained cultural and economic capital in the recent past (Keohane, 2006), remain fearful of falling down the social structure (Young, 2007), as happened to a sizeable portion of

34 see Census 2016: https://www.cso.ie/en/census/census2016reports/

82 them when the construction industry collapsed in the post-2008 period (Bobek and Wickham, 2015). The central point, however, is that there are two distinct “class histories” that are important to grasp to better understand our study participants. The first is that of the socially deprived who, as mentioned, live in social housing estates constructed in the 1930s, 1950s, and to a lesser extent the 1980s. This population has been subjected to waves of historical abuse ranging from British colonialism, experiences of poverty and disease in tenement slums, Tuberculosis (TB) epidemics in the 1930s, 1950s, and 1960s, economic and social shocks in the 1970s, 1980s, as well as the most recent post-2008 crisis.

Meanwhile, the lower middle-class have experienced many of the culture shocks as the socially deprived; however, they also experience difficulties associated with urbanisation and the movement of people from rural Cork to the city. As will be argued in Chapter five, in the contemporary world, they experience a fear of falling down the social structure, a fear linked to their recent accumulation of cultural, economic, and social capital, and the insecurity of the contemporary social and economic landscape.

The historical evolution of drug trends in Cork differs somewhat from the rest of the country, particularly from Dublin's experience. Most notably, while the use of cannabis, hallucinogens, prescription medications, and amphetamines was somewhat common in the 1980s (see O’Carroll, 1997), Cork appears to have avoided the levels of heroin use witnessed in Dublin in this period. Indeed, a 1983 study (Bradshaw et al, 1983) in the city noted that while the use of the aforementioned drugs was not uncommon, and a sizeable population of diconal35 users also existed, the heroin using population was small and quite transient. Like Dublin, Cork witnessed the emergence of a significant ecstasy

35 This is a strong prescription opiate, and is used medically to treat severe pain.

83 using population in the 1990s linked to rave culture, a situation which mirrors the wider British and European experience (see Murphy et al, 1998).

Furthermore, evidence from treatment providers (see Murphy et al, 1998) in this period36 indicates that the typical person presenting to treatment in Cork would have been a polydrug user (ecstasy, amphetamines, cocaine, alcohol), and while instances of heroin use were rare, they were increasing. While evidence from the late 1990s indicates an increase in heroin use in highly localized deprived communities in Cork (see Irish Government, 1996), the period 2004-2016 witnessed the most substantial increase in heroin use (600%)37. In the contemporary context, the drug scene in Cork mirrors the rest of the country with a broad range of drugs being used, and the typical drug user presenting at treatment being a polydrug user38.

Finally, drug treatment in Cork also has a slightly different developmental trajectory to Dublin. That is, while harm reduction measures such as needle exchange and methadone maintenance were introduced in Dublin in the 1980s (see Butler and Mayock, 2005), these were not extended to Cork until 2006 (see Collins, 2006). Furthermore, while Cork has developed community-based drug services that have developed country wide since the 1990s (e.g. Local Drug Task Forces), services in Cork (particularly residential treatment) tend to be disproportionately based on the Minnesota mode, while more variety in treatment modalities exists in Dublin. Cork was chosen as the research site for a number of reasons. Firstly, addiction research in Ireland to date has been disproportionately centred on the experiences of drug users in Dublin. Given that

36 It should be noted that this treatment data may be limited given that Cork had few treatment facilities in this period, and many did not admit opiate or other drug users. 37 See: https://www.drugsandalcohol.ie/tables/ 38 https://www.drugsandalcohol.ie/tables/

84 harmful drug use has increased39 throughout the country in the last decade, that the situation in Cork City seems to be particularly acute, and the historical evolution of drug use and drug treatment in Cork differs to the rest of the country, it seemed appropriate to base the study there. Secondly, given that treatment facilities and voluntary support groups are quite rare in rural Ireland, it seemed that the study would need to be urban- based for practical reasons linked to the scope of PhD research. Finally, Cork was preferred to other urban centres outside Dublin on the basis that it has a much broader array of treatment providers and voluntary support groups, and thus access to populations of harmful drug users is more feasible. We will now turn to a discussion of the sampling procedure used in the interviews.

Identifying and accessing sample - interviews

The interviews which informed the case study, in Cork City, utilised a purposive sampling strategy (Lavarakas, 2008). That is, a wide range of participants40, with particular social, ethnic, gender-based, age, and economic characteristics, were targeted41. In the literature review, a central criticism made against the social deprivation/addiction link in Ireland was about its restrictive methodological base. Given this limitation, and the current study’s aim to analyse the intersection between understandings of self and addiction, purposive sampling was deemed most appropriate. Indeed, as Green and colleagues (2015) point out, purposive sampling is widely used in qualitative research for the identification and selection of information-rich cases which can provide comprehensive insights into the phenomenon of interest. In total, 12 participants were interviewed. As the aim was to explore participants’ understanding of addiction within the context of their lived experience, a participant was

39 The period 2006-2016 witnessed the number of those seeking treatment for opiate use in Limerick, Waterford, Galway, Cork and Kerry increases substantially (at minimum the figure doubled). The increase, however, may have been more gradual in more rural areas, larger towns, and in the East of the country. See: https://www.drugsandalcohol.ie/tables/

40 See table two for summary of participants details 41 In all likelihood conceptions of self and understandings of addiction will differ to some degree according to ethnicity, gender, class, etc

85 considered an “addict” on the basis of self-identification in a treatment setting. While this is no doubt fraught with issues such as self-selection, the exclusion of those who may come to view themselves as addicts but are currently “in denial”42, and an overt focus on those in treatment settings, there are a number of justifications.

Firstly, if a person does not consider themselves to have a problem, then it is unlikely they will engage with treatment services or a research study which explores people’s experiences of harmful drug use. Therefore, self-selection was a matter of practicality. Secondly, as there is no way to determine whether someone is “in denial”, or genuinely believes they do not have an issue, this was not an inclusion/exclusion criteria the current study could adopt. Finally, as it would be unfeasible in the context of the current project to recruit participants who had never engaged with any treatment or support system related to drug use, this also could not be a inclusion/exclusion criterion.

However, while this selection criterion was appropriate from a practical perspective, it is limited philosophically. For example, this study argues that experiences of symbolic violence in treatment settings are vital to the embodiment and enactment of an addict identity in concrete contexts. Therefore, it would certainly be important to interrogate this argument by analyzing the way in which those who have not engaged with services, or who have engaged with services based on alternative treatment modalities (i.e. non-12 step) embody, resist, and/or enact dominant addiction understandings. Furthermore, it would also have been useful to analyse the ways in which those considered to be “in denial”43 by friends, family, and others (but who do not consider themselves to have a “problem”), negotiate dominant addiction understandings. While

42 It is recognised that this language can be stigmatising, however there is no clearer term in circulation.

43 Future research should also explore the issue of whether “being in denial” is real or enacted.

86 it was unfeasible to study these groups within the remit of the current study, this is certainly an area which requires further research. I will now turn to the process of identification and access in the study.

Early in the study, I identified a treatment centre44 which caters primarily to those from the Munster region in Ireland. Indeed, the decision to use formal treatment centres is quite common in drug research (Pearson, 1987; Parker et al, 1988; and Summerson- Carr, 2011). While the director of the centre was not known to me personally at the time, I was introduced to him by a family member who knew him well. From here, the clinical director recruited45 participants from both a middle class and socially deprived background, ensuring a spread across the other dimensions specified (drug used, gender, age, and class.). A participant was deemed middle-class if they were in full-time employment, securely housed, had paid for treatment through their health insurance, and had come from an area deemed “above average”, or higher, on a widely-consulted deprivation index46

The clinical director made initial contact with the participants and when they indicated they were interested, a meeting was set up. At this meeting, I presented each participant with a Participant Information Sheet (see Appendix 2) and consent form (see Appendix 3), explained what the study’s aims were, and what their participation would entail. The participants then took some time to consider their involvement, and all decided that they would like to take part in the research. The second organisation approached was a homeless service in Cork City. I recruited a total of four participants

44 I have agreed to anonymise the centre in this research so I cannot be any more geographically precise.

45 I had explained the purpose of the interviews in relationship to the project, so the treatment director was aware of selection criteria.

46 See: https://maps.pobal.ie/index.html

87 from this organisation. This time I made a direct approach to members of staff who dealt with communications and addiction; however, others in the organization had been made aware of my research through the family member I have already mentioned. From here, I met with a member of staff in Cork City to explain my research, and what it would entail for both the homeless organisation and the participants involved. Assurances were given that my study would not place constraints on the organization’s functioning, and that participants would be completely free to participate solely on their terms (BSC, 2015). Eventually, separate meetings were set up with the potential participants, we went through the same procedure as with the participants from the treatment centre, and all agreed to participate. I interviewed six participants from the treatment centre, and three from the homeless service, between November 2017 and January2018. Each interview lasted approximately 90-120 minutes and took place either in the treatment centre, or in a room provided by the homeless services. Furthermore, each participant was presented with a 30-euro cash voucher as a gesture of appreciation for taking the time to participate (ethical issues regarding the payment of drug users will be discussed in the “ethical issues” section). While I was initially satisfied that a diverse sample had been achieved across the criteria specified (age, gender, and social class.), upon reflection, it soon became apparent that there were a small number of specific limitations.

Firstly, it became known to me47 that a population of Eastern European “harmful” drug users existed in Cork. To attempt to access this population I reached out to friends who were active members of 12-step recovery groups, family networks, and social networks, however, the consensus seemed to be that this population tended to socialise primarily with one another and thus an introduction proved difficult. Luckily, I noticed a list on an official website that contained the name and email address of all registered addiction

47 I discovered an organisation which specifically dealt with Eastern Eurpean addicts, noticed a number on the streets while home in Cork conducting research, and also noticed a number of “Russian Speaking Narcotics Anonymous” meetings advertised in Cork.

88 counsellors in Ireland. From here, I emailed all of the counsellors with “Eastern European sounding names” in the Cork region. Fortuitously, one replied and played the same role the other facilitators had in helping me recruit my participants. This led to the recruitment of a Polish male who primarily used cannabis, alcohol, and amphetamines. Subsequently, I attempted to recruit an Eastern European opiate user through this organisation. However, I was informed that they do not have the facilities to deal with opiate users and having exhausted other avenues, I had to abandon hopes of recruiting an opiate user from this community, which can be seen as a limitation.

Secondly, in terms of opiate users I realised that I had not yet spoken to an intravenous (IV) heroin user or a heroin user from a more middle-class background. The reason this was deemed necessary, was due to research evidence in a British context which demonstrates that heroin use may be more prevalent higher up the social structure, but also more hidden (see Stevens, 2011: Chapter 2, in Wakeman, 2014). As IV use is typically seen as the most harmful type of drug use, completely omitting this population would undermine the study’s relevance. In order to recruit an IV heroin user, I returned to the homeless organisation I had previously had contact with, and through the same process they identified a person who was willing to speak with me, and I eventually interviewed him. The quest to identify a middle- class heroin user was trickier, partly due to the reluctance of this population to engage with addiction services. In order to access a member of this population, I had to consult a trusted contact that had been in recovery for a number of years, and was heavily involved in the recovery movement. This person agreed to approach a female that they had been supporting and asked if she would be willing to speak with me. She agreed, and with the help of a mutual acquaintance, we procured a room in an addiction service centre, set up a meeting, and followed the same procedure as with the other two organisations. These final three interviews (total 12 as mentioned) were conducted between February and May 2018.

In terms of drug of choice, while there was some overlap, typically those, whose drug of choice was alcohol, only used other drugs occasionally or experimentally. Two participants fell into this category, and while they had experimented with drugs (ecstasy, cocaine, and cannabis), this had not become harmful and had only occurred on occasion many years previously. A further six participants were polysubstance users but had not used heroin. Typically, they used alcohol alongside “uppers” (cocaine, amphetamines, ecstasy), and in some cases, benzodiazepines and cannabis. Finally, four participants were primarily heroin users, but also drank significant quantities of alcohol, ingested benzodiazepines, and smoked cannabis daily. Of this group, two smoked heroin, and two used intravenously. Four participants were either homeless or insecurely housed, at the time of the interview, while the rest were securely housed. Six participants were from lower-middle class backgrounds, and the other six were from socially deprived backgrounds. Furthermore, as every participant discussed in their interview the general geographical area in which they grew up, and the area they lived in/resided now, this could be checked against a recently released Irish deprivation index. In terms of the homeless participants, it was assumed on the basis of research (see Finnerty, 2018) that they would most likely come from deprived areas, and this was confirmed through discussions during the interview and through the use of the aforementioned deprivation index.

The participants were evenly spread in terms of age, with an equal number in their 20s, 30s, and 40s. There were four female and eight male participants. Moreover, given that research (see Woods, 2008) in Ireland has demonstrated that gender specific (i.e. regardless of class, age, and gender) issues such as domestic abuse and sexual abuse, underpin much harmful alcohol and drug-related harm among women, it was decided that an even spread of females should be recruited across class and age groups. Thus,

90 two socially deprived females (one in her 40s, one in her 30s), and two lower-middle class females (one in her 20s, one in her 40s) were recruited. Finally, five participants were unemployed at the time of interview, and the remaining seven were either in part- time or full-time employment.

91 Table 1: Participant details Name Gender Class Age Nationality Drug of Choice Tracy Female Socially 35-40 Irish Alcohol Deprived Background Roisin Female Lower -Middle 40-45 Irish Alcohol, Ecstasy, Class Cocaine

Patrick Male Lower-Middle 45-50 Irish Alcohol Class

John Male Lower-Middle 40-50 Dual British/Irish Alcohol, Class Cannabis, Amphetamines, Benzodiazepines

Donnacadh Male Lower-Middle 35-40 Irish Alcohol, Class Amphetamines, Cannabis

Johnathan Male Lower-Middle 30-35 Irish Alcohol, Cocaine Class

Ryan Male Socially 20-25 Irish Alcohol, Heroin Deprived (smoking), Background Benzodiazepines, Cannabis

Connor Male Socially 20-25 Irish Alcohol, Cocaine, Deprived benzodiazepines Background

Collette Female Socially 30-35 Irish Alcohol, Heroin Deprived (smoking), Background Benzodiazepines

Siobhan Female Lower-Middle 25-30 Irish Alcohol, Heroin Class (Inject) Background David Male Socially 35-40 Irish Heroin (Inject) Deprived Background

92 Jakub Male Socially 30-35 Polish Alcohol, Deprived Cannabis, Background Amphetamines.

93 Novel Approach to drug addiction – Interviews

To examine participants’ understandings of self and addiction, it was essential to examine their lived experiences. As such, in-depth qualitative interviews were utilised with all study participants. The length of each interview varied, with the shortest being a little over one hour, while the longest was just under 3 hours. There was neither a minimum nor maximum time set for the interviews. Rather, a topic guide was prepared and brought to the interview, and each conversation was allowed to flow naturally within the relatively loose structure of this topic guide (Appendix 1). The topic guide itself was prepared by taking note of the main themes which emerged in the literature review and tailoring the questions accordingly.

The specific interview method this research adopted was Seidman’s (1998) tripartite in-depth interviewing method. This method was chosen on the basis that it was most suited to examining how the participants’ understanding of themselves and their addiction fit in with their life experiences. It was, therefore, most suited to examining the processes which led to the embodiment, resistance, and re-articulation of dominant addiction understandings in the concrete contexts of participants' lived experiences. The justification for the under-taking of the tripartite interviewing method was that people’s behaviour only becomes meaningful and understandable when placed in the context of their lives and within a particular societal and cultural context (Seidman, 1998). Therefore, the first section of the interview was intended to establish the basics of the context of the participant’s experience (aspects of their life story), the second section allowed the participant’s to reconstruct the finer details of that experiences with addiction within the context established in the first section, and finally, the third section aimed to encourage the participants’ to reflect on the meaning their experience of addiction held for them (see Appendix 1 for topic guide).

94 We will now turn to a discussion of each section of the tripartite interview structure in more depth. The first section aimed to situate the participants’ experience in a context by asking them to tell me as much as possible about their life before addiction. Furthermore, the theoretical insights gleaned from the literature review were used as signposts to guide the conversation. The purpose of the second section was to concentrate on the concrete details of the participant’s experiences in the context of their addiction. The participants were asked to reconstruct these details. So, for example, participants were often asked to relate from start to finish their typical day using drugs. These experiences were then placed within the context of the social setting, which was gleaned in the first section. In the second section, the task was to reconstruct experience from stories. To do this, participants were often asked to reconstruct their day from the moment they awoke until they went to sleep. Importantly, as Seidman (1998) argues, it is the interviewer’s job to pause, consider, explore, and reflect upon anything that seemed pertinent to the research questions. The reason that participants were asked to tell stories about their experiences with addiction is that this is a way of eliciting potentially important details.

In the third section, Seidman (1998) recommends that the participant be invited to reflect on the meaning of the experiences discussed in the second section and within the context established in the first. This is intended to examine the vital interconnections between the participant’s addiction, self, and life. Such questions involved exploring the role addiction plays in participants’ lives and what sense this makes to them. The combination of examining participants’ pasts to clarify events that led them to addiction, and describing particular details of their addiction, established the conditions upon which they and the researcher could reflect on the meaning of the experiences and attempt to address the research questions (Seidman, 1998).

95 The interview with Ryan illustrates how effective this interview structure was. While Ryan believed that his early traumatic experiences led him on a path of harmful drug use and homelessness, he also viewed those experiences as central to his recovery. While such a view may seem counter-intuitive or even contradictory, the tripartite interview structure rendered it explicable and meaningful within the context of how Ryan viewed himself and his addiction. Central to this story is Ryan’s attempts to shield his younger siblings from his mother’s alcoholism and self-harming. His attempts to play the “saviour” role in his family endowed him with a deep sense of commitment to his siblings, and an intuitive feel for understanding other people’s emotional states and how to react empathetically to them.

Yet he viewed his addiction as basically his inability to deal with the emotional fallout of his childhood. In effect, he felt that his ability to nurture, protect, and understand his siblings and others pain, did not equate with an ability to care for or be compassionate with himself. He credits the support structures of Narcotics Anonymous, weekly counselling, and a stint in drug treatment with providing him with the ability to recommence this “saviour” role by helping other addicts while providing him with enough support so that he does not get overwhelmed. In his words:

“When I was younger I took on more than I was able to handle, trying to shield my family from what was going on with my mother. In recovery, now I still help newcomers and things like that, but I have support and I’m aware of my limits and what I need to do to keep myself sober and healthy”

It seems clear that without the three sections of the interview, a deep understanding of this relationship between understandings of self and understandings of addiction would have been lost. It is only when both of these understandings are placed in the context of lived experience

96 that they become explicable. However, it should also be mentioned that a limitation with this approach is the sheer volume of information that can arise. For example, my interviews with both Patrick and David lasted almost 3 hours each. It is possible that they discussed life experiences in section one which were vital to their understanding of themselves and others, which I simply did not cover due to time constraints. Furthermore, it would have likely taken several interviews to explore all of the issues which came up in greater depth. For example, David claimed that while he had a significant problem with heroin and cocaine, he felt that his use of alcohol was never particularly problematic. Indeed, he stated during the interview that he drinks 2-3 nights a week, in a manner he considers to be quite moderate:

“Surprisingly though, drink has never really influenced my life. You know, I never got into major trouble on drink, I never had a major problem with it. I still drink to this day and I don’t have a problem with it. I don’t fall around drunk, I might drink a few beers in the evening and at that it wouldn’t be every evening, maybe 3 days a week kind of thing like. That’s grand with me. I know some of my mates there, they just won’t stop like. They’ll drink until they fall over”.

When I questioned David as to why he felt he had developed a problem with heroin and cocaine and not alcohol, he was unable to answer. As this came up towards the end of the interview, it was an issue I was not able to follow through to any significant extent. Nonetheless, on balance, the tripartite interview structure seemed to be the best method through which to examine participants’ understanding of addiction and themselves within the context of their lived experience.

Each of the interviews was tape-recorded, having first gained the participant’s consent.

97 Following each interview, I transcribed each interview using a word processing document. From here, I sent a copy of the transcript to each gatekeeper who, in turn, passed it on to the participant. Once each participant was satisfied that I had accurately transcribed what they had said (or if more than 10 days had passed from when they received the transcript: see appendix 2), I would delete the audio recording. I will now discuss the issue of identifying and accessing the interview participants.

Research sites

There were two research sites in the current study. The first was an in-patient residential treatment facility for drug users, operating in the Munster region. The treatment services offered are primarily based on the Minnesota Model, which can be described as an institutionalised form of the 12-step model, operating alongside confrontational style methods, counselling, and meditation. The treatment centre operates according to an abstinence-based philosophy, and all in-patients have to be fully detoxed from alcohol and drugs before they are admitted. This centre was chosen on the basis that it catered to clients who paid through their private health insurance, and therefore, were more likely to be from a middle-class background. However, two participants from socially deprived backgrounds were also recruited through this study site. Research at this site took place in rooms provided by the organisation, while an addiction counsellor was available on site should they be needed - before, during, and after the interviews.

The second site was a non-governmental organisation that catered to the needs of homeless individuals in Cork City. This charity provides emergency accommodation, outreach services, drug services, as well as other health services. In terms of its addiction services, it operates according to a “trauma-informed care” paradigm, while still advocating the use of 12-steps and residential treatment where it is felt this would

98 benefit the client. This site was chosen on the basis that it could provide access to homeless drug users in Cork City. Interviews took place at venues provided by the organisation, and again a trained addiction counsellor was available before, during, and after the interviews.

Reflecting on the interview process

It is now widely recognised that qualitative interviews are interactive and interpretative enterprises, whereby both parties serve as co-creators of knowledge (Holstein and Gubrium, 2004; and Seale, 2004). As with any social interaction, then, there may be important ways in which my dispositions and characteristics influenced the process. Of course, there are numerous social characteristics that I possess, which may have exerted an influence in this regard. However, I will focus on three characteristics that struck me as having the most significant influence: age, social class, and gender. I will deal with each in turn.

Firstly, during some interviews with older participants, it became quite clear that they were extremely eager to explore their experiences in as much depth as possible to assist me in producing the best possible Ph.D. thesis. While I cannot be certain, it seemed that this was a kind-hearted attempt by them to help someone younger than themselves, and from the same city, to achieve one of his goals. For example, when I asked Donnacadh if there was anything he wished to add at the end of our interview he replied: “I’m sure I’ll think of a couple of crackers now on the way home, it could be the start of his thesis a quote from me. If that would help you that would be great like”.

Another example can be seen at the end of Patrick’s interview, where he states:

99 “I have great respect for people that come to [be involved in the recovery movement]. This will always be important to me. And if I can help them in any way or even you young man, you know I’ll definitely do it, in any way I can”.

While Manderson et al (2006) have noted that interviews between younger interviewers and older participants tend to be more formal, due to the tendency of inexperienced researchers to more rigidly adhere to the topic guide in order to seem professional (and perhaps due to nervousness), this did not match my experience. From examining this study’s interview transcripts, it is clear that a more conversational style and sense of rapport was apparent. This is perhaps due to my localized cultural knowledge48, and indeed Kitchen (2019) argues that interviews wherein both participants share a cultural background tend to be less formal.

Secondly, while I felt that my social class made me seem less formal and perhaps enabled socially deprived participants to open up to me a little bit more (see Manderson et al, 2006 for discussion of this issue), I can recall one interview where it certainly seemed like the participant censored aspects of her story for fear of offending me. Siobhan came from a middle- class community on the opposite side of the city to me but had lived for a time in an affluent area overlooking the socially deprived housing estates where I grew up. When discussing her mother, it became apparent that they had moved house as her mother did not wish for her to become friends with young people from these estates. When I asked her how she felt when she moved she replied:

48 As mentioned, I am originally from Cork City.

100 “Well I was young so I don’t really remember. I just remember when I lived there that mum wouldn’t let me go to the shops down the road or hang around in the local park, she didn’t want me influenced by the “norries49” as she’d say”.

I distinctly remember the look on this participant’s face when she seemed to remember that I had told her before the interview the general area in which I grew up. She immediately became anxious to get across the point that this was her mother’s view and not hers. From here on, she tended to downplay her mother’s views of the Northside to a certain extent. This seems to be a limitation in that other participants (particularly Donnacadh and Roisin) expressed the view that class bias and status concerns among their parents prevented them from forming friendships when they were younger, and that this may have contributed to their harmful drug use. Therefore, this was an issue I wished to explore with this participant at some length. Eventually, I was able to discuss this issue; however, it took quite a bit of effort, and ultimately, I felt that due to my background, she was holding back somewhat, so as not to risk offending me.

Finally, there were some areas where I felt my gender impacted the research process. For example, when discussing relapse, Tracy describes how this experience was significantly worse than anything she had endured before getting sober initially:

“I relapsed after 15 months like and I’m telling you 2014 all happened in 5 days. I relapsed in 2015, I was drinking for 5 days only and it was like 2014 all over again. I didn’t leave the house for 5 days. I stocked up on drink, I didn’t shower, and everything happened all over again. Everything, and more stuff that I’m not going to go into, things that didn’t happen before

49 Potentially derogatory term for somebody originally from the northside of Cork City.

101 that, that you’d think would have in 2014 but no it happened in 2015, so I know it gets worse”.

While I cannot know for sure, it did seem that in this instance, Tracy did not feel comfortable sharing particular aspects of this story with me, and it seems quite possible that this was linked to my gender. Furthermore, when I asked Collette if she felt that her gender had a specific impact on her experience of homelessness, she responded almost entirely by focusing on the risk of sexual assault or violence:

“Personally no, but I have seen and witnessed it. The best way to put it is it was survival of the fittest. If a man knew that you weren’t the type of person they could gain anything from or if you were any bit strong they don’t come around you. They will always prey on the vulnerable, the weaker, and I’ve seen that happen I have intervened in that happening. I did that a couple of times over the years”

While this was a perfectly reasonable way to interpret my question, it does seem that Collette interpreted the question according to a societal view that highlights women’s increased risk of sexual assault and violence as integral to their experience of homelessness. There seems to be little doubt that my status as a male researcher, indicated to Collette that this was the type of experience I was probing her to discuss. Indeed, she may have interpreted my open question in this instance as an awkward attempt to probe for information without directly asking about experiences of sexual violence. Finally, while female participants openly discussed their experiences of sexual and domestic violence, it is perfectly possible that they omitted certain details due to my status as a male researcher. Indeed, Redman-Maclaren et al (2014) highlight difficulties with discussing experiences of sexual violence as an issue which frequently arises in interviews between male interviewers and female participants. In

102 conclusion, I viewed my status as a researcher and as a person with particular social characteristics not as producing superior research (even if there were benefits), but rather different research (Dwyer and Buckle, 2009: 56). Invariably, a different researcher with different characteristics would have faced different challenges and had different opportunities.

Practical issues and Interviews

Interviews - like all fieldwork - entail certain practical difficulties. While no significant practical issues arose in the course of the interviews, there were a number of more minor issues. Firstly, it was at times challenging to keep participants focused on a question, particularly those who had been sober for a significant period of time. I believe this was due to their having told their stories many times in the rooms of NA and AA and to various addiction counsellors and mental health professionals. While it has previously been argued that open-ended questions are well-suited to generating in- depth reflection, central to participants’ conceptions of self and addiction, this tendency to veer off topic was perhaps a limitation. However, difficulties of this sort were, for the most part, limited to the opening question. For example, when I opened the interview with Patrick by asking him to tell me about his “early life before drugs and addiction” he replied:

“When I was in school I bumped into this person you know and I didn’t like school at all I went to [name of school], the nuns you know and I found them very tough, and my life at that age I was full of fear and you know full of fear and full of resentment even at a young age and it kind of came out more as I was growing up a bit. As I said I went to [name of school] and some of them were very tough and strict. And I know I played a part in that as well. And I found it tough I really found it tough at a young age. So, I was going into school and I was full of fear and I didn’t

103 want to go to school because I was frightened. I left there then and I moved onto [name of other school] and there was one particular brother . . .”.

His response to my initial question went on for some time, covering his adolescence, and into jobs he had after he had left school. This type of expansive reflection occurred with many of the other participants. Though this was not necessarily negative, I did sometimes find it disorienting to have such a detailed stream of consciousness pour out after my first question. The central difficulty with this was the need to balance the participants’ right to discuss whatever they felt relevant against the time constraints of the interview, and relatedly, to ensure that we covered all of the other topics. In general, my approach to dealing with this type of issue was to only interrupt when the participant began to talk about something which I would have asked later on anyway. In such a case, I would typically say something like: “I want to hear more about that later, but first could you talk a little bit more about . . .”.

A second practical issue pertained to a language barrier with the participant from Poland, Jakub. It should be pointed out that this participant’s English was quite good, and this only affected the interview in subtle ways. The following excerpt from our interview should illustrate this point:

SOM: AA and NA say people have a disease, what do you think of that?

Jakub: For me I think NA is a bigger problem because when I come to Cork shopping I see one of them on the streets but I never see that with AA.

104 SOM: Ok are there a lot of people in Cork from Poland who would be in NA?

Jakub: I think a few percent of the population. I think every country is the same shit. If you’re choosing your bad things and bad life, and stick with bad people you are going in deep, deep, deep and you start more drinking, more drugs and bad things happen. But if you’re doing good life then you can stop doing bad things and have a good life.

In the first instance, it seems that Jakub did not understand that I was asking him for his opinion on the disease theory of addiction, instead he believed that I was asking whether drugs or alcohol were a bigger problem in the Polish community. Secondly, when I followed this up by asking if there were many Polish nationals who had drug problems in Ireland, it seems he believed I was asking if Poland had a bigger problem than Ireland. This is completely understandable given that English was not his first language, and by and large, this seemed to be one of few areas of confusion in our interview.

Data analysis

Both the interview and historical data were analysed thematically with the aid of NVivo software. Thematic analysis was deployed as it offers a rigorous, yet flexible, method of data analysis. Furthermore, it enables the identification, analysis, and reporting of meaningful themes identified in the data (Willig, 2013). Crucially, data analysis proceeded according to an interpretivist approach (Willig, 2013), which of course is compatible with a relational ontology and epistemology, as interpretive researchers assume that access to reality is only ever partial and mediated through numerous channels (language, shared meaning, the coming together of multiple research studies.). In this way, substantive arguments were developed throughout the research, as the interview and historical data were coded and thematically analysed. For example, codes

105 such as communal violence, parental conflict, and trouble at school, were identified in each of the transcripts belonging to a participant from a deprived community. These codes were then analysed and led to the concept of “alienation”. Furthermore, a similar process led to the creation of the themes state abuse and punitive social control, alienation and political attachment. As all of these themes related to politics, the economy or both, they were included under the political-economic section of the structural violence framework.

Furthermore, this process also developed by critically analysing emerging themes in light of the available research literature. For instance, criticisms of the social deprivation/addiction link coupled with codes (domestic abuse, sexual assault) and themes (e.g. cross-class gender specific issues) which emerged from the interview data and broader theoretical reading, in part, led to the decision to adopt the concepts of structural violence and social suffering. A further example can be seen in the historical data. Initially, I coded all of the instances where drinking was problematized in the period immediately after Irish independence (1922-1939). From here, I thematically analysed the data which had been coded in Nvivo under the node “problematic drinking”, and realised that drinking was only problematized when it occurred outside of the law (typically in shebeens or in relation to brewing poitin: see Chapter four). This led to an emphasis on the immediate political context in post-independent Ireland and the argument that the Irish case demonstrates the need to take specific political contexts more seriously in the international literature.

Furthermore, the need to account for the rich accounts of meaning offered by the study participants (interview data), and the need to avoid structural determinism, led to the adoption of the concept “webs of significance”. In summary, the key stages involved in

106 the process of data analysis were: (1) importing the transcriptions into NVIVO; (2) reading the transcripts multiple times to gain a familiarity with them; (3) coding the data; (4) identifying themes through an examination of the available academic literature; and (5) identifying themes from the “data itself” (see Boyatzis, 1998). Ethical concerns

Qualitative research with vulnerable populations raises numerous issues of ethical concern. The ethical issues relevant to the current research included: The ethics of paying drug users, confidentiality and anonymity, participant and interviewer safety and well-being, and data security. Each will be dealt with in turn. First, however, a word on the process of gaining ethical approval.

Gaining ethical approval

When I initially approached the two research sites, they both informed me that once I gained ethical approval from the University of Manchester and provided them with participant information sheets and consent forms, which they could go through with potential participants, they would sign off on ethical approval. This process was probably greatly simplified due to both research sites being non-statutory bodies. This undoubtedly saved me the trouble of the more bureaucratic process which one can face when dealing with the Government and government agencies, as once the director of the particular research site was satisfied he/she could simply sign off on ethical approval.

From here, my attention turned to the ethical approval process at the University of Manchester. This consisted of two stages: (1) an online application form via the university’s “Ethnical review manager”; and (2) a subsequent formal meeting with the ethics board. The online application consisted of questions to do with data management,

107 how the interviews would be conducted, topic guides, informed consent, ethical issues, and how they would be dealt with, the recruitment process, benefits and harm to the participants, and finally, harm to the researcher. I completed this form in May 2017, and then met with the ethics board in the summer of 2017. After the first meeting, they advised that I would need to resolve some issues regarding harm to the researcher and my distress protocol. In response, I committed to contact both my supervisors and a family member via mobile phone both before and after each interview. Furthermore, it was agreed that a trained addiction counsellor would be on-site during each interview to deal with potential participant distress. Having made these changes, I was granted ethical approval in September 2017.

The ethics of paying drug users

Numerous researchers have noted the ethical quagmire of paying drug users for their participation in research studies (Seddon, 2005; Fry et al, 2006; Festinger and Dagosh, 2012). The studies just referenced seem to be in broad agreement that careful consideration is crucial to the successful resolution of the issues involved in the payment of drug using participants. For example, for homeless participants, the economic incentive could be such that they may participate despite serious reservations, simply because they are in desperate need of the money. Obviously, this could be viewed as exploiting vulnerable people and would raise uncomfortable questions regarding consent. At the same time, it would seem quite unfair to offer remuneration to middle-class (or more financial stable in general) participants and not to homeless participants for example. Indeed, this would seem to play into prejudiced and classist assumptions which construct the poor and vulnerable as irresponsible and unable to make sound judgment.

108 Ultimately, I agreed with Ritter et al (2003: pp. 1-2) that the primary goal should be to ensure that participants were not “out of pocket” due to their participation. Therefore, I offered each participant a 30 euro “all in one” cash voucher as a token of gratitude for their participation. However, there were further steps in my decision-making process, which should be outlined. While I was satisfied that a 30-euro voucher would communicate gratitude to participants, it also seemed that they should receive more than merely what it cost them to participate, to communicate that their contribution was much appreciated. It was, therefore, decided that 30 euros would be sufficient. This was calculated on the necessarily loose basis that it would be a significant enough sum to reimburse travel costs and leave enough over as a token of gratitude for participating. At the same time, it did not seem to be so much that it may have compromised consent by offering undue incentives.

A further issue then arose concerned whether to offer cash or a voucher. I anticipated that the gatekeepers and the ethics board would be reluctant for me to hand over cash, in case it was used to purchase drugs. Indeed, this issue does frequently arise in the literature (see Seddon, 2005). Initially, I was determined in my view that cash should be offered. I was, and still am, of the view that once it is decided that remuneration is due, it is entirely up to the person being reimbursed to decide how they wish to spend that money. Therefore, it seemed to me that objecting to cash on the basis it may be used to buy drugs, was an insufficient reason to not offer cash.

However, another issue that arose (in discussion with my supervisors) was that vouchers could potentially be exchanged for cash or goods, but for less than their face value. This raised the possibility that participants may have been short changed. Ultimately, I argue that this is a similar consideration as to whether to give cash or vouchers in the first place. That is, once it is decided that remuneration is due, it is the

109 up to the participant to decide what to do with the cash/voucher. In light of these considerations, potential objections from the ethics board, and having extensive consultations with my supervisors and gatekeepers, I decided that it would be best to offer vouchers.

Informed consent, confidentiality and anonymity

Informed consent was obtained before conducting the interviews (see Appendix 3). In line with the British Society of Criminology’s ethical guidelines, it was ensured that consent was (1) informed, (2) freely given, and (3) ongoing (BSC, 2006). As mentioned, participant information sheets (PIS) and consent forms were issued in person before the interviews to ensure consent was informed and freely given. One issue which arose in this context was that very few participants read the PIS. This raises the thorny issue as to whether the PIS and consent forms exist to ensure that informed consent is provided freely (see Bryman, 2016), or whether they exist to protect researchers and academic institutions in the event of formal complaints. In any case, I ensured that before each interview began, I summarised the PIS, and I also sought verbal assurances from each participantthat they knew exactly what they were consenting to. Throughout this process, all participants confirmed that they understood the research aims, their role in it, and consented to participation on the terms set out in the PIS (ensuring consent was ongoing).

In terms of confidentiality and anonymity, Crow and Wiles et al (2008) point out that full assurances of these factors are ultimately based on the participant trusting the researcher. Indeed, this level of trust was made strikingly clear to me in my interview with Roisin. While discussing her having been sexually assaulted, she informed me that:

110

“Even when I was in [treatment centre] I never spoke about it, but it was always going to come up. When I say I dealt with it, I haven’t really dealt with it, I’ve analysed it, understood it, and I don’t know if I’m finished with it yet”.

Immediately after this, it became clear that Roisin had only spoken about this with perhaps half a dozen other people, most of whom were family members. Given that I had only just met her, this disclosure impressed on me the level of trust which I had obtained, and how important it was that I do everything I could to honour it. Indeed, the only case in which confidentiality could be breached was if I felt the participant would harm themselves or others (see Appendix 3). Thankfully a situation like this never occurred, and I abided by strict standards of confidentiality. As such, all written materials such as the PIS, consent forms, and the topic guide, were stored in a locked drawer and will be disposed of securely when I have completed this thesis. Meanwhile, interview recordings and transcripts were stored on a password-protected computer in my office at the University of Manchester.

There was a more practical issue relating to informed consent, confidentiality, and anonymity which emerged in the field. That is, while I generally emailed participant’s transcripts to them directly, this was not possible with a number of homeless participants. In this case, I emailed the transcript to the participant’s addiction case worker, who acted as an intermediary. This did raise potential issues regarding confidentiality and anonymity, particularly as consent to email trainscripts to gatekeepers was not covered in the participant information sheet or consent form. However, as these participants did not have regular access to the internet or an email account, this was the only practical way to ensure they were satisfied that I had

111 accurately transcribed their words. Leaving practicality issues aside, each participant gave explicit consent that they were happy to receive their transcripts via this process. That is, at the start of our audio recording participants gave verbal consent to this process, and also gave written consent to the homeless services. Indeed, this approach is recommended by the British Society of Criminology (BSC, 2015). They recommend that if third parties are to receive this type of data, then the participant’s explicit consent is required. Finally, it should be pointed out that all participants confirmed that they were happy that the transcripts were accurate and that the audio had been transcribed fairly.

Finally, the issue of the limits of anonymity should be addressed. This is an issue that can be particularly acute in research which is based in small cities like Cork. Indeed, a famous ethnographic study in neighbouring county Kerry highlights most dramatically the pitfalls which present at the limits of anonymity. Nancy Scheper-Hughes’ study of the village “Ballybran” led to one local proclaiming that “she should be shot” (2001: p. xviii). While on her most recent visit to the village she was violently removed from the town, and informed that if she ever returned her safety would not be guaranteed (Scheper-Hughes, 2001). Luckily, I do not envisage that my research will result in my violent expulsion from Cork City.

Simply put, Cork is a city of over 120,000 people, and while small, it has a large enough, and dispersed enough, drug-using population to ensure that anonymity can be preserved. Indeed, though I sometimes mention that participants are from socially deprived estates on the city’s Northside, for example, this would hardly be enough information to identify them. Relatedly, even including combinations of information would not compromise anonymity. For example, I mention that Ryan and David come

112 from socially deprived estates, left school early, engaged in various forms of criminality throughout their lives, and eventually became addicted to heroin. unique slang words and phrases used by the participants. Ultimately, I am satisfied that anonymity has been preserved to the necessary extent given that I have not named the centre, that many of the participants have been to multiple treatment centres in Munster, and crucially that the treatment centre representatives are satisfied with the steps taken to anonymise their involvement.

Participant and researcher safety and well-being

Qualitative interviews present many potential risks in terms of participant and researcher safety and well-being. These include the risk of causing emotional harm to participants and the risk of emotional harm to the researcher. While researchers have highlighted other potential risks such as the physical safety of the researcher, and issues arising from the potential for the participant being intoxicated (see Williamson, 2014), these issues did not arise in the current research. Therefore, the primary issues to address are to do with the potential for emotional harm to the participant and the researcher. Given the nature of in-depth qualitative interviews, asking participants to reflect on their past, their drug use, and their understanding of themselves could easily have led to the reliving of traumatic experiences which may be harmful (see Lee, 1993).

As mentioned, the open-ended nature of the questions was intended to militate against this risk, while participants were informed before the interviews that they did not have to discuss anything which made them uncomfortable. Furthermore, I had a distress protocol in place which dealt with the issue of potential harm to the participant (see Appendix 4). Finally, a qualified addiction counsellor was on site

113 before, during, and after each interview in case a participant became distressed or required further support.

During the interviews, two participants did become visibly upset when discussing certain experiences. For example, Patrick became visibly upset when discussing experiences that left him on the brink of suicide, while Siobhan became visibly upset when discussing stealing money from her grandparents to fund her heroin use. In Patrick’s case, I asked if he was ok to continue with this line of conversation and he indicated that he was:

SOM: Just before you came to treatment, talk me through what your life was like

Patrick: I was going down a very dark, narrow, horrible, despicable road. I was lonely, depressed, and suicidal. I didn’t want to live, and that’s where drink brought me. It brought me to being in the room, curtains pulled, bottle of whiskey and a load of pills. I told my wife and kids get out of the house I wanted to end it all, cheek of me, their house like. I had nobody to talk to, I’d lost all my friends, I just wanted out [clears throat and pauses] sorry

SOM: I can see this is difficult to talk about, we don’t have to discuss it, it’s completely up to you Patrick: No, it’s ok, as I said ask anything you want man, I’m an open book

In this case, while it was necessary that I check-in to ensure that Patrick was ok (see BSC,

114 2006; and 2016), he was adamant in this instance and throughout the interview that he wanted to talk about his experience in as much detail as possible. Once Patrick indicated that he wished to continue, we did so. However, in Siobhan’s case, I intuitively sensed that this was an issue that was so fraught with emotional valence that to continue probably would have caused harm. Given that Siobhan had told me that she was sleeping rough and had relatively recently (roughly 3 months previous) moved from smoking heroin to injecting, I felt that it was best to err on the side of caution:

SOM: How did you fund the heroin when you lost the job?

Siobhan: I had to borrow money, use my savings, and then eventually I’d rob from my family and my friends, even my grandfather [voice breaks visibly upset]

SOM: Ok, I can tell this is a difficult topic, only continue if you want to, if you don’t there’s absolutely no problem, and well move on.

Siobhan: I’m sorry, I’m just so ashamed of myself.

SOM: Ok, we’ll move on.

While it is difficult to explain precisely why I felt this topic should be abandoned, there are a couple of reasons. Firstly, it seemed to me that Siobhan was much more vulnerable than Patrick. In the first instance, she was far younger, homeless, and while Patrick was sober for a couple of years, her drug use seemed to be escalating. Secondly, the incident she was discussing had occurred more recently than in Patrick’s case. Finally, Patrick had more support structures in place in terms of AA, weekly counselling, and aftercare in the

115 treatment centre. In contrast, apart from sporadic attendance at NA, and the addiction counsellor who would be available only for a short time after our interview, Siobhan seemed to have very few support structures (see Allen, 2017 for discussion of this ethical issue). Besides, Siobhan’s emotional reaction to the question probably reveals more about the meaning of that particular experience than words ever could, and even if this is not the case, her welfare had to take precedence over research based considerations.

Although some participants found aspects of the interview were distressing, others found that the interview process had a cathartic effect. For example, Ryan and Johnathan expressed the view that the interview had actually helped them in their recovery:

SOM: Ok, so is there anything you’d like to add before we finish up?

Ryan: Eh no, I just want to thank you, you know for giving me a chance to talk like this, because this is helping me too like you know and I really appreciate it you know.

SOM: I suppose before we finish up is there anything you’d like to add?

Johnathan: No not really, I enjoyed this actually. I enjoyed this to be fair. It was actually helpful. I suppose we talked about everything from start to finish kind of way. But it was great, I’m looking forward to reading the transcript after this.

116

In contrast to the issue of harm to the participant, little attention has been paid to the well-being of researchers in the field (Dickson-Swift et al, 2007). While no significant issue arose, there was one minor issue. To my surprise, I did find myself emotionally exhausted at times during the period I was conducting interviews, which led to difficulties relaxing and on occasion sleeping. However, I soon realised that this was in part due to my tendency to over-work. In terms of the interviews, I would sometimes undertake a 2-3 hour interview, and almost immediately after spend another few hours transcribing, reading it back, and doing some preliminary thematic analysis. This would sometimes add up to 10-12 hours a day. When I did notice that I was suffering from burnout, I forced myself to take the remainder of the post-interview day off, and complete transcribing and coding the next day.

Furthermore, in general, I had good support structures in place, including family, friends, and academic supervision, and therefore, every step was taken to minimize the risk of harm in this regard. However, in retrospect, it was probably the case that my over- working interacted with my daily exposure to secondary accounts of traumatic events. Indeed, recent research in Cork (Lambert, 2017) highlights issues with “secondary trauma” among those who work with and research groups with lived experience of homelessness and addiction. Therefore, I would certainly take this issue more seriously in future qualitative research, and would encourage other researchers to be mindful of these issues.

Data security

Firstly, as mentioned, all “raw data” (interview material) was transcribed within one week of each interview. All transcriptions were then stored on a password-protected computer and anonymised to remove any identifying information, as recommended by

117 Lin (2009). For example, as David was an older heroin user and had also been involved in dealing for many years when heroin use was much rarer in Cork, I had asked him for his opinion on why heroin use was now much more common. In his response, he spoke about older members of known crime families previously having an aversion to heroin, fear of republican paramilitaries, and how the younger generation was not as subjected to these considerations (hence more heroin dealing). His response to this question obviously had to be heavily edited with names removed, as well as several anecdotes that involved violence being deleted entirely.

However, since this was tangential to the research question, I do not feel it affected the quality of the data. In general, as mentioned previously, I argue that anonymization did not affect the quality of the data to any significant degree. One copy of each transcript was kept on the computer with pseudonyms, for data analysis with a memory stick back up kept in a locked filing cabinet. Meanwhile, all meta-data (contact details, consent forms, etc.) were kept on a password protected computer. These data were never reproduced or shared (apart from with my supervisors). Furthermore, all data will be stored under the above conditions for five years in compliance with the Data Protection Act 1998. All of this was clearly stated on the participant information sheet which each participant received. I will now deal with issues of validity, reliability, and generalizability, before offering some concluding remarks.

Validity, reliability and generalizability

Although there is some disagreement about how qualitative research should be evaluated, there are three broad approaches aimed at offering guidance on this issue. The first is to retain the concepts validity, reliability, and generalizability, but to redefine

118 them in terms deemed more appropriate to qualitative research. This is an approach favored by Kvale (1989) and others (Lewis, 2009; Golafshani, 2003). A second approach is to propose different terms, specific to qualitative research. The reasoning behind this approach is that as validity, reliability, and generalisability originated in the positivist research paradigm they are ill-suited to the methodological, epistemological, and ontological underpinnings of most qualitative research approaches (Guba and Lincoln, 1989; Flick, 1997; Miller and Cresswell, 2000; Dowling, 2007).

The third approach to this issue is taken by postmodern researchers who argue against the use of any criteria by which to judge qualitative research. This is because postmodernists challenge the methodological assumptions associated with rigorous, modern social science inquiry, whether of the qualitative or quantitative variety (Rosenau, 1992). This is perhaps best captured in Richard Rorty’s remark that we should “let a hundred flowers bloom…” (Rorty, 1982: P.219), rather than proscribe a particular set of criteria by which to judge any particular methodology or school of thought. This research adopted the second approach, and in particular, followed Lincoln and Guba’s (1985) framework for establishing trustworthiness and rigour. This framework consists of four criteria by which to assess the current research: (1) truth value, (2) consistency, (3) neutrality, and (4) applicability (Lincoln and Guba, 1985).

By way of justification, consider the famous “apple and orange problem” (Northcote, 2012). Imagine the criteria by which one might judge the “best orange in the world” – ability to produce orange juice, and brightness. Obviously, if these criteria were applied to an apple – the apple is going to come up short, no matter how “good” it is on its terms. This is because an apple is a different type of fruit and requires different criteria of assessment. The same goes for qualitative and quantitative research. The basic validity question in most research is whether the object of measurement is actually measured (Stenbacka, 2001). Since qualitative research

119 deals with subjects, not objects, it is an inappropriate criterion by which to judge qualitative research. Similar arguments have been made in relation to reliability and generalizability (see Stenbacka, 2001).

In relation to postmodern approaches, it is argued in response to Rorty (1982), that just as flowers need sunlight and water (identifiable ingredients) to bloom, so too qualitative research requires identifiable criteria through which to orient the study and ensure quality. Finally, the specific reasons I preferred Lincoln and Guba’s (1985) criteria are twofold. Firstly, the criteria closely match the ontological and epistemological underpinnings of my research design. Secondly, and more pragmatically, it is the most popular framework utilised by qualitative researchers. Truth value refers to the issue of transparency. Briefly, this involved the researcher outlining personal experiences and viewpoints that may have resulted in methodological biases. This was undertaken clearly and accurately (Lincoln and Guba, 1985). For example, I was perfectly aware throughout the entire research process that my political persuasion intimately influenced what arguments, concepts, and frameworks I found convincing. To be sure, it is hardly surprising that the genealogical method and the concept of structural violence, with their emphasis on a multitude of oppressive power-relations and social hierarchies, would appeal to someone quite sympathetic to anarchist political theory.

This orientation no doubt also influenced my criticisms of the social deprivation/addiction link and my arguments for the superiority of the concepts structural violence and social suffering. Furthermore, it also likely underpinned my criticisms of the police and the social service bureaucracy. However, I do not view this as a limitation. Ultimately, my arguments should be accepted or rejected on their merits (or lack thereof), and any tendency to linger on the impact of my political orientation runs the risk of committing the genetic fallacy. In any case, given that I have been up

120 front and transparent about this influence, it seems that enough has been done in this regard. The use of the criteria of truth value was intended to replace the criterion validity. Consistency can be seen as the commitment to maintaining a “decision trail” (Lincoln and Guba, 1985). This involved the researcher documenting decisions taken clearly and transparently, and in a way which would allow another researcher to reasonably arrive at comparable findings. This decision trail can be seen in the clear rationale provided for the use of the genealogical method and for undertaking in-depth interviews based on the tripartite interview structure (Seidman, 1998). The neutrality criteria related not to the practice of being “objective”, but rather to the practice of acknowledging the contingency of findings and their intrinsic link to the researcher’s philosophical position, experience, and opinions (Lincoln and Guba, 1985). These should be accounted for, and the process through which they lead to the formation of theoretical and philosophical claims should be clearly outlined. Specifically, my commitment to the practice of keeping a decision trail and to Stinchcombe’s (2013) notion of “deepening analysis” demonstrates my acknowledgement of the contingency of my findings and their link to those above. Taken together consistency and neutrality were intended to replace the criteria of reliability.

Finally, applicability related to whether the findings are generalizable to other contexts, settings, or groups (Lincoln and Guba, 1985). Generalizability here is meant in terms of generalising to theory and opposed to statistically generalizing to population. As Seale (2004) argues, it is only when a finding is placed in a relevant theoretical context that it can acquire significance in terms of generalizability. Therefore, knowledge of social theory and an ability to place one’s research findings within broader theoretical frameworks is central to the criteria of applicability. Examples of applicability include my findings in relation to the issue of sexual violence and domestic abuse underpinning female drug use (see Chapter five), which has previously been documented in the Irish literature (see Woods, 2008). Similarly, previous research has also found a link between institutionalisation (Cork Simon, 2009; 2017) and

121 addiction in Cork (see Chapter five), as well as social deprivation and harmful heroin use (see O’Gorman, 1998 for overview). By placing these findings, and others, within the literature and broader theoretical frameworks (e.g. structural violence), the criterion of applicability is met. Having justified the adoption of Lincoln and Guba’s (1985) assessment criteria, I now turn to some concluding remarks in relation to the current chapter.

Conclusion

This chapter has outlined and justified the research paradigm and procedures adopted in the current study. Informed by ontological and epistemological relationality, a genealogical research method, philosophical study of problematisation processes (see Bacchi, 1999), as well as a qualitative interviewing design, was deployed. The genealogical method, when combined with Bacchi’s (1999) problematisation framework, can provide an account of how dominant addiction understandings develop over time and what effect this process has on drug-using populations. Meanwhile, in-depth interviews based on Seidman’s (1998) tripartite interview structure can enable a comprehensive analysis of how participants understand dominant addiction concepts and themselves within the context of their lived experience. These methods were, therefore, well suited to address the research questions and ancillary issues.

A breakdown of the 12 participants recruited, and the historical materials utilised was also provided along with descriptions of the research sites, processes, and reflexive accounts of all of the former. Furthermore, I also gave an account of some of the practical issues faced in the course of the research. This chapter closed with a discussion of ethics, and issues regarding validity, reliability, and generalizability. The next section of the thesis will be concerned with presenting the substantive findings of the study alongside their theoretical and philosophical implications. It is to these issues we now turn.

122

PART TWO

Chapter

123 Chapter Four

FROM SHEBEENS TO SUPERVISED INJECTING CENTRES: THE SOCIO- HISTORICAL CONSTRUCTION AND PORTRAYAL OF ADDICTION IN IRELAND.

The naming and shaping of addiction and its effects.

Having addressed all methodological considerations, the central issues that this chapter will address are: (A) how and why addiction understandings change over time; and (B) the effects of this process on drug using populations. In doing so, this chapter will problematize the epistemological underpinnings of dominant addiction understandings in contemporary Ireland. This is necessary as currently the number of people using drugs problematically in Ireland is increasing dramatically (see Chapter one), and approaches which reduce addiction to a set of positivistic factors are limited. As argued in Chapter one, this necessitates that we take a critical approach to our understandings of what addiction is, and where those understandings come from.

As examined in Chapter two, the international literature on shifting addiction understandings across time has been Anglo-American centric to the neglect of more peripheral jurisdictions50. Furthermore, there has been an over- emphasis on how structural determinants condition addiction understandings, and a concomitant lack of focus on the impact of politics, ideology, and contingent events. The presentation of a case study based on the Irish experience then has the potential to address this limitation

50 There are of course exceptions, and these have been discussed in the literature review.

124 and to build on recent Cross-European research (Berridge et al, 2016) which has begun to examine more peripheral jurisdictions.

Furthermore, by examining the effects of dominant addiction representations on drug using populations this chapter can address the tendency in the international literature to study “addiction without the addicts”, as highlighted in Chapter two. The core concern of this chapter then is to address the issue of how addiction in contemporary Ireland came to be viewed as a health issue (Irish Government, 2017). That is, why is the disease model of addiction (and the social deprivation/addiction link), and the population consumption model of “alcoholism” (see Butler, 2010), the most accepted ways of viewing harmful substance use in Ireland contemporaneously. Relatedly, what impact do these dominant representations exert on drug using populations?

The argument advanced throughout this chapter is that addiction as a health issue is a power-infused historical construct which has become legitimated over time due to the influence of a host of political-economic and socio- cultural processes, power-struggles, and contingent events. As such, this dominance is not solely (or largely) based on objective scientific evidence or academic research, and therefore is a political accomplishment rather than a scientific discovery (Reinarman, 2005). Furthermore, this political accomplishment has led to the drawing of an arbitrary51 distinction between drug addicts and non-drug addicts, as well as addiction and normal functioning. Moreover, drug users have been overtly stigmatised and portrayed as a corrupting influence in an otherwise well-functioning Irish society, obscuring the impact of harmful social arrangements on vulnerable populations. Finally, it will be argued that the process

51 They are arbitrary because they emerge based on political-economic and socio-cultural developments, power struggles, technological developments and contingent events, rather than solely (or largely) on the basis of objective evidence based science

125 whereby addiction understandings are constructed produces stereotyped and essentialised views of addicts and obscures a large portion of their lived experience.

The genealogy in this chapter will be presented in a somewhat unorthodox fashion. That is, a criticism this thesis has levelled at the genealogical approach is that while it has been indispensable in demonstrating that dominant addiction understandings are arbitrary and contingent52, there is often a tendency to overtly focus on addiction as an ideology, and to relatively neglect the effects which dominant representations may exert on drug using populations. Therefore, to demonstrate that dominant understandings of addiction are contingent and arbitrary, while also investigating the effects they have had on drug using populations, our genealogy will be combined with Bacchi’s (1999) WPR approach. This is appropriate and useful for two reasons.

Firstly, Bacchi’s (1999) approach is heavily influenced by Foucault (1977), and as Larsson (2017) has argued, is philosophically consistent with the genealogical method. Secondly, two of the six questions on which the approach is based, directly address the twin concerns of this chapter (though all questions are relevant). These are questions three, which is concerned with the emergence and descent of dominant addiction understandings over time, and question five, which concerns the effects dominant addiction understandings have had. The following sections will address each question sequentially, and this chapter will conclude by specifically addressing the central concerns of this chapter, and also placing them in the wider context of the projects as a whole.

52 They are contingent due to their political, social and cultural nature. That is, as understandings are constructed rather than real, they can be understood and constructed differently

126

What is the problem represented to be in a particular field (Q1)

For Bacchi (1999), research is never simply descriptive of a “problem” or issue, it is always political. Therefore, Bacchi’s (1999) first question is concerned with identifying how a particular issue is currently framed, so as to demonstrate its implicit political and ideological assumptions. For our purposes, the question is as follows: How is addiction currently represented in Ireland? To answer this question, we can examine how our four claim-making groups currently view addiction. Arguably, there are two dominant representations of drug addiction: (1) The disease53 model of addiction; and (2) A governmental representation which views drug addiction as largely explicable by the marginalization experienced in certain deprived communities (see O’Gorman, 2005 for overview).

In terms of alcohol, there are also arguably two dominant representations. These are: (1) The population consumption model (see Butler, 2010); and (2) The disease model of alcoholism (Butler, 2010). Crucially, it is in analysing these dominant models that we find the value in Foucault’s call to “Cut off the King’s head” (Foucault, 1976: pp. 88-89). That is, despite the dominance of the population consumption model (alcohol), and the link between social deprivation and drug problems, at a governmental and healthcare level, media discourse as well the lived experience and views of “addicts” and “alcoholics” in recovery still tends to be based on a representation of addiction as a disease. The task of this section then is fourfold:

53 This is the dominant view in the majority of government funded treatment centres, though by no means the only view within such centres. See for example: http://www.taborgroup.ie/ ; https://cuanmhuire.ie/ ; www.ruthlandcentre.ie

127 To demonstrate that the government and the medical profession represent alcohol-related problems as a function of total population consumption in contemporary Ireland

To demonstrate that the government and medical profession represent drug-related problems as a health problem, largely explicable by the marginalization of a number of deprived communities.

To demonstrate that there also exist parallel representations of both alcohol and drug problems, which are based on the disease model of addiction.

To critically explore this apparent disjuncture in order to describe the dispositive of the addiction field in Ireland today.

In order to demonstrate our first point, we can look at the Government’s major alcohol policy documents and legislation over the last ten years. For example, in the most recent piece of alcohol-related legislation (Public Health Act, 2018: p. 5) the Irish Government in its preamble stated that the act was intended to . . . ” Provide for the minimum price per gram of alcohol, to confer the power on the Minister for Health to, by order, increase the price, to provide for the labelling of alcohol products including the inclusion of health warnings and the alcohol content and energy content of alcohol products on alcohol product containers. . . to provide restrictions in relation to the advertising and sponsorship of alcohol products . . .” The act goes on to specify a number of measures related to minimum pricing, banning alcohol advertising in sport, and several other demand-side measures intended to reduce total population consumption levels. Of course, as Butler (2015) points out, such measures are based on the Ledermann curve, or the view that a reduction in total population consumption levels will lead to a reduction in alcohol related problems Indeed, these specific policy

128 discussions date back at least to 2012 with the establishment of the Steering Group on a National Substance Misuse Strategy, which had been compiled under the direction of the Department of Health. This group was tasked with integrating alcohol policy into Ireland’s National Drugs Strategy, owing to Ireland’s higher total population consumption levels, relative to other countries in the EU (Butler, 2015). As we will see later (Q3), this model's dominance is the result of over two decades of political struggle between the medical profession (and public health lobby) and the alcohol industry. Indeed, Curtin (2004) summarized the public health approach in a wide-ranging explication and defence of the total population consumption model. While more recently, the Institute of Public Health Ireland, enthusiastically welcomed the Public Health (Alcohol) Act 2018, arguing that Ireland had finally adopted an evidence based approach to reducing total population consumption levels (see O’Mahony, 2019).

Having just demonstrated that alcohol problems are represented as being linked to population consumption levels, it is now necessary to focus on drug-related problems. For this part of the discussion, it is necessary to begin with a landmark governmental document published in 1996 (Irish Government, 1996). This report was the first time that the Irish Government had accepted the abundant research evidence (see O’Gorman, 1998 for overview) demonstrating that drug problems could not be accounted for by individual differences or decision making, but were largely explicable by reference to the extreme social and economic marginalization of certain communities (Irish Government, 1996). In the preface to the report, the Chairman Pat Rabbitte (T.D) summarized the Governments position as follows:

Ireland has a drugs problem. But beyond this simple fact we must also recognize that Ireland’s drug problem is primarily an opiate problem – mainly heroin. . . The core concentration of opiate abuse and addiction are in the

129 great metropolitan region, with a second cluster in Cork City. . . They are concentrated in communities that are also characterized by large-scale social and economic deprivation and marginalization.

As we will see (Q3), following this report it becomes common place for Government deputies (and opposition deputies), the media and the medical profession to highlight these social and economic factors when discussing drug problems. However, the implicit political and ideological underpinnings of this representation can be seen by examining subsequent policy document. For example, the 2001 report (Irish Government, 2001: P.22) on reducing the demand for drugs argues that “The majority of people being treated for drug misuse are unemployed and have low educational attainment…”. Furthermore, the 2009 report (Irish Government, 2009: P. 28) refers to research which focuses on the risk factors associated with drug problems. These risk factors include early school leaving, poor educational attainment, a history of unemployment, and poverty, poor mental health, and familial breakdown, family history of addiction, marginalization, and involvement in drug-using network. Indeed, the Government’s most recent drug policy document (Irish Government, 2017: p. 7), despite not focusing on socio-economic factors as prominently, ultimately argues that:

“The new strategy will foster a person-centred approach to those who develop drug or alcohol-related problems, while underlining the need for a whole-of- Government response to the socio-economic, cultural and environmental risk factors contributing to the causes of substance misuse”.

While there is no attempt to explain why precisely such communities are excluded or deprived, there is a distinct focus on the issue of lack in such communities – that is – lack

130 of education, material resources, supportive family networks, pro-social friendship networks. and more recently, social capital (see Irish Government, 2017). Indeed, a rare if brief, discussion of such communities in any wider context argues that the existence of drug problems in disadvantaged communities is an international norm. This can be found in the initial Rabbittte report (Irish Government, 1996: P. 9), which argues that this situation can also be found in Barcelona, Paris, and the United States. Of course, this does imply that such social deficits are, in some sense universal, and unavoidable in advanced liberal democracies.

There is no attempt in any Irish drug policy document to analyze whether government decision making and the wider political-economic background 4 might condition the existence of deprivation; and exclusion and lead to the existence of such social ‘deficits’ in such communities. Indeed, to return to Bacchi (1999), the implicit political and ideological assumptions underpinning this representation are that the relationship between drug-related harm and deprivation, can be explained by a number of risk factors which exist in deprived communities. As Goodard (2012) points out, research based on the identification of risk factors tends to craft interventions which place the responsibility for social and communal change on vulnerable individuals and communities, who are then responsibilised as deserving of punishment if they do not take advantage of interventions and programs intended to assist them in overcoming risk.

While the link between social deprivation and drug-related problems is the dominant representation in Governmental and Medical discourses, and the total population consumption model in relation to alcohol problems, there exists a parallel discourse which views both alcohol and drug problems as a disease. This discourse is most prominent in government funded treatment centers, which are based on the Minnesota

131 model, and in 12-step recovery groups. As the 12-step recovery disease model will be analysed later in relation to our study participants (see Chapter five), we will now focus on these treatment centers.

According to Cuan Mhuire, a drug treatment provider founded in 1966, and operating treatment facilities in Kildare, Galway, Limerick, and Cork and Down, drug and alcohol problems are best viewed as a disease. They further argue that alcoholism and drug addiction exist, and are not merely symptoms of some other underlying disorder – that is - they deserve to be treated as primary conditions (MacNamara, 2000). This mirrors the view of AA and NA that alcoholics and addicts suffer from a disease which affects them physically, mentally and spiritually (see Wilson, 1939). This view is mirrored by the Tabor Group, an organization which provides addiction services (including residential rehabilitation and aftercare) in Cork and Kerry. In a two-part article, examining whether there is a role for counselling in the treatment of addiction, the clinical director of Tabor Group argues that “Addiction is a chronic disease . . . It is a brain disease which diminishes the persons recognition of the problem” (Devine, 2017). Furthermore, it is argued that the group’s adherence to the Minnesota model is based on a “disease concept of addiction and favours the long-term goal of a “drug free life” for clients (Devine, 2017).

Indeed, numerous other addiction service providers in Ireland adhere to the Minnesota model and the disease concept54, demonstrating the existence of a parallel discourse. To return to Foucault’s call to “cut off the king’s head” (Foucault, 1976: pp. 88-89), we can now see the value of looking beyond the government in our analysis of dominant representations. By viewing the government as one amongst many claim-making groups, we have identified the dominant ways in which alcohol and drug problems are

54 See for example: https://hopehouse.ie/?page_id=27 ; https://www.anchorcentre.ie/

132 represented in Ireland today. We will now turn to the WPR frameworks second question – What presuppositions or assumptions underpin this representation.

What presuppositions or assumptions underpin this representation (Q2)

According to Bacchi (1999), the goal of the second question is to identify and analyse the conceptual logics that underpin specific problem representations. The term conceptual logics refers to particular meanings that must be in place for a particular problem representation to make sense. The results of the current research have identified a very particular assumption and conceptual logic which underpins understandings of addiction, both in relation to alcohol and other drugs.

Throughout the entire period under investigation there is a particularly pronounced assumption underpinning all these representation, which is the view that drugs and drug addiction are a corrupting influence in an otherwise well-functioning Irish society. While addiction understandings have shifted according to broader political-economic and socio-cultural developments, as well as power struggles and contingent events - this portrayal has remained consistent. By association, this construction has meant that drug using populations have been constructed as “problem populations” distinct from the rest of the population, in need of some sort of control or correction. Furthermore, drugs and alcohol are often blamed for a whole host of social problems (crime, violence, and suicide), in an almost unidirectional fashion55.

Crucially, this holds regardless of whether one is discussing population consumption models, the social deprivation link, or the disease concept/Minnesota model. This

55 That is drugs and drug addiction causes a host of problems, rather than drug addiction being a symptom of deeper social malaise, which indicates the need for radical social and political change

133 probably reflects the tendency in Irish addiction discourse to eschew detailed ideological and theoretical discussion and debate in favoured of pragmatic and bureaucratic measures (See Butler, 2007). We will now look at some examples of this portrayal of alcohol and drug problems (and addiction) as corrupting factors in an otherwise well- functioning Irish society. Take for example an article published in the Leitrim Observer in 1989 (Daily News Correspondent, 1989a). Senator Willie Farrell argues that much of the poverty, health, and domestic abuse problems in Ireland are caused (in large part) by the abuse of alcohol. While it cannot be denied that the abuse of alcohol plays some role in the etiology of these various problems, it seems overly simplistic to suggest that poverty (for example) in 1980s Ireland was caused in large part by alcohol abuse. Historians are in broad agreement that the 1980s in Ireland represents perhaps one of the most precarious decades in Irish history economically (Bartlett, 2010; Ferriter, 2004; Bielenberg and Ryan, 2012).

Therefore, it seems that the Senator’s claim that alcohol is to blame in large part for these problems is at worst an attempt to obscure the role of government policy and wider economic developments, and at best a failure to grasp the importance of these wider processes. Another example of this portrayal of psychoactive substances can be seen in an article published in 1985 entitled: “Drink toll: sober facts” (Daily News Correspondent, 1985a). The article argues that alcohol and alcoholism is the most common cause of child abuse, violence, crime, and accidental death (Daily News Correspondent, 1985a). Again, it seems implausible to implicate alcohol as the cause of all of these varied problems.

Furthermore, even leaving aside the question of how to define “crime”, alcohol cannot be seen as the most common cause in such varied crimes as burglary, tax fraud, and murder. In terms of child abuse it is difficult to say, as the current author has not

134 researched this issue in any detail. However, it seems that establishing cause and effect here may be difficult given that there is no evidence to suggest that most “alcoholics” are child abusers. This portrayal of psychoactive substances is not limited to alcohol. Indeed, Fianna Fail TD Chris Flood is quoted in a 1995 article as stating that: “much of the crime in Ireland was based on the need of drug abusers to feed their habit” (MacCormaic, 1995). A similar point is made in other articles (Power, 1995; O’Mahony, 1999). The main argument against this position is that it simplifies the drug-crime nexus (see MacGregor, 2000; Seddon, 2006; and Hammersley, 2008). Indeed, it is not at all clear in an Irish context whether criminal behaviour precedes or is a result of drug use or addiction (O’Mahony, 2008). Furthermore, given the strong association between socioeconomic deprivation and both crime and drug addiction (see O’Mahony, 2008 for overview) it seems that such an argument also obscures the role of larger social forces and simplifies the issue.

Perhaps the most forthright example of this portrayal can be found in an Irish Independent article published at the turn of the 21st century entitled: “Parents warned on ‘curse’ of drug abuse” (Daily News Correspondent, 2000). The author argues that drugs are the curse of an affluent society and will be the ruination of people in the 21st century unless they are controlled (Daily News Correspondent, 2000). It is also argued that drugs have no boundaries either geographically or socially (Daily News Correspondent, 2000). The first point to make concerning the claim that drugs are the curse of an affluent society. This is the strongest indication of the portrayal of psychoactive substances and addiction as the corrupters of otherwise well-functioning societies. In the first instance the use of the word affluent means to have a great deal of money or wealth (Merriam-Webster.com). One would assume to achieve such a level of money or wealth a social system would need to function relatively well. Drugs then are set up as the enemy and potential ruination of this system.

135

Of course, this ignores the fact that Ireland has one of the most unequal concentrations of wealth in the Western world (Allen, 2007). Therefore, it seems the portrayal of drugs here as the main enemy of the current social structure serves to obscure issues to do with inequality, social deprivation, economic and physical dislocation, and how these issues provide fertile contexts within which “harmful substance use” thrives. Furthermore, it’s disingenuous to suggest that drugs are the scourge of affluent societies when drugs have been present and problematized in a wide range of affluent and poor societies (see Singer, 2012 for an overview).

A similar trend can also be observed in the medical journals examined. In a 2005 study which examined suicidality and recent alcohol intake from a neuropsychological perspective this tendency can be seen quite clearly (O’Connell and Lawlor, 2005). The study found that of emergency room attendees, higher blood alcohol contents were found among patients attending for assessments for suicidality than among those attending for other reasons. The authors also propose that some individuals drink alcohol to relieve unpleasant mental states but when the alcohol does not have the desired effect, they are propelled to suicidal ideation and behaviour (O’Connell and Lawlor, 2005). They conclude that the experimental evidence supporting this neuropsychological approach is compelling and servers as a potent reminder of the dangers of alcohol consumption in relation to suicidal ideation and behaviour (O’Connell and Lawlor, 2005). The argument here is not that alcohol has no impact on the etiology of suicide. Rather, the claim being made is that by positing the substance itself as the central causal mechanism the authors decontextualize the social and economic factors central to the etiology of suicide, and portray alcohol and related problems as the corruptors of an otherwise well-functioning society. While there is certainly no consensus as to the etiology of suicide numerous authors have noted the importance of taking into account a number of social and environmental factors (see

136 Milner et al, 2013 for an overview). This portrayal can be seen in other research studies which implicate cocaine use in increased suicide rates (Lynn et al, 2010), in research which blames alcohol for overburdening A&E departments (Cassidy et al, 2008) – ignoring the critical lack of state investment in such services (Social Justice Ireland, 2016), and in research which blames injecting drug use and users for the spread of HIV/AIDS in Irish society (Lynn et al, 2010).

There are numerous other medical articles which specifically link alcohol and drug use to increased suicide rates in Ireland (Hogan, 2001; Keating, 2003; O’Sullivan, 2010). An article examining strategies to reduce the risk of AIDS argues against needle exchange on the basis that there is no evidence that it will reduce the risk of infection. The author concludes that the overwhelming evidence suggests that addicts are irresponsible to themselves and society and, therefore, a needle exchange programme is an untenable strategy to reduce the risk of AIDS (Cassin, 1988). Keating (2003) argues blames alcohol for the supposed preponderance of impulsivity among young people in Ireland.

An analysis of The Furrow’s publications reveals that the Catholic Church has also portrayed alcohol and drug abuse as a corrupting influence in an otherwise well-functioning Irish society. This, however, has been tempered by a discourse which highlights broader social, cultural, and economic forces as potentially corrupting. Like the other claim-making groups the Catholic Church argues that alcohol and drug abuse are intimately connected to the increased suicide rates in Irish society (Kelleher, 1995). Specifically, withdrawal from alcohol and drugs is posited as a precipitating factor in a large number of suicides (Kelleher, 1995). One author (Kelleher, 1995) argues that a highly effective strategy for tackling suicide would be to educate people in the harmful consequences of using these substances.

137 While this portrayal is constant throughout the whole period analysed it is also tempered by a parallel discourse which simultaneously blames social forces for many of the same problems which alcohol and drugs are blamed for. Take an article published in 2010 as an example (O’Sullivan, 2010). The author argues that as alcohol is a depressant and affects serotonin levels, is can also affect mood regulation, decision-making, and executive reason – leading in some cases to suicide. Furthermore, the author quotes Fr John Connolly who argues that: “Ireland’s rising suicide rates are partly linked to the increase in alcohol abuse, and in particular, the trend towards binge drinking among young people” (O’Sullivan, 2010). However, the author also quotes Sr. Stanilaus Kennedy who blames: “our success-ridden intolerant and demanding society…” which: “… results in many adolescents feeling stressed, under severe pressure, and filled with anxiety” (O’Sullivan, 2010). An example of these discourses operating side by side can be seen much earlier in a 1978 article which examines the role of the social worker as a Christian. The author from the outset recognizes that income inequality and related socio-structural issues drive poverty in Ireland (Colbert, 1978).

However, the author argues that it would be wrong to see all poverty as caused by the structure of society. She argues that alcoholism affects all social strata and affects hospitals, causes poverty, and results in family violence, particularly “wife beating” (Colbert, 1978). It seems, therefore, that while the Church acknowledges that there are problematic aspects to the Irish social structure right throughout the period, they do not ultimately consider the political-economic or socio-cultural basis of alcohol abuse. This portrayal is also seen in numerous debates in the Oireachtas. A pertinent example of this is Senator John Crowe’s contribution to a Seanad debate in relation to societal alcohol consumption. He states that:

”If everyone in Ireland stopped drinking alcohol completely tomorrow. It would be a better place. We would have a colossal decrease in the prevalence of cancer of the head, neck, oesophagus, stomach, pancreas,

138 breast, colorectal and the liver. Chronic liver disease would become rather uncommon. Obesity and diabetes, and all the complications associated with them, would decline dramatically. We would have a colossal decrease in violent crime, domestic violence, violence against women and rape. We would have a colossal decrease in road traffic accidents and some decrease in traffic deaths. We would have a major decrease in the use of our accident and emergency departments. We would have a major shortening of the waiting lists for our health facilities. There would be a decrease in absenteeism at work…” (Dáil, 2012).

In short, the Senator argues that many of the social problems the country faces would disappear almost immediately if people were to refrain from consuming alcohol. Such an argument seems to oversimplify the issue, given that in 2012 (when the statement was made) Ireland was on the verge of economic collapse and in the midst of an unprecedented economic crisis.

Indeed, many of the social problems the senator highlights as resulting from excessive alcohol consumption can reasonably be located within that political- economic context, in particular the issue of hospital waiting lists, and a general lack of investment in health services (Social Justice Ireland, 2016). Furthermore, while the reasons for the increase in violent crime and violence against women in the last few decades are vigorously debated, few researchers would implicate alcohol use as the sole, or even main, etiological factor. This portrayal can also be seen in a governmental committee discussion in relation to the inclusion of alcohol in the National Drugs Strategy. Dr.

139 Siobhan Barry speaking in relation to the supposed increase in alcohol consumption56 in Ireland states that:

“The Department of Justice, equality, and law reform has figures that relate to drunk driving, public order offences and crime. In society in general, we have reports from the Family Support Agency on domestic violence, consequent child abuse and relationship difficulties. Attendances at accident and emergency departments associated with alcohol use have risen considerably in recent years. In the work domain, a consequence of problem alcohol use is absenteeism. IBEC members speak about 12% of their male absenteeism and 4% of their female absenteeism being directly as a result of alcohol use” (Committee, 2008).

Meanwhile in a 2010 debate on alcohol misuse Senator Jerry Buttimer implicates alcohol abuse in the overburdening of the health services, the dramatic increase in male suicide and general public disorder (Seanad, 2010). Similarly, Deputy Ciaran Caffe implicates alcohol abuse as the main etiological factor in the increase in male suicides, reports of rape, and the increase in people presenting at emergency departments (Seanad, 2010). It is worth repeating that such debates occurred amid a domestic and international economic crisis, in which the country was facing insolvency and had surrendered its economic sovereignty. Yet such political-economic developments are excluded from any analysis of the social problems mentioned, in favor of an almost exclusive focus on alcohol. It has been demonstrated that in an Irish context alcohol, drugs, and addiction in general have been portrayed as corrupting influences in an otherwise well-functioning Irish society. So, while the development in how addiction is characterised is intimately

56 It should be pointed out that evidence presented by Butler (2010), and more recently Mongan and Long (2014) does demonstrate that alcohol consumption is increasing over time in Ireland.

140 related to broader socio-cultural and political-economic developments, the portrayal of addiction as a corrupting influence in an otherwise well- functioning Irish society provides a politically expedient and culturally sanctioned (I assume, following Keohane, 2008 that Ireland has almost fully embraced individualism) means of explaining this particular type of social disorder in individualised terms.

To return to the WPR framework (Bacchi, 1999), Question two is concerned with the presuppositions, binaries and assumptions underpinning the addiction problematisation in Ireland, and requires some attention. The assumptions underpinning this problematisation include the conviction that addiction is a problem of pathological individuals and communities, is a main cause of a whole host of social problems, rather than both addiction and the aforementioned social problems being explicable by broader structural issues. Indeed, it seems that this portrayal and associated responses are becoming more prevalent over time. For example, O’Gorman (2016: 34) argues that “Neo-Liberal government policies have increasingly employed a social deficit model to address social issues related to inequality. This model focuses on the social deficits of people who are unemployed, unskilled or educationally disadvantaged rather than tackling the structural issues that bring about these deficits”. Indeed, as we will see in Chapter five, the socially deprived do not suffer from exclusion or social deficits, but rather from the impact of social bulimia, alienation and a whole host of other violent structures (states social service bureaucracy, police, etc.). We will now address the question of how this representation of the problem came about.

How did this representation of the problem come about? (Q3)

Bacchi (1999) emphasizes that the goal of question three is to highlight the conditons that allow a particular problem representation to take shape, and to assume dominance. Indeed, as Garland (2014) argues, to examine how a particular representation achieved dominance, it is necessary to take the long historical view to

141 examine the emergence and descent of this representation. Therefore, we will begin with a watershed moment in Irish history, the independence of the 26-counties of Southern Ireland from the United Kingdom (see Lee, 1989).

State building and state legitimacy (1922-1940/45)

This section will argue that political concerns with state-building and portraying an essentialised version of Irish identity (separate from Britain) in the aftermath of independence, and within the context of the specific form that modernisation took in Ireland, are the main influences on addiction understandings in this period. First, however, it will be necessary to provide some historical context. The period from the foundation of the modern Irish state to the outbreak of World War Two was one characterised by state- building and a concern with carving out and emphasising a unique Irish identity distinct from Britain (Jackson, 1999; Ferriter, 2004). Socially and culturally, the country was largely homogenous. That is, it was mainly rural (apart from an urban base in Dublin), the population was overwhelmingly Catholic and nationalist – with a strong emphasis placed on the Irish language, traditions, and music (Brown, 2004). Crucially, the state relied heavily in this period (and beyond) on a religious, institutionalised system of social control. This took the form of an archipelago of religious institutions57 which incarcerated “problematic” (read: ‘poor’) men, women, and children (Raftery and O’Sullivan, 2001; Smith, 2007; Arnold, 2009).

57 These were (1) psychiatric hospitals for those with the most severe cases of mental illness, and after the 1945 Mental Health Act they also admitted (usually, though not always, male) “alcoholics”, both voluntarily and involuntarily; (2) Mother and Baby homes for unmarried or poor women, while they were pregnant, and thereafter until the baby was adopted; (3) Magdalen Laundries which were institutions where “promiscuous”, destitute, or prostitute women, and unmarried mothers were incarcerated and forced into unpaid labour, and (4) Industrial schools for poor children, whose parents could not or would not look after them

142 In short, Ireland went through two stages of modernisation and industrialisation (Inglis, 1998). The first saw the creation of an educated and disciplined tenant farmer class (latent bourgeoisie). Secondly, due to the dominance of the Church thereafter and the implementation of a rigorous morality based on self-denial, this latent bourgeois class did not fully realise itself and remained Catholic rather than capitalist, while agricultural production remained within peasant subsistence rather than a modern entrepreneurial type model. Ultimately, it was the prominent role of the Catholic Church (and its social teaching of subsidiary in particular) in the context of a rural-based society which emphasised self-denial and self-sacrifice to family and community over self-fulfilment, which militated against the emergence of any unified theory of addiction until the 1960s (see Butler, 2010).

However, the immediate context of post-independence Ireland was also crucially important. Levine (1978) has argued that in pre-industrial agrarian societies, excessive drinking is seen as a relatively minor, moral issue that can be curtailed by public opprobrium. In the context of Ireland’s specific form of modernisation (power of the Church), and the immediate need to portray Ireland as a functioning country with its own identity, when concern did emerge in relation to alcohol use it was typically not related to excessive use but issues such as alcohol use which occurred outside of the law (drinking of poitin58, drinking outside of licensed drinking hours, and shebeens). While due to constraints of space, the current section will focus on only two prominent examples of this tendency, the reader is directed to the following sources for further evidence (see: Irish Independent, 1929; 23rd January: P. 9; Dail, 1924; 1930; and Nationalist and Leinster Times, 1933; 8th April: P. 3).

58 This is an illegal traditional Irish distilled alcoholic beverage (90-95% ABV).

143 This concern with state-building and state legitimacy can be seen quite clearly in a statement by the Minister of Justice Kevin O’Higgins, who justifies new legal restrictions on opening hours and the further criminalisation of shebeens, based on the state of emergency in the country after the civil war. He states:

“If the circumstances were other than what they are, there might be a case for greater latitude, but with the tendency in the county…”” (Seanad, 1924).

The Minister’s reference to the “tendency in the country” here refers to the extreme instability caused by the attempts of anti-state republicans to dismantle the institutions of the fledgling Irish state. Indeed, in this period, it was not obvious that the state would survive (see Ferriter, 2004). The reservation concerning longer opening hours and increased access to alcohol in general was based on the idea that alcohol would inflame the situation. This was particularly the case as it was widely believed at the time that republicans would use pubs and sheebens as meeting places to plan military operations (see Share, 2003).

The area where alcohol issues were most vigorously debated demonstrates a similar point and also demonstrates the importance attached to portraying a unique Irish identity in this period. The Eucharistic Congress is a gathering of all Roman Catholic clergy to celebrate the real presence of Jesus Christ in the sacrament (Ferriter, 2004). The first congress to be held in Ireland was in 1932 and viewed by the state as a crucial opportunity to express its unique identity from Britain (Ferriter, 2004). It was to be a celebration of all things Irish and at this historical juncture, Catholicism was seen as perhaps the greatest expression of what it meant to be Irish (Ferriter, 2004). It is within

144 this context that the issue of extending pub opening hours to accommodate the influx of tourists was discussed. Deputy Curran argues that:

“Surely, it is not for drink or such like that people will come to the City of Dublin in the course of the next few weeks. [In reference to particular clauses] I oppose them because I believe it is not for drink people will come to Dublin in the course of the next few weeks…. I see some deputies’ laugh and it is no laughing matter at all. If the Government ofthe country stands for an extension of hours to get drink in the city of Dublin during congress week, I say it is a public scandal that such a thing should be introduced into this house” (Dáil, 1932a).

The implication from Deputy Curran’s statement is that legislating “for drink” is inappropriate due to the religious nature of the event in question. However, this reservation must be seen within the context of what the Eucharistic Congress represented. This was seen as an opportunity for a country struggling economically to demonstrate to the outside world that they were a devout, pious, functioning Catholic country separate from Britain (Ferriter, 2004). It seems that Deputy Curran and others like him were nervous that this legislation may distract from that and play into old stereotypes of the drunken Irish59. However, others saw this issue in a completely different light. In response to Deputy Curran’s remarks, Deputy Fitzgerald-Kenny argues that alcohol is permitted within Catholic doctrine and, therefore, there should not be a problem. He states:

59 These stereotypes can be traced to cartoons in the English “Punch magazine”, which depicted the Irish as perennially drunk and simian like.

145 “I must say that so far as I am concerned I fail to follow Deputy Curran's argument at all. This Eucharistic Congress is a great Catholic Congress. It is not a Mohammedan assembly. I know that Mohammedans prohibit the use of intoxicating liquor, but no branch of the Christian religion, and certainly not Catholicism…” (Dáil, 1932b).

The issue at stake here is centred on how Ireland should best express itself as a Catholic nation during Congress week, one side viewing alcohol as an expression of Catholicism, the other a distraction from that expression. Regardless, the use of alcohol in and of itself is not considered problematic by any of the speakers. Furthermore, an in-depth examination of the media’s portrayal of alcohol issues further demonstrates this focus on nation-building and the crafting of a uniquely Irish national identity. This was done, however, by emphasising the huge problems associated with alcohol in other countries. The lack of coverage of such issues in Ireland reinforced a view of an Ireland free from its colonial masters, now free to follow a new pristine destiny, a view very popular at the time (see Brown, 2004).

In 1922 and 1923 we find articles entitled: “Killed by alcohol: debauchery in ‘dry’ America” (Daily News Correspondent, 1922a: January 3rd, Page 6), “Alcohol and prohibition” (Daily News Correspondent, 1923); and “Partial blindness from wood alcohol” (Daily News Correspondent, 1922b: August 21st, Page 6). Similar headlines appeared until the end of prohibition in America (Irish Examiner, 1928: August 10, Page 2; Evening Herald, 1929: May 14th, Page 4; Belfast Newsletter, 1933: June 10th, Page 5). Its significance lies in the clear editorial lines, across multiple newspapers, which are unequivocally critical of prohibition and, indeed, alcohol policy and problems in almost every country discussed (see for France Irish Examiner, 1940: February 10th, Page 5).

146

Simultaneously, the achievements of the Pioneer Total Abstinence Association were frequently applauded, while the apparent low rates of consumption and drunkenness in Ireland was consistently lauded (Irish Independent, 1923; Nationalist and Leinster Times, 1933a). It should be emphasised that the lack of concern with alcohol related problems in Ireland, and the moral condemnation of excessive drinking when it did occur meant that alcohol-related problems were not seen as a medical issue. Indeed, in this period we find just three articles in the relevant journals which are tangentially related to addiction (Macerlean, 1934; Kelly, 1936; McGrath, 1939). However, with the advent of the motor car, alcohol related problems seem to be taken somewhat more seriously (see McGrath, 1939). This was typically due to fears that pedestrians may be killed due to motorists driving drunk, or else cause a large number of roadside fatalities. In short, the political-economic and socio-cultural structures in Ireland at this time meant that concerns with state-building and the construction of an essentialised and distinct national identity took precedence over addiction related issues per se.

Where alcohol became problematized was in areas where it impacted on such endeavours, and to a much lesser extent in relation to the invention of the motor car. Furthermore, reactions to excessive alcohol use can be plausibly located within the broader societal response to social problems – i.e. moral condemnation and institutionalisation. For those social problems (illegitimacy, excessive alcohol use, poverty) that could not be exported to Britain or America were often hidden behind the walls of religious institutions. This attitude can be mainly explained by the need to portray Ireland as a functioning, stable country separate from Britain, the need to carve out a distinct essentialised identity, and relatedly a strict adherence to Catholic social teaching, within the specific context modernisation took in Ireland.

147

Liberalisation and gradual social and cultural change (1945/50-1960/65)

The key development in this period is the appearance of a discrete theory of addiction for the first time in Irish history. This was the disease theory of alcoholism. First, however, this must be placed in an historical context. The political-economic and socio- cultural structure of Irish society sketched in the previous section began to slowly unravel in the period following World War Two. However, it is in the years after the war that we see the most dramatic changes. Chief among these was the widespread rejection of rural life that after the war led to perhaps the greatest exodus since the Famine (Ferriter, 2004). This was the beginning of a process of urbanisation which would transform Ireland from a largely agrarian society to an urban-based society.

On the economic front, the late 1950s (1958 onwards) saw a liberalisation of the Irish economy through a shift to an explicit drive for economic growth via the attraction of foreign direct investment and the elimination of trade barriers (Lee, 1989). In social and cultural terms, the advent of foreign holidays and the collapse of the Church- sponsored censorship laws, in tandem with TV, radio, and satellite becoming popular, opened Ireland up to the influence of foreign social and cultural mores (Brown, 2004). This period, as many commentators have noted (Inglis,1998; Ferriter, 2004), represents the beginning of the rapid decline in the influence of the Catholic Church in Ireland.

Within this context, the disease concept of alcoholism emerged in Ireland. The arrival of AA in Ireland (AA’s first European meeting occurred in 1946 in Ireland) and its subsequent development is a useful lens through which to analyse the emergence of the disease concept. This story is relevant to our current purposes as given the level of opposition to AA and the

148 disease concept at the time (see Butler and Jordan, 2007), and that its institutional support structure and philosophy was heavily linked to Protestantism – it is surprising that AA and the disease concept were not attacked more directly by the Church, and over the next two decades actually succeeded in gaining widespread acceptance.

How then do we explain the gradual acceptance of the disease concept which emerged over the next decade? The answer is multi-faceted. Firstly, As Butler and Jordan (2007) demonstrate Sackville’s60 ability to expand AA and spread the disease concept of alcoholism was undoubtedly down to his strategic and theological proficiency. It seems Sackville was able to avoid conflict with potentially hostile members of the clergy while simultaneously promoting his agenda among sympathetic Church members, particularly by forging links to the national Catholic seminary in Maynooth (Butler, 2010). This study’s examination of The Furrow provides further evidence for Butler and Jordan’s (2007) point in this regard. In every article published in the journal by an AA member, there is an explicit attempt to demonstrate how compatible the organisation is with Catholicism. This can be seen in the following statement: “The 12 steps appeal to me as being in complete harmony with the Catholic faith and morals, as being clearly stated religious and moral principles in language which is simple and easily understood” (AA Member, 1953). Furthermore, members argue that they had witnessed alcoholics who had been saved by AA strengthening their lapsed Catholic faith (AA Member, 1953), and they even mention conversions to Catholicism by non-Catholics (AA Member, 1953). AA made it clear that they were not a threat to the Pioneer movement: “and we ask them not to look at us as rivals to any temperance movements already sponsored by them” (AA Member, 1953).

There are many more examples in multiple articles demonstrating this theological and

60 He was one of the AA’s early secretaries in Ireland, a retired British Army general.

149 organisational nous (see for example A Victim, 1953; AA Member, 1956; Abbott, 1970). From the late 1940s to the late 1950s and beyond then, through a combination of strategy and theological sophistication Sackville persuaded the Church leaders to accept his and AA’s philosophy. Another factor influencing addiction understandings is again highlighted by Butler and Jordan (2007) – that is – the increased influence of the World Health Organisation (WHO) in Ireland. In 1959, the Government introduced a Bill in parliament which sought to liberalise the country’s licensing laws (Butler, 2010). The Church, however, vigorously opposed the Bill arguing that an expansion of opening hours would lead to more drinking and thus, more drink-related problems (Butler and Jordan, 2007). Interestingly, given the dominance of the Church in this period, the Government ignored their protestations and passed the Bill citing WHO reports, which purported to demonstrate that alcoholism was a disease (based on the research of E. M. Jellinek), as justification (Butler, 2010).

The claim repeated by many deputies was that alcoholism was a disease of a minority of the population totally unrelated to per capita consumption levels (Butler, 2010). Of course, the political-economic context is vital here. In the late 1950s the Irish Government decided to apply for membership of the European Economic Community (EEC). With a commitment to free trade, deregulation, and other laisse-faire economic principles now dominating governmental policy, it was only a matter of time before Ireland’s restrictive licensing laws would be the target of liberalisation (Daly, 2016). Importantly, as the Government wished to pursue this new liberalisation agenda, it was very convenient that at a time when the country was looking outward for economic policy influences (Daly, 2016), a concept of alcoholism existed which suggested it was a disease of a limited number of individuals, unrelated to population consumptions levels.

150 Another important issue to consider in attempting to understand and explain the gradual acceptance of the disease theory of alcoholism, which has not been explicitly addressed in the Irish literature to date, is the internal needs of the various claim- making groups themselves. In relation to the Catholic Church, AA resolved a doctrinal problem presented by the need to drop moral conceptions of alcohol problems. In short, numerous articles began to appear in The Furrow which suggested that there were a large number of priests with alcohol problems in Ireland (Ford, 1960; Abbott, 1970; Hanley, 1970). So, if the priest, God’s representative on earth, could not moderate his drinking through the use of prayer and self-denial, then the laity61 could hardly be expected to. To this end, AA seemed to pose a solution. The fifth step in particular was quite similar to expressions of penance in Catholic theology (Sellne, 1983). The doctrinal problem was to do with the issue of sin, free will and responsibility.

While the idea of alcoholism as a disease appealed to the Church in this period for reasons mentioned, it did present a problem. For if alcoholism was a disease, the alcoholic was under the control of forces outside of themselves and could not be said to have free will, and therefore, could not be held accountable for his/her actions. Such a notion contradicts very fundamental notions in Catholicism (free will, moral responsibility for one’s actions). However, AA’s model enabled the Church to circumscribe this problem. The alcoholic could simultaneously be seen as responsible and not responsible for his condition. That is, ‘he’ was not responsible for having the disease but ‘he’ was responsible for his recovery from the disease.

In terms of the media, the Alcoholism as a disease conception chimed with a deeply engrained cultural script. That is, redemption from a state of degradation. Thus, we

61 This refers to followers of the Church as opposed to official representatives such as priests or bishops.

151 find in this period articles about extreme suffering (Daily News Correspondent, 1953: January 7th, Page 2; Cash, 1960) and miraculous rebirth (Sheen, 1954) among those caught in the grips of alcohol. This narrative, of course, provided a culturally sanctioned and recognisable, as well as sensationalised, means of reporting on alcohol and related problems. For the medical profession, it was an attempt to draw on international best practice to declare alcoholism as a disease which required medical as well as spiritual treatment. While as Butler (2010) points out, the medical profession surprisingly made no submissions to the debates on liberalisation, members of the psychiatric profession were prominent from the 1950s onwards in attempting to set up the Irish National Council on Alcoholism, modelled on its American counterpart (Butler, 2010).

In this period then we witness the rise to prominence of the first discrete theory of addiction in Irish history – the disease theory of alcoholism. This can be explained by reference to power-struggles, contingent events, as well as political-economic and socio-cultural processes. Firstly, the onset of the second phase of Ireland’s modernisation (economic liberalism), together with widespread structural change, weakened the Church’s authority and ability to resist the state’s desire to embrace alternative addiction understandings (for its own end). Secondly, the organisational and theological sophistication of AA’s early chairman, AA’s compatibility with principles of subsidiary, free will, and moral responsibility, coupled with the internal needs of the Church itself (research demonstrating high levels of alcoholism among priests), led to a willingness to embrace AA and the disease model.

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Hope and despair (1960/65-1994/1995)

The 1960s witnessed for the first time in over 100 years, net inward migration to Ireland. Furthermore, the policy of economic liberalisation and the attraction of foreign direct investment saw Ireland rapidly industrialise. Socially and culturally, the country became slowly influenced by outside social mores and norms (Brown, 2004). This period, as many commentators have noted, represents a further decline in the influence of the Catholic Church in Ireland. It could be argued that from the early 1960s and as far as the late 1990s, Ireland went through a struggle between two competing visons of what the country should look like.

That is, between a traditional, Catholic, conservative homogenous and inward looking country, and on the other hand, an individualist, consumerist, consumption driven secular-liberal Ireland (Brown, 2004). Within this context, we witness the entrenchment of the disease model, increased concern with the issue of alcoholism in Ireland, and for the first-time widespread concern about opiate abuse in Ireland. However, these issues were initially conceptualised in highly individualised terms, obscuring broader politico-economic and socio-cultural issues. The first indication that alcoholism as a disease became more entrenched in this period is the huge increase in the use of the term to refer specifically to a disease. From 1940 to 1960 there were roughly 50 references to alcoholism as a disease in Irish parliamentary proceedings (see Dáil Debates). From 1961 to 1981 this increases to over 500 references to Alcoholism as a disease (see Dáil Debates).

153 While it could quite rightly be argued that this statistical fact alone is a weak indicator of the entrenchment of the concept, an analysis of the references demonstrates that the notion of alcoholism as a disease is uncontroversial in this period. That is, there is no significant debate around whether or not alcoholism is a disease. Deputies who invoke the alcoholism as a disease concept make use of it as an “objective” condition. Take, for example, a debate in 1972 on the problem of alcoholism. The debate here concerns the issue of treatment for alcoholics. Deputy Governey, a member of the opposition, asks the Minister for Health what: “action is being taken by his department to deal with the serious problem of alcoholism and drinking by children under 17 years of age” (Dáil, 1972a). In response, the minister argues that enough is already being done, pointing out that “treatment for alcoholics is provided in all mental hospitals and in three special units” (Dáil, 1972a). Notice that the issue here is whether or not the Government is doing enough to tackle the issue of underage alcoholism. The existence of alcoholism as a condition is seen as an uncontroversial objective fact, by both the Government and the opposition.

In the Church’s view of alcohol-related issues in this period, alcoholism continued to be accepted as a disease by all contributors to the Furrow (Sellne, 1983; Furrow contributor, 1994). However, this period also sees a decline in focus on alcoholism and a schism between the Church and the Pioneer Total Abstinence Association. Indeed, the movement essentially lost all its power from the mid-1960s onwards and went into a period of self-preservation (Ferriter, 1999). This is mainly attributable to the Pioneers being not opposed to alcohol as much as they were committed to the broader religious and cultural practice of self-denial.

In terms of alcohol-related problems then, in this period every news source consulted viewed alcoholism as a disease when discussing etiology (Anglo-Celt, 1963: March 2nd, Page 1; Irish Independent, 1963a: March 22nd, Page 11; b: December 27th, Page 9; and

154 c: November 28th, Page 17; Irish Press, 1963; November 25th, Page 9). Many worried that alcoholism was on the increase due to a decline of religion and traditional social control more broadly. This can be seen with the setting up of a national council on alcoholism in 1964 (Butler, 2010). Furthermore, consider an article in the Irish Press in November 1963. It states that there were an: “estimated… 75,000 alcoholics in Ireland” (Irish Press, 1963; November 25th, Page 9). Furthermore, an article in the Anglo-Celt in 1963 argue that Ireland is rated as: “one of the countries that has a severe problem of Alcoholism” (Anglo-Celt, 1963: March 2nd, Page 1). The article goes on to discuss liberalisation legislation which will, it is argued, make the situation much worse (Anglo- Celt, 1963: March 2nd, Page1). Therefore, while it seems the media and the Church (see Butler, 2010) were opposed to the Government’s liberalisation agenda there was no opposition to the idea of alcoholism as a disease.

Within the medical profession, however, despite the acceptance of the alcoholism as a disease concept (see setting up of the Irish National Council on Alcoholism in Butler, 2010), it was argued that drinking and related problems needed to be understood within a broader context. Dermot Walsh (1975) sets himself the task in his research article, of assessing the “alcoholism as a disease” concept in light of competing models of alcoholism. In terms of causation, the author highlights genetic, environmental, and social factors. Furthermore, he argues that prevention programmes should focus on educating the youth, while culture is also taken into consideration. The author argues that in some cultures those with neurotic personalities do not attempt to solve their problems through drinking, however, in Ireland they almost always do. He goes on to argue that Ireland has the highest rate of alcoholic psychosis in Europe, spends 12% of its total personal expenditure on alcohol, and has one of the highest admittance rates to hospitals for alcoholic psychosis. Finally, the author mentions that the genetic basis for alcoholism as a disease is slight and the evidence that does exist is contradictory – he continues – by arguing that a sociological approach is perhaps the most appropriate and then examines several potential causal factors including sexual frustration, low marriage rates, and a lack of

155 food. This article has been summarised due to the vital theoretical issues it raises. Firstly, given that it has been previously demonstrated that alcoholism as a disease was firmly entrenched in governmental and media conceptualisations, it seems strange that it would be problematized to such a degree in a prominent Irish Medical Journal.

However, as Butler (2010) has pointed out that in this period a minority view began to emerge within the Irish National Council on Alcoholism (INCA), advocating a problematizing approach toward the disease model, and which viewed population consumption models more favourably (as represented by Walsh, 1975). It seems that this view remained a minority one due to the importation (From America) of the Minnesota model (basically the institutionalisation of the AA model with confrontational type of approaches and some counselling/meditation) by Catholic clergy (Sr. Margaret Kiely in Cork for example: see O’Carroll, 1997). Important too was the relative lack of power held by the INCA and its wish to avoid confrontation (given it was split on the issue), and also the recency with which disease models had become entrenched, and their acceptance by the media and government (Butler and Fagan, 2011). Moreover, the articles analysed represent the first-time alcohol or drug addiction in Ireland was mentioned in the journals consulted and is representative of the fact that the medical profession had only recently become organised at an institutional level on a legislative basis. Indeed, it was not until the 1970 Healthcare Act, which created regional boards that a coherent healthcare service began to emerge in Ireland. This period represents the first time in Irish history that drugs and drug addiction became significantly problematized in Ireland.

Indeed, the emergence of the “opiate epidemic” in Ireland represented something of a watershed in attitudes to the use and “misuse” of psychoactive substances. Drug addiction, particularly the use of opiates in Dublin, would become the dominant feature of discussion in the 1980s. In this decade, the initial response across the entire array of claim-making groups was one of panic, stigmatisation, and moralism. At the beginning

156 of this period, drug problems were seen as either an individual disease, or a moral failure within governmental debates Butler, 1991; 1996). For example, Deputy Ferris argues that there should be no freedom of communication in relation to the use of cannabis or other drugs (Seanad, 1984), and Deputy Robb expresses misgivings but believes that the heroin epidemic is so serious that the banning of books is necessary (Seanad, 1984). Furthermore, drug addicts were frequently portrayed as criminals. As Deputy O’Hanlon points out in 1984:

“. . . particularly worrying about the use of heroin is the amount associated with crimes…. Heroin addicts spend up to 100 pounds a day to get their supply on the black market….. [therefore] many of them are involved in crime…” (Dáil, 1984).

Moreover, in a debate on drug addiction in prisons dating from 1985, the Minister for Justice Mr. Noonan argues: “We all know that drug addiction leads to involvement in crime in quite a number of cases” (Dáil, 1984). There are numerous other examples linking drug use to crime that one could point to (see Dáil, 1985; Dáil, 1995; Dáil, 1996a). This tendency is even more pronounced in relation to the Catholic Church. Fr. Brian Power published the first article to deal with the pastoral and religious implications of drug addiction in Ireland in 1984 (Power, 1984). He states:

“By 1982 some had begun to snort and inject heroin but it was halfway through that year before I realised with a sort of dismay bordering on disbelief that the heroin habit was spreading rapidly through the borough” (Power, 1984).

157 He refers to the first report on this problem in 1982 published by the Medico- Social Research Council concerning heroin addiction in Dublin’s inner city – conducted by Dr John Bradshaw and Fr Paul Larelle (see Bradshaw et al, 1983). Drawing on this research and his own investigations Fr. Power concludes that the typical heroin user was an unemployed male, aged 17-23, poorly educated, alienated from community, society, and criminally involved (Power, 1984). This argument quite clearly places etiology in the realm of socioeconomic deprivation (see Chapter two). Similar conceptualisations are seen throughout the 1980s and 1990s (Power, 1987; Hannon, 1991).

The author also, however, expresses moralistic overtones remarking that addicts:

“although baptised Catholic…. [they do not] go to church [except] when in detention or for the purposes of attending the marriage, baptism, or funeral of a close relative or friend” (Power, 1984).

Furthermore, the author argues that addicts fundamentally lack self-control harming themselves and society. Since, as the author argues, self-control is fundamental to the Christian way of life, addicts are incapable of living such a life (Power, 1984). The author also expresses the opinion that pop music: “the words of which are unintelligible to the average adult, sustains this illusion drugs are safe] and indeed, popularises the drug culture among the young” (Power, 1984). In sum then the Church’s initial conception of drug addiction while based, at least superficially, on the notion of socioeconomic deprivation as causative, is also highly moralistic (at one point addicts are described as mentally immature), and reflects broader societal and religious anxieties surrounding social and cultural change. In the 1980s the medical profession also became deeply concerned with the issue of opiate addiction in Dublin.

158 For example, Carr et al (1980) recruited from a cohort of 100 drug abusers who attended a drug advisory and treatment centre attached to a large general hospital in central Dublin (Carr et al, 1980). In the study a drug abuser was defined as someone who takes psychoactive drugs and suffers medical, psychological, or social complications as a result (Carr et al, 1980). The study mentions previous research which found that drug abusers were disproportionately found among the working classes (Carney et al, 1972; Kelly and Samman, 1975; referenced in Carr et al, 1980). Interestingly the two largest groups of drug abusers in the study were found to come from the working class (largest group) and the lower-middle classes, who were labelled self-medicators (Carr et al, 1980). Those from the working class, labelled “extragressors” in the study, were found to be more likely to suffer family inadequacies, be poorly educated, unemployed, unmarried, and male (Carr et al, 1980).

Interestingly, the second group (self-medicators) are ignored in subsequent research studies in this period. Crucially, this conceptualisation is not justified in any of the studies, it is simply adopted axiomatically. For example, Barry (1988) portrays addiction as the result of vulnerable communities with large families, high rates of unemployment, and few recreational facilities. This trend is repeated in multiple studies in this period (see Kinsella et al, 1990; Thornton et al, 1990; Keenan et al, 1993). It is argued that the reason for this development is threefold. Firstly, drug use is usually only problematized if those using the drug come from a powerless social group (Courtwright, 2009). Certainly, the “extragressors” are a much less powerful social group than the lower-middle class “self-medicators”. Secondly, with the rise of HIV/AIDS in the 1980s it is not surprising that heroin use becomes more problematized than the use of barbiturates or minor tranquillisers. Thirdly, the research studies referenced state that the extragressors were more likely to obtain drugs illegally, whereas the “self-medicators” were more likely to get drugs on prescription form a doctor. Regardless, this demonstrates that the conceptualisation of addiction in this

159 period was more of a political accomplishment than an objective medical categorisation.

If one examines media articles concerning the etiology of drug addiction in this period, several interesting themes emerge. Etiology is variously located in the problems of teenagers growing up in a “confused world” and lacking religious faith (Evening Herald, 1970: January 16th, Page 4), socioeconomic deprivation (Irish Press, 1970: December 10th, Page 11), the pharmacological effects of the drugs themselves (Irish Independent, 1979: February 26th, Page1), and aggressive “pushing” by drug dealers (Sunday Independent, 1970: December 10th, Page 11). Ultimately, however, in the majority of articles, drug addiction is linked to pathology, in particular individual pathology – although in some cases community pathology is mentioned.

It should be highlighted that there was a limited counter-current among various social movements and a sole T.D (Tony Gregory), which proved to be an exception to this stigmatization, moralism, and panic. For example, throughout the 1980s Tony Gregory, a T.D for the north-inner city (an area with the most severe heroin problem), continuously raised the issue of increased funding for drug treatment (Dail, 1985), the development of new treatment facilities (Dail, 1985), and crucially whether or not the government would commit to the view that drug addiction was concentrated in areas of social and economic marginalization (Dail, 1985; 1986; 1988). However, despite the Government’s rhetorical commitment to deliver on the issues Gregory raised, his views were largely ignored in the 1980s. Indeed, in a 1985 debate (Dail, 1985), he states:

“I do not want to accuse the minister of ignoring or covering up on the questions, very important questions in regard to the treatment of heroin addiction”

160

Furthermore, while there is some evidence that groups such as the Concerned Parents Against Drugs (CPAD)62 movement and the Coalition of Communities Against Drugs (COCAD) were interested in issues of social and economic marginalization as they related to drugs, they tended to focus on community action against drug dealers, and drug prevention and education activities (See Cullen, 1991; 1994). In any case, while the Gregory deal (see Cullen, 1994) brought increased investment to inner-city communities and placed the issue of a lack of state investment on the political landscape, these community groups tended to be demonised by the government and media for alleged links with vigilantism and the IRA.

Crucially for the current argument, apart from these limited counter currents, broader socio-cultural and political-economic developments are not considered to any great extent in the 1980s. This is unfortunate as the 1980s was characterised by high emigration, unemployment, deindustrialisation (which saw working class jobs all but disappear). Social research in Ireland has demonstrated how these processes and developments contributed to crime, addiction, and disorder in Ireland (see for example O’Mahony, 2008). However, the individualising, moralising and stigmatising discourse which posited addiction causation as the result of some pathological feature of the individual or, in some cases the community, obscured these broader structural forces.

62 A movement formed by parents in the inner-city in Dublin in response to high levels of drug abuse. They were accused on vigilantism and associations with the IRA by the government and media (see Cullen, 1991; 1994).

161

The celtic tiger. (1993/1994-2008)

At the beginning of the 1990s by European standards, Ireland was quite poor – high unemployment, high levels of poverty, and low growth (Jackson, 1999). The reasons for the rapid economic growth that followed are debated, however, from the early 1990s to the year 2000, Ireland was transformed from one of the poorest to one of the wealthiest countries in Western Europe63 (Ferriter, 2004). However, income inequality, addiction, crime, and suicide rates also increased dramatically. The Irish Sociologist Kieran Keohane explains these seemingly contradictory developments by recourse to a rapid socio-cultural and politico-economic transformation:

“The experiences of accelerated modernization, whether in eighteenth century France, nineteenth-century England, or in globalized contemporary Ireland are defined by the coexistence of dialectical oppositions […]. Even as modernity 'delivers the goods' as it were, of affluence, of health, of political liberty and freedom of choice, it generates new problems: […] secularization is accompanied by existential anxiety, inner loneliness and boundless egoism; […] the dissolution of the authority of tradition is accompanied by normlessness and social disconnectedness; […] global labour markets and rationalized organization generate new forms of exploitative divisions of labour, insecurities, inequalities and alienation.” (Keohane, 2008: 119-120).

This quote perfectly captures the tensions present in the widespread socio-cultural and politico-economic transformation in Ireland in the 1990s, and in particular, the 2000s.

63 It is recognised that it is complicated to measure wealth. However, in terms of GDP, GNI, Private wealth and other indicators Ireland consistently ranks as one of the wealthiest countries in Western Europe. However, it should be pointed out that there are significant regional differences within the country itself (West is poorer than East for example; for discussion see Allen, 2007).

162 While Ireland had become rich, it had also become deeply unequal and would suffer all the consequences of this in the years to come. In terms of addiction, the most noticeable developments are the increased influence of a parallel discourse in relation to population consumption models, operating alongside the disease concept of alcoholism, and the gradual acceptance of the social deprivation/drug addiction link. These shifts in conceptualisations, as always, are intimately linked to politico-economic and socio-cultural transformations. The social-deprivation addiction link can be seen in several media articles. A letter to the editor of the Irish Examiner in early 2000 makes this point most cogently. The author argues that:

“. . . with an unprecedented amount in the exchequer it is high time we to address the causes of drug addiction – poor housing, bad education, and lack of facilities; people dropping out of the education system; inadequate recreational resources, and inadequate employment opportunities” (Crowe, 2000).

The link between drug addiction and socioeconomic deprivation is also made in a 2005 article published in the Irish Independent (Doherty, 2005). The author describes the profile of a typical drug addict as a young male, unemployed, insecurely housed, and poorly educated. This link is made in numerous articles from the 1990s onwards (Daily News Correspondent, 1993a: May 7th, Page 12; Daily News Correspondent, 1993b: July 11th, Page 18). While it has already been argued that initially, the Government viewed addiction as the result of some kind of individual moral failing or pathology, this changed in the closing years of the 20th century. Perhaps one of the earliest indications of this shift can be seen in a statement by the Minister for Health Deputy Noonan in his response to a question in relation to treatment services for drug addicts. He outlines the Government’s response to drug misuse, in particular, heroin misuse in Dublin, which for the first time included a committee investigation which:

163

“…examine[d] the root social factors which give rise to drug misuse in the Dublin inner-city area” (Dáil, 1996b). This shift towards social deprivation as causation can also be seen in a 1997 Dáil discussion on drugs and drug addiction. Deputy Flood points out that various committees have concluded that the problem of heroin abuse is concentrated in the most socially and economically deprived parts of Dublin” (Dáil, 1997).

Therefore, he argues, a solution to the drugs problem is to be found in the area of social inclusion (Dáil, 1997). Meanwhile, Senator Norris argued in a Seanad discussion on the National Drugs Strategy (Seanad, 2007) that: …”the vast majority of casualties from drugs are from clearly defined social categories and postal districts in Dublin…” This portrayal is seen in numerous contributions offered in the houses of the Oireachtas (Dáil, 1998, Dáil, 1999, Dáil, 2001, Dáil, 2007).

The reasons for this shift in conceptions demonstrates that the Government were more influenced by politico-economic and socio-cultural developments than a concern with objective policy making, based on scientific evidence. The first point to make concerns a report published in 1984, commonly referred to as the “Bradshaw report” (see O’Mahony, 2008). In this report, the authors found that addiction was clearly linked to social deprivation (other studies came to a similar conclusion see O’Gorman, 1998 for overview). However, the Government suppressed the research findings, reaffirmed their belief that addiction was down to individual pathology and personality differences, and randomly distributed across society (Butler, 1991; 1996).

164 Interestingly, the report was later leaked, much to the Government’s embarrassment. However, in the closing years of the 20th century and with the release of a series of government-backed reports, the social deprivation – addiction link was accepted, and a harm reduction philosophy adopted (Rabbitte, 1997; Ryan, 2001; Ahern, 2005). This included the setting up of needle exchanges, methadone maintenance, and the creation of the drugs task force – government-funded counselling, community and psychotherapy services in the most disadvantaged communities. How do we explain this radical change?

In short, this was due to the advent of the Celtic Tiger. In an affluent society, the existence of a drug problem concentrated in certain communities seemed problematic. As the rest of society was deemed to be functioning relatively well, the idea was that by enacting specific policies, these areas would eventually catch up with the rest of the country. This is representative of what Jock Young has called liberal othering (Young, 2007). In short, the problem in these communities was viewed as their lack of material means, in comparison to the rest of the community. Ireland as a whole was seen as functioning in economic, social, and cultural terms for the most part, and by investing in better services in these communities, the issue of drug addiction would be solved.

The Celtic Tiger also witnessed a dramatic change in alcohol policy. In this period, the disease model of alcoholism is challenged by the emergence of a parallel discourse which highlights population-based arguments in relation to alcohol problems, a development which is rooted in a neoliberal risk-based discourse. Deputy Ormonde expresses a clearly articulated shift in thinking in this regard, in relation to underage drinking. She argues: “research undertaken by the Mater Dei institute has proven that when alcohol is less available and less convenient to purchase, there will be less consumption” (Seanad, 2001). She continues by arguing that: “alcohol-related problems

165 will be lowered if we can confine the number of sales outlets” (Seanad, 2001). The clear implication here is that in order to tackle alcohol-related problems the population at large, rather than individual alcoholics, must be the target of intervention. In this debate, no mention of alcoholism as a disease is made, and it is obviously the case that the programme “living and choosing”, with its emphasis on population drinking habits, is becoming highly influential in governmental thinking.

In terms of the medical profession, an article published in 2004 also demonstrates this shift to viewing alcohol problems as intimately linked to total population consumption levels (Curtin, 2004). However, for the most part the medical profession is concerned with advocacy work, which attempts to establish minimum pricing laws and to put restrictions on alcohol advertising rather than publishing research, which demonstrates that alcoholism is linked to total population consumption levels (Butler, 2010). This is perhaps due to the evidence demonstrating this point coming from the WHO. Indeed, in submissions to the Government advocating stricter advertising standards and minimum pricing, the medical profession often quote this research (Butler, 2010). The media, like the Government, in this period come to view alcoholism as directly related to total population consumption levels.

Virtually every article which examines the “alcohol problem” focuses either on reducing supply or demand. In terms of supply, suggestions include the introduction of more restrictive licensing laws (O’Hanlon, 1995; Foy, 2000). On the demand front, there are calls to ban alcohol advertising (Donlon, 1999; Eviston, 2000), and extend education programmes to warn of the dangers of excessive alcohol consumption (Eviston, 2000; Foy, 2000). The justification for such an approach seems to be based on a conception of individuals as rational utility-maximisers, derived from economic theory (see Hodgson, 2012). In other words, if alcohol becomes increasingly expensive and less available, if

166 the person is exposed to less alcohol advertising, and is more aware of alcohol-related harms, then they will realise that the cost of drinking outweighs the benefits and subsequently drink less. This, in turn, will lead to a reduction in average population consumption levels and, therefore, to less alcoholism and drink-related problems in general.

This type of thinking is evident in a number of newspaper articles in the period. Take for example, an article published in 1999 entitled: “Cardinal takes issue with failure to deal with drink issue” (Donlon, 1999). The article quotes Rd. Michael Woods as stating that: “Alcoholism is without a doubt the greatest single source of human misery in Ireland today” (Donlon, 1999). In terms of solutions, the article suggests that warning labels should be placed on all alcoholic drinks, access to alcohol should be restricted, and alcohol advertising should be significantly curtailed (Donlon, 1999). If we turn to a letter to the Editor of the Irish Independent dating from the year 2000 we see a similar concern and proposed solutions. The concerned citizen argues that during the festive period, alcohol consumption is particularly excessive and turns: “sober Dr. Jekylls into drunk and dangerous Mr. Hydes” (Eviston, 2000). His proposed solution is to ban alcohol advertising, though he admits the power and wealth of the alcohol industry would make this quite difficult (Eviston, 2000).

This point is made in even more dramatic fashion in a 2005 article published in the “Western People” entitled “Descent into alcoholic anarchy” (Daily News Correspondent, 2005: January 26th, Page 5). The proposed solution to this “alcoholic anarchy” is indicative of the supply and demand logic. It is argued that increased disposable income is to blame for the supposed increase in alcoholism. To remedy this, it is proposed that young people’s access to alcohol should be restricted, the legal drinking age should be increased to 21, and advertising that portrays alcohol in a glamorous light should be

167 replaced with ads which highlight the harms caused by alcohol consumption (Daily News Correspondent, 2005: January 26th, Page 5).

The increased influence of population consumption models can be explained by reference to a number of factors. Firstly, the decline of the Catholic Church and the increasing power and influence of the medical profession and international bodies, such as the WHO, are vital to consider (see Butler, 2010). Secondly, a shift in how individuals are expected to manage threats to their ability to act responsibly is equally as important. In the previous period, threats of this nature were viewed as intrinsic to the individual (genetic, biological, and psychological.), whereas in the current period, these threats are viewed as extrinsic (in the form of positivistic risk factors). This shift must be viewed within a changing social context, and particularly, a change in how social problems are responded to in Ireland. In the past, specific types of individuals (the fallen mother, the poor child, the alcoholic or mentally ill man) were deemed to have a particular condition that warranted some form of institutionalisation (Magdalen laundry, industrial school, or psychiatric facility) or management (AA meetings, confession). In this context, the alcoholic as a person who was deemed to have a particular disease or illness (something wrong with them in and of their being) made perfect sense. However, in contemporary neoliberal Ireland, given that the management of social problems has gradually shifted from a focus on causes to risks (see the next section for more), population consumption models seem to be more prominent.

Boom to bust (2008-2018)

In this period, we witness a shift from discussions of causation towards an overt focus on the risks associated with substance use. This can be seen among all of the various claim-making groups. Furthermore, this focus on risks tends to obscure discussions of

168 the impact of large scale economic restructuring on patterns of harmful alcohol and drug use. These trends are, of course, linked to the banking and financial crisis in Ireland. From 2008, onwards the Irish economy fell into financial crisis. Many commentators have argued that this was due to an imploding construction sector, which rendered the country economically uncompetitive (Honohan, 2009; O’Sullivan, 2010; Clark and Hardiman, 2012). The 2007-08 worldwide financial crises exacerbated this crisis. The result was that the country fell into recession for the first time since the 1980s, while emigration and unemployment rose sharply (Duffy, 2012).

The long-term effects of this political-economic restructuring are still, of course, unknown. However, in the short term, this led to mass unemployment, mass emigration, a homeless and housing crisis, a healthcare crisis, a general slashing of the budget of various essential social services, and an increase in short-term precarious employment (Conefrey et al, 2014). In socio-cultural terms, it is hard to say what the impact has been. However, there does seem to be some identifiable trends. Sociologists and political commentators of various orientations have argued that these political- economic measures have increased the probability that children from socially deprived areas will experience socio-emotional problems (anxiety and mood disorders, for example, see Layte and O’Reilly, in press), have contributed to increased levels of suicide (Corcoran et al, 2015), and led to the worst homeless and housing crisis in the history of the state (Baker, 2017; Reid, 2018). While it is difficult to map out shifts in addiction concepts in this rapidly changing terrain, there does seem to be an identifiable trend.

In short, the post-2008 political-economic and socio-cultural crisis has led to a shift in focus from the cause of addiction per se to the risks associated with various forms of drug and alcohol consumption. Evidence of this can be seen among all of the claim-

169 making groups. In the media, for example, the primary focus of commentators in the post-2008 period is on the spread of addiction throughout the country. Consider an article in the Connacht Tribune from December 2010 (Mackay, 2010). The article argues that Galway is in the grip of a heroin crisis and that there are hundreds of addicts in the city. Furthermore, it is argued that seven out of every 1,000 people in Ireland is addicted to heroin, one of the highest rates in the EU (Mackay, 2010). Other articles express a fear that heroin addiction had spread to Kerry (Brouder, 2010), Waterford (Dwyer, 2016), and several regional towns in Munster (see O’Keeffe, 2017).

However, such a discourse is perhaps most evident in a 2011 article published in “The Irish Times”. Una Mullally argues that in rural areas, heroin users are getting younger. In the past three decades, heroin use has spread from inner-city Dublin to its suburbs and other cities and is now available in almost every town (Mullally, 2011). Furthermore, the article focuses on a range of risks associated with drug use, in particular polydrug use, the use of so-called “head shop drugs”, and the risk of overdose (Mullally, 2011). Numerous other articles focus on these risks and others, including, the consumption of alcohol and violence (Buckley, 2015), drug and alcohol consumption as precipitating factors in suicide and attempted suicide (Gleeson, 2014; Barry, 2016), as well as the strain such consumption is having on the healthcare system (Murray, 2013), and the criminal justice system (O’Keeffe, 2009). Ultimately, in analysing the risks resulting from alcohol and drug consumption, such articles fail to examine the political-economic and socio-cultural context which may make such risk- taking increasingly likely.

The Catholic Church has, in general, followed a similar trend. Similar to the media, the Church also views alcohol as problematic due to its perceived etiological relationship to suicide (Hogan, 2001; Hegarty, 2002; O’Sullivan, 2010), and homelessness (McVerry,

170 2001). Furthermore, there appears to be an attempt by some authors (O’Conaill, 2008) to portray alcohol as the cause of sex abuse and violence, issues which some commentators have implicated the Church and Catholic teachings in. In sum then the Church in contemporary Ireland seems much more interested in analysing issues to do with suicide, homelessness, societal change, as well as its own decline, rather than alcohol and drug-related problems in and of themselves. Where concern about these problems is expressed, it is in relation to their impact and associated risks as opposed to strictly causative concerns. This focus on risks, as opposed to causation has, as mentioned, been identified by numerous commentators as a hallmark of Neoliberal ideology (see Seddon, 2010 for example).

The medical profession too manifests an increased interest in risk. In the profession’s scholarly journals, this manifests itself in concern over polydrug use and alcohol-related admission to hospital A&E departments. In terms of polydrug abuse, this manifests in relation to the mixing of benzodiazepines and heroin among the socially deprived and homeless (Barry and Ward, 2001), and also alcohol and cocaine among the middle-classes (Lynn et al, 2010). The focus on hospital admissions can best be seen in a research study that examined alcohol-related admissions to an intensive care unit in Dublin (O’Brien et al, 2010). Though the article focused on intensive care admissions, it also implicates alcohol misuse with a range of other harms. The authors state: “Additionally, alcohol misuse is associated with a variety of other harms including accidents, trauma, child neglect, relationship difficulties, public safety problems, and productivity loss” (O’Brien et al, 2010: p. 405). Despite the sweeping nature of this claim, no evidence or context is provided, it is simply asserted that this is the case but never expanded on or analysed.

At a policy level, the medical profession has been extensively involved in lobbying the

171 Government for the introduction of minimum pricing laws concerning to the sale of alcohol and a ban on alcohol advertising (Butler, 2010). The reasoning behind such arguments is that by making it more expensive to purchase alcohol and reducing the exposure of people to alcohol, then supply and demand will be calibrated in just the right measure to ensure that consumers are disincentivised from purchasing alcohol. The aim of such policies is explicitly to reduce alcohol related harm, in particular, underage drinking, alcohol related violence, domestic abuse, and admissions to the A&E. In government debates (see Butler, 2010), such thinking culminated in the Public Alcohol Bill (2016), which allowed for the introduction of minimum pricing laws, restrictions on alcohol advertising, and other measures advocated by the medical profession as previously mentioned. While many commentators argue that the Bill does not go far enough and the Government has come under the undue influence (lobbying, etc.) from the alcohol industry, in particular, the Vintner’s Association (see O’Keeffe, 2017), this Bill represents the culmination of a neoliberalisation of Irish alcohol policy.

In terms of drug policy, this process of neoliberalisation culminated in the 2017 publication: “Reducing harm, supporting recovery: A health-led response to drug and alcohol use in Ireland”. Throughout the document, there is an explicit shift away from discussing causation and towards risk, minimising risk, inter-agency co-operation to contain disorder among those groups at risk and, in particular, the need to minimise the risks associated with intravenous drug use (Irish Government, 2017). This has led to the passing of legislation allowing for public injecting centres, the expansion of needle exchange, and other harm reduction type measurers (Irish Government, 2017).

In sum, conceptualisations of addiction in Ireland in the post-2008 period are intimately linked to radically altered political-economic and socio-cultural contexts. In response to this crisis, Ireland, like numerous other jurisdictions, has fully embraced the ideology of

172 Neoliberalism, not just as an economic ideology, but as an all-encompassing response to a host of economic and social problems – of which addiction is one. This has obscured discussion of how these structural readjustments may condition patterns of harmful alcohol and drug use. Ultimately, this has resulted in a shift from focusing on the cause of drug and alcohol addiction, towards an increased focus on the risks emanating from the consumption of alcohol and drugs. These discussions of risks typically focus on risks associated with particular “problem populations” (homeless, IV drug users, socially deprived, youth, “at risk families”), which tends to obscure understandings of substance use among other groups (say wealthy prescription drug users, or middle class cocaine users), and also obscures political-economic and socio- cultural developments which may put these “problem populations”, “at risk of experiencing risks”, thus making it easier for them to be stigmatised as deserving of their fate when they fail to take heed of the newly available harm reduction supports.

Indeed, the recent political moves to decriminalize drug use in Ireland (see Bray, 2019) demonstrate this failure to consider structural forces which put certain populations at the “risk of experiencing risks”. This political move to decriminalize drugs has led to legislation being drafted, which would see a health-based response for a person caught with drugs on their first and second occasion and then a criminal justice sanction thereafter. However, this approach would likely only benefit recreational or occasional users and not those populations whose use has become more harmful. Therefore, it lacks any significant consideration of how structures condition patterns of drug-taking.

To conclude, Bacchi (1999) emphasizes that the purpose of this question is to challenge any search for origins or any suggestion of some easily traceable evolution of policy. Rather, the objective is to bring to light the plethora of possible alternative developments. For example, had the Irish Government pursued an economic policy

173 based on an imperative other than liberalization in the late 1950s, it is perfectly possible that an alternative trajectory in understandings of alcohol-related problems, would have unfolded. This question then demonstrates that as our current understandings of addiction could have been different, they can also be constructed differently in the future. We will now turn to question four

What is left unproblematic in this problem representation? (Q4)

According to Bacchi (1999), the key issue that is to be tackled in question four is an in-depth reflection and consideration of issues and perspectives which have been silenced by the dominant problematisation process. The central point is to destabalise an existing problem representation by drawing attention to silences within it. As we have seen, the portrayal of addiction as an actually existing condition has led to drug using populations, or at least drug use and drug addiction, being seen as a corrupting influence in an otherwise well-functioning Irish society. Furthermore, as this chapter has demonstrated, the addiction construct develops a particular configuration at a particular time due to historical and contemporary power struggles, and broader political-economic and socio-cultural developments. Importantly, however, once the addiction concept becomes attached to individuals and groups it becomes part of their sense of self, or serves as an imposed subjectivity. However, the ability to problematize a particular group’s drug use, or indeed the ability of some groups to resist problematisation, is deeply influenced by their level of power, particularly symbolic power64 (Bourdieu, 1989). This is an issue that has been silenced by the dominant problematisation process.

Indeed, one of the first media articles to deal with a drug problem in Ireland is concerned with the use of Amphetamine Purple Heart “pep pills” by nurses. The author states that: “among

64 Symbolic power includes nontangible markers of class distinction. This could include the possession of rare paintings, speaking in an upper class accent, or having a high degree of respectability or prestige in one’s community

174 nurses, drug addiction, on a minor scale is inevitable” (McNiff, 1964). This article caused a significant controversy with the Irish Medical Association penning a rebuttal in the same paper a week later (Sunday Independent, 1964a). Interestingly, the “letters to the editor” section of the newspaper the following week contained letters, purporting to be from nurses, both agreeing with (Sunday Independent, 1964b) and condemning (Sunday Independent, 1964c): “the sentiments expressed in the original article”. Towards the end of the 1960s, this focus on Purple Heart abuse. in the media intensifies significantly with one paper even asserting that the Purple Heart pill was a: “pill of dynamite” that always led to “… despair, degradation, and misery” (Evening Herald, 1964). Consider the different reactions to revelations of drug use among this group, to similar revelations of heroin use among the socially deprived in 1980s Dublin. Keep in mind that the impetus to conduct academic research and governmental investigations in inner-city Dublin in the early 1980s came from a number of newspaper editorials (see O’Gorman, 1998). It seems uncontroversial to say that members of both groups had negative experiences with psychotropic substances under particular social conditions. However, the process through which these experiences were understood, conceptualised, and responded to within the broader society was far different. The nurses, backed by a powerful group – the Irish Medical Association – were able to resist and critique claims that a number of them were drug addicts. This was a label they did not want associated with members of their profession, and it was a way of being which seemed anathema to their respectable position within Irish society (by virtue of their profession and class position).

Indeed, the issue of “Purple Heart” use in 1960s/1970s Ireland has not previously been written about, no scholar who has analysed the development of Irish drugs policy or attitudes to drug use has mentioned it. If one examines debates and discussions in the houses of the Oireachtas, again there is not a single mention. There was no legislation, criminal or otherwise, passed to tackle the problem of “Purple Heart” use, as happened when heroin use became a “problem” in Dublin (see O’Mahony 2008 for an overview). Importantly, the nurses themselves due to their position within Irish society were able

175 to partake in a negotiation (debate, critique, counter-critique) whereby their drug use did not result in them being identified as particular type of people by virtue of their use. This is in marked contrast to the heroin users who took part in no such negotiation. One does not find letters to editors of newspapers from members of the unemployed heroin using groups arguing for or against the existence of a drug problem among their ranks. By and large, the way their drug using experiences are defined and conceptualised excludes them from the negotiation. This exclusion means powerful claim making groups craft particular subjectivities from their (heroin users) drug using experiences, without their input. This in essence represents the imposition of a stigmatised subjectivity. Their drug use becomes not just another facet of what they do, or who they are, but an all-encompassing sense of self, one which becomes imposed as a result of a negotiation between the Government, media, treatment regimes, and other claim- making groups. Two further examples of this are readily apparent in the media. The first is the contrast between reactions to drinking among prison staff, and the discourse which emerges concerning teenage binge drinking. The second concerns the representations and reactions of middle class and student cocaine use.

If we examine the reaction to “alcoholism” among prison staff, the issue of power distributions and imposing subjectivities can be seen clearly. An article published in 1995 refers to research which found high levels of alcoholism among prison staff (Brady, 1995). Due to this, a programme to deal with alcoholism among prison staff was commissioned by the Justice Minister Nora Owens (Brady, 1995). However, throughout the article both the reporter and those he quotes, continuously points out that the vast majority of prison staff would not need to avail of this programme (Brady, 1995). This is in complete contrast to the portrayal of binge drinking. To take one example, an article published in 2000 (Bielenberg, 2000) quotes Gerry Cooney (Ruthland treatment centre) as stating unequivocally that: “Ireland has a teenage drink problem” (Bielemberg, 2000). This statement is based on comparative European research, which demonstrates that

176 Ireland has one of the highest rates of teenage binge drinking in Europe (Bielenberg, 2000). However, this research is no more or less indicative of a widespread drinking problem among a particular group than the research quoted in relation to Brady (1995). However, the reactions and representations are vastly different.

It is argued that the deferential attitude towards prison staff which stresses that the majority of them have no problem with alcohol is due to the level of power, prestige, and respectability they possess within Irish society. Put simply, any attempt to impose an alcoholic subjectivity on this group would be resisted, as was seen previously with the nurses. Indeed, apart from this article the issue of alcoholism among prison staff is never again discussed. In contrast, and much like the socially deprived heroin users, teenage binge drinkers have very little power to resist this portrayal of them and their drinking. As previously argued, Irish society witnessed a dramatic transformation in the 1990s. The resultant generalised anxieties which emerged from this period were,in part, articulated in concerns about drinking and drug use. This is in line with the portrayal of psychoactive substances as the corrupters of otherwise well-functioning societies. However, groups with power are largely able to avoid having their use of psychoactive substances portrayed in this manner. Powerless groups, in contrast, have stigmatised subjectivities such as alcoholic, binge drinker, or drug addict imposed on them. This ultimately is a way of individualising generalised anxieties and obscuring larger social forces.

The representations and reactions to middle class and student drug use are also indicative of this issue. Consider the reaction of a medical doctor, in a 2006 article, to the issue of cocaine users refusing to admit they have a problem. He argues that: “despite the indifference of many middle-class coke users, the reality of taking the drug is that it comes with serious health risks…” (Horan, 2006). Furthermore, he argues that

177 these users are becoming warped in their thinking by refusing to admit they have a problem. Another article features a doctor highlighting that the middle-class students are refusing to take his advice and admit they have a drug problem, often seeing their use as little more than recreational (Daily News Correspondent, 2000). This is in marked contrast to the discourse in relation to drug use among the socially deprived. Here we find no mention of resistance to the problematisation of their drug use. As mentioned, this is partly due to their lack of power and inability to resist. Moreover, in this period (early 2000s) research studies which (EMCDDA, 2006; HSE, 2006) examine cocaine use tend to focus on health risks associated with cocaine use, rather than the social characteristics of users.

This could plausible be a result of cocaine users coming from more middle-class backgrounds (this may be changing in more recent years). That is, any attempt to highlight social deficits among cocaine users (i.e. something about their social world), would have been resisted by this group. Indeed, it is often axiomatically assumed that the middle class have attained a valuable social position and their environment is seen as the ideal, which the deprived strive for (Jock Young, 1999 has called this liberal othering). To return to the example of socially deprived heroin users in 1980s Dublin, what is interesting is that an early publication by a priest and medical practitioner, excludes a group of identified “middle class” heroin users. What is of particular interest, however, is when Fr. Power mentions that:

“Before I decided to close the sample there were indications that there were other heroin users in the borough, coming from middle-class families, less inclined to frequent the streets and not as accessible as members of the sample”(p. 86-87).

178 His reasoning for excluding these members from the sample is as follows:

“To follow up the new avenues of investigation, however, would have delayed the production of a report the main purpose of which was to establish that a grave drug problem existed (P. 87)”.

As mentioned by Power (1984), the report aimed to establish that there was a very serious problem rather than to thoroughly investigate the heroin using population and their social characteristics. This is the reason given for the authors closing the sample and excluding the identified group of middle-class heroin users. This plausibly represents what I have called imposing subjectivities. The research aims (establishing that there is a grave problem) of powerful claim-making groups, their underlying assumptions, the limitations of research data – conditioned by socio-cultural factors (i.e. the relative invisibility of middle class heroin users), all contributed to the creation of the heroin- social-deprivation link. This link is then strengthened by researchers who go into these communities , and through social workers, and community workers (groups high in symbolic power and unlikely to operate in middle-class communities), recruit addicts from such communities, and claim to demonstrate an authoritative link between heroin use and social deprivation.

It should be mentioned that it is not being argued that no such link exists – it does in some form. However, the exclusion of the middle- class user group, and the other problems highlighted together with the exclusion of the socially deprived heroin users from the process of constructing this socially deprived heroin user subjectivity, limits the type of knowledge that is produced in relation to addiction, and represents what I have called imposing subjectivities.

179 It seems, therefore, that question four in our WPR framework has been successfully addressed. It is now necessary to address the fifth question in Bacchi’s framework (1999). That is, what effects are produced by this representation? As this question has been addressed to some extent, the next section will largely involve a summary of points already made.

What effects are produced by this representation? (Q5)

The goal of question five in the WPR framework is to identify the effects of specific problem representations so that they can be critically assessed (Bacchi, 1999). Crucially, by effects Bacchi (1999) means political implications rather than specific outcomes that we can identify and measure via research studies. As we have seen, the political effects of this dominant representation are multiple. Firstly, addiction has been portrayed as a corrupting influence in an otherwise well-functioning Irish society. This has obscured broader social, political, and historical determinants, which can plausibly be said to condition addiction. Furthermore, this has led to an arbitrary distinction between addicts and non-addicts, and the view that there is a sharp and fundamental distinction between addiction and normal functioning. Finally, it has led to the imposition of a stigmatized subjectivity on vulnerable populations of drug users, who are rarely consulted in discussions of addiction, and whose lived experience is only occasionally drawn on in the literature (see the work of O’Gorman, 2005; 2016 and Mayock, 2005 for notable exceptions).

Ultimately, these effects occur regardless of which model we are discussing (population consumption, disease, social deprivation, etc.), and this is probably due to the tendency among Irish addiction researchers and providers to eschew detailed philosophical, political and ideological debates (see Butler and Mayock, 2005) and discussions concerning addiction, in favour of pragmatic and bureaucratic measures. Indeed, it is arguable that this portrayal is inevitable given the view that addiction is associated with social exclusion, a view that portrays

180 society as relatively well functioning apart from a minority of excluded communities (see Young, 2007) who suffer as a result of their social deficits. As we will see in the next chapter, these effects enable mechanisms of symbolic violence (Bourdieu, 1989) to operate unchallenged and to individualize addiction at the level of the socially, culturally, and politically embodied drug user. The final task then is to address the sixth and final question in Bacchi’s (1999) framework. This question is concerned with the production, disseminationand defence of the dominant representation.

How/where has this representation been produced, disseminated/defended (Q6)

Finally, the sixth question in Bacchi’s (1999) framework is concerned with paying attention both to the means through which some problem representations become dominant and to the possibility of challenging problem representations that are judged to be harmful. The primary goal in question six then is to raise the possibility of contention. This question has been addressed specifically in question three, but also more generally throughout. That is, this representation is produced, disseminated, and defended in the contested fields of media publications, governmental debates, and legislation, the medical profession’s publications as well as the Catholic Churches publications.

In particular, this representation is produced and disseminated through the seemingly objective use of scientific evidence, while simultaneously obscuring socio-cultural and political economic interests. For example, the medical profession draws on research which purports to demonstrate a link between total population counsumption levels and alcohol-related problems, as a means of justifying economic controls (e.g. minimum unit pricing) on alcohol sales (see Gleeson, 2014; and Barry, 2016). However, Moore and Hart (2014) have convincingly argued that this representation is based on a number of simplifications and political-ideological assumptions. For example, this

181 assumes that alcohol is a stable agent which influences people on predictable ways, and de-emphasises the importance of social context and cultural meanings in producing alcohol effects.

Similarly, the dominant representation of the relationship between drug-related harm and deprivation, assumes that the relationship is best captured by the social deficits (or risk factors) which exist in deprived communities. As previously argued, this is particularly visible in Governmental policy documents (see Irish Government, 1996; Irish Government, 2001: p. 22; Irish Government, 2009: p.28; Irish Government, 2017: P. 63). Of course, this focus on risk factors and social deficits is related to strategies of responsibilisation which are quite prevalent in neoliberal policy processes (Goddard, 2012). Most importantly, it obscures the role of structural issues in creating risks and deficits in deprived communities, as O’Gorman (2016) has highlighted.

The coming chapters will disrupt this representation and argue for an alternative approach by combing a novel theoretical framework with the lived experience of our study participants. This, it is argued, can contribute to a more theoretically convincing, and philosophically and ideologically transparent approach to the study of addiction in Ireland.

Discussion and conclusion

How is it the case that alcoholism and drug addiction in contemporary Ireland has come to be conceptualised as health problems of pathological individuals and or communities? The first branch to note is the origins of the tendency to categorise people who use alcohol in ways that are deemed excessive, as “distinct” kinds of people. This tendency has its roots in the invention of the motor car (late 30s/early

182 40s) and associated concerns with drunk driving, as well as fears of alcohol use outside of the confines of the law (poteen brewing, drinking in shebeens etc.). Though there was not much concern with excessive drinking overall, the drunkard was certainly seen as a distinct type of drinker. The next branch of the genealogy is the gradual acceptance of the alcoholism as a disease construct. Initially, this was more of a medico-moral construct in that treatment consisted of 12-steps Alcoholics Anonymous meetings (moral/spiritual treatment) operating alongside medical treatment in psychiatric hospitals.

As has been argued the gradual acceptance of the disease model occurred due to the Government’s liberalisation agenda winning out in the power struggle with the media and church, the internal needs of the various claim-making groups, Sackville’s organisational and theological sophistication, as well as broader political-economic and socio-cultural developments. Gradually the more spiritualistic and moralistic elements receded from governmental thinking in line with the decline of religion, the embrace of Neoliberalism, and more general socio-cultural and political-economic change. Within this context, levels of alcoholism came to be viewed as intimately connected to total population consumption levels. The culmination of this process can be seen in the Public Alcohol Bill 2016, which allowed for the introduction of minimum pricing laws, restrictions on alcohol advertising, and other measures advocated by the medical profession and based on the population consumption model. This population consumption model, however, sits alongside abstinence models in government funded treatment centres, which operate through the Minnesota model, which is basically an institutionalised version of the 12- steps, supplemented with counselling and meditation.

183 In terms of conceptions of drug addiction, as we have seen, the development here is intimately tied up with the social group using the drugs, broader political-economic and socio-cultural change, contingent events such as the HIV/AIDS crisis, as well as the power struggles between various interest groups for ownership of the “drug problem”. As we have seen, the first group of drug users to become significantly problematized in Ireland were socially deprived heroin users in 1980s Dublin. Interestingly, the impetus to study this group came initially from media articles documenting high levels of heroin use in certain inner-city communities. As mentioned, it was the media who also ran the first stories of a drug problem among a defined social group in Ireland, that is, amphetamine use by nurses. However, these stories were never met with the same level of interest by researchers due to the level of symbolic power the nurses were able to mobilise, backed up by the Irish Medical Association.

Important too, was the broader structural context. In 1980s, inner-city Dublin, there was widespread unemployment due to deindustrialisation, and the closing down of industries in manufacturing and also the docklands. This coupled with tenant housing policies that encouraged the better-off sections of the working class to move out, created an incredibly precarious position in such communities (O’Mahony, 2008). It could be argued that drug use in the context of this level of precariousness was intrinsically more threatening to the state and the status quo than amphetamine use among nurses. The same could be said of teenage binge drinking in the context of changing social and cultural mores in 1990s Ireland (Inglis, 2014), compared with the reaction to excessive alcohol use among respectable prison officers.

As mentioned, the initial response to drug addiction was to conceive of it as the result of individual level pathology. Furthermore, the treatment regimens which developed initially were based on the Minnesota model and run by religious orders (Butler, 2016).

184 This basically consisted of 12-steps methods operating alongside confrontational style approaches whereby the addict would be confronted with all the harm they had done, in order to “break them down”, so that they could then be built back up again. However, with the advent of the HIV/AIDS crisis and broader structural developments, alongside the shift towards a neoliberal social policy, the Government began to conceive of drug addiction as a socio-economic problem. Eventually, talk of causation was replaced with a focus on risks and the notion that addiction was a health problem in government thinking. However, the Government still funds abstinence based treatment regimens, which still operate according to this religious/spiritual based tradition. Furthermore, the funding of the local drugs task force by the Government reflects a more community based social approach to addiction. The field currently, then, contains abstinence based models which operate according to a quasi-religious ethos, harm reduction measures which represent the interests of the medical profession, as well as government inspired neoliberal policies which are aimed at containing disorder among the socially deprived, particularly in light of the HIV/AIDS crisis and the economic crash of 2008. Therefore, our conceptions of and responses to drug addiction are based on power-struggles between various groups to gain ownership of the drug problem, the view that the drugs used by the socially deprived are more problematic than those used by powerful social groups, broader structural changes (economic, social, and cultural), as well as contingent events.

This is the dispositive of the addiction field in Ireland, or the heterogeneous ensemble of discourses, institutions, and ideologies upon which it is structured. Addiction then can be said to be the name given to that type of substance use which threatens the status quo, occurs among “problem populations” at times of widespread structural change and economic dislocation, and comes to be conceptualised according to the ideology of dominant claim-making groups.

185 The process through which the addiction construct has come to be represented has also had some effects. Firstly, the problem of addiction has been represented as a problem of individual and community pathology (O’Gorman, 2016 labels this the “social deficits model”). Relatedly, this leads to addiction and addicts being seen as the cause of a whole host of social problems, rather than social dysfunction being the cause of addiction and the aforementioned social problems. Furthermore, this problematisation process has created a sharp distinction between addicts and non-addicts, as well as addiction and normal functioning. It has portrayed addicts as particular kinds of people with an identifiable pathological condition and undesirable and damaging characteristics. Finally, this has led to the imposition of a stigmatised subjectivity on already marginalised drug using populations, and the relative neglect of issues surrounding drug use among powerful groups. However, a focus on ideology and on the macro-level can only get us so far.

In order to say something about causation, it will be necessary to examine the issue of how addiction as an actually existing condition is understood, negotiated, enacted, and incorporated into addicts’ sense of self and how this impacts on day-to-day lives in concrete contexts. In order to understand and analyse this, it will be necessary to turn to Pierre Bourdieu’s concepts of habitus, symbolic violence, field, and capital (Bourdieu, 1989). Furthermore, it will also be necessary to draw on the concepts of structural violence and social suffering developed by Johan Galtung (1969), and Paul Farmer (2009), respectively. This will enable the presentation of a novel approach to drug addiction in the penultimate chapter.

186 Chapter Five

THE ADDICTED HABITUS IN CORK CITY

The embodiment, enactment, and rearticulation of a stigmatised habitus.

The conclusion to the previous chapter highlighted what would be required to present a novel approach to drug addiction. For this we turn to the French social theorist Pierre Bourdieu (1989; 1993) and his concepts: symbolic violence, and habitus, the Swedish sociologist Johan Galtung’s (1969) concept of structural violence, as well as Paul Farmer (2009), and Kleinman and colleagues (1997) concept - social suffering. These conceptual tools will be used to interpret and theorise the “data” collected from in- depth qualitative interviews, and to demonstrate how the addiction ideology becomes embodied, enacted, negotiated, and incorporated into people’s sense of self, in concrete contexts. The last chapter demonstrated how the ideology of addiction as an individualised, actually existing condition, came to take its current form. At a macro level, it was also demonstrated how this ideology becomes imposed on populations of drug users, as a stigmatised subjectivity

This chapter will first demonstrate how political-economic and socio-cultural developments, obscured by the addiction ideology, cause social suffering among the study participants. From here, the analysis will focus on the mechanisms by which the addiction ideology is embodied, enacted, negotiated, and incorporated into people’s

187 sense of self, in response to this social suffering. Finally, it will be demonstrated how those mechanisms ultimately individualise people’s suffering and enable them to rearticulate the dominant discourses and ideologies. Once this has been achieved the stage will be set to present a novel approach to drug addiction which draws together the materials presented in the current chapter, the previous chapter, Bourdieu’s (1993) concept of habitus, as well as new interview materials, in order to answer the research question(s).

The interviews on which the current study is based were conducted in Cork City, Ireland (as discussed in Chapter three). The single participant who isn’t analysed in this chapter is Jakub – the Eastern European participant. While he experienced many similar issues to the other participants, there were aspects of his story that were unique, and therefore, it was decided to analyse his case in-depth in the next chapter. As mentioned in Chapter three, the interviews were conducted in Cork for specific reasons. For the remainder of this chapter, however, it is important that we recall the two distinct “class histories” (socially deprived and lower-middle class) in Cork previously outlined (Chapter three), as they will become relevant when analysing the interview materials.

Now it is necessary to outline the structure of the chapter. Firstly, we will briefly recap the main elements of our theoretical framework. Secondly, this framework will be used to analyse the interview “data”. Finally, all of this information will be synthesized in the conclusion and discussion section.

188 Theoretical framework

As the theoretical framework was discussed in some detail in Chapter one and Chapter two, it will only briefly be described here to provide a reminder to the reader. There are three concepts relevant to the current chapter, and they are as follows:

Structural violence:

As mentioned in Chapter two, structural violence (like social suffering) is analytically broad as it brings together an assemblage of human problems that have their consequences in the devastating injuries that social forces can inflict on human experiences (Farmer et al, 2006). This can overcome the tendency in the Irish literature to reductively focus on biology/psychology, or simply one facet of social experience/identity – i.e. social class (see Chapter two). Structural violence can highlight how systems such as religious institutionalisation, gender, and alienation, can intersect with social class to create diverse systems and experiences of oppression. Structural violence in this research refers to the social arrangements and developments that put individuals and populations in harm’s way or demonstrably curtail their agency (Farmer et al, 2006).

Social suffering:

Social suffering, at its most basic level, captures the lived experience of distress, while exposing the often-close linkages of personal problems with social problems, thereby challenging the problematic tendency in the social sciences of focusing solely on the individual (Kleinman et al, 1997). The deployment of social suffering then is intended to demonstrate that though addiction is a historical construct, the suffering of addicts is no

189 less real, and indeed goes far beyond their drug use. This suffering actually exists in a moral, political-economic, and socio-cultural nexus, which is historically conditioned.

Symbolic violence:

As mentioned in Chapter two, there are three specific mechanisms of symbolic violence that are relevant to the current research. These are: (1) misrecognition; (2) condescension; and (3) complicity/consent. Misrecognition (see Chapter two for more detail) is the process whereby power relations are perceived not for what they objectively are but in a form that renders them legitimate in the eyes of the beholder (Bourdieu and Passeron, 1977). Condescension can be seen when a powerful individual or group temporarily suspends the power hierarchy between themselves and the dominated in an apparent attempt to help or assist, but in this apparent act of “reaching out” the dominant actually end up reinforcing the hierarchy and obscuring structural violence – thus shoring up their position in the hierarchy (Bourdieu, 1993). Finally, complicity/consent refers to the way the social order is inscribed on the body through the learning and acquisition of dispositions. Basically, complicity/consent refers to the dominated coming to embody the ideologies of the dominant in terms of their perceptions, predispositions, and cognitions (Bourdieu, 1993).

Habitus and the social self

The argument that this chapter will make is that the widespread and dramatic socio- cultural and political-economic changes which have occurred in Ireland from the 1970s (roughly) onwards have fundamentally altered the “doxa65” within various fields. Study participants were, in a sense, “caught between two Irelands”. That is, on the one hand, their parents and older generations Ireland, and on the other a new “modern” Ireland. In such a situation, their socialisation, interactions with their parents, schooling, and

65 Bourdieu (1989) argues that the doxa are the unstated rules or assumptions which structures a particular social field

190 participation in the community becomes uncertain. As will become clear, this has important implications for their attempts to form a valued sense of self and leads to a high degree of ontological insecurity and social suffering. These are cultural developments which (apart from social bulimia) impacted all of the study participants regardless of class. However, there were a number of social systems and developments which caused class-specific social suffering. These are all political-economic forms of social suffering. In terms of the socially deprived they experience (A) alienation; (B) political detachment; and, (B) state neglect and punitive social control; while the lower- middle class experience: vertigo. Crucially, all of these socio-cultural systems and developments are forms of structural violence, as they limit participant’s agency and cause them harm in the form of experiences of social suffering. The socio-cultural systems and developments will be dealt with first.

Socio-cultural

In terms of socio-cultural developments, the following issues emerged from an analysis of the interview data: (1) changing gender roles and patriarchal structures in Ireland; (2) lack of symbolic capital; (3) changing attitudes to authority and the decline of the Church; (4) and social bulimia. Each of these socio-cultural systems and developments are forms of structural violence, and lead to experiences of social suffering amongst the study participants.

Patriarchal violence

An issue that was common to all four female participants (regardless of class- background) was their experience of domestic and sexual violence. For example, Tracy discusses her experience with a long-term boyfriend whom she dated in her 20s:

191 “I was so vulnerable and so full of low self-esteem that anyone who showed me a bit of love I was all over it like. But he was my first proper boyfriend and I was mad about him, he was the one. No matter what he did to me, if he showed me an inch of love I was all over it. Never mind the crap he did, I stayed too long. I had these notions in my head about it being romantic and all this crap and he knew and he played on it. It was really violent and psychologically abusive and all that stuff. It was just really fucking bad you know”.

Tracy also expressed the view that she was happy that her drinking did not reach its most excessive while she was in this relationship:

“I’m glad in one way my drinking didn’t blow up then because there would have been no support. He would have, if he knew I had been in a treatment centre, he’d be having a fucking party, he’d love that shit, and he’d love me to be in the gutter like. I met him when I was 21, you’re very young at that age you know, and I was like”.

Meanwhile, Siobhan discussed her mother’s attempts to shield her from potentially negative influences (particularly regarding male intimate relationships), which she believes led to her feeling isolated and desperate for male attention which ultimately she believes led to her abusive relationship with a college boyfriend:

“Well he started taking a lot of coke say around October/November of 3rd year and when he was on that he’d get violent, not really towards me but sometimes he would hit me. I think he hit me maybe 4 or 5 times. It hurt really

192 badly, not just physically but it made me feel afraid and alone and I never told anyone. He never did it in front of anyone”.

Finally, as we will see in the next chapter (Chapter six), Collette highlighted domestic violence, and Rosin discusses sexual violence, as issues that caused them extensive suffering. As feminist theorists have argued, a patriarchal society breeds attitudes and social norms of acceptance of domestic violence, sexual assault, and abuse (see Kalra and Bhugra, 2013). These social norms stereotype women as inferior to men – they are bearers of children and housewives – slaves to the domestic and domestic authority. It should not be forgotten that up until the closing years of the 20th century, Ireland operated Magdalene Laundries – institutional carceral regimes that effectively imprisoned women and used them for cheap labour (Smith, 2007). According to the Church, this was to preserve and protect collective morality. That is, women who had children outside of marriage, sex outside of marriage, were ‘promiscuous’, drank too much, or generally offended the moral order, were sent to such institutions sometimes under strong social and familial pressure but oftentimes were forcibly incarcerated by the police and the courts.

If we examine the female participants’ interviews, we can see echoes of this institutional past. It is here we see the socio-cultural logic which justified incarcerating66 “fallen women”, in Ireland’s institutional “past”, operating in a reconfigured form in relation to female problem drug users in contemporary Ireland. When discussing her initial experience of entering treatment, Tracy stated:

“I was fecking delighted, because you see I’d been locked away in my house all on my own. And next thing I was surrounded by people, and there was this structure. I could have easily been institutionalised I think,

66 This incarceration was sometimes agreed to by the woman’s family, but was also often legally mandated by the courts.

193 desperate thing to say about yourself I know, but I actually think I’d have done well. But I liked the structure of getting up, showering every day. Because I hadn’t been doing any of that, so all that was back in my life”.

Meanwhile, Roisin’s decision to enter treatment in the first place was at the behest of her husband, who gave her an ultimatum that either she enters treatment or she was out of the house (see Chapter six). Finally, when I asked Collette to explain to me her understanding of addiction, she recounted her experience in a treatment centre where the counsellors spent a considerable amount of time convincing her to focus on the harm she was causing and her own behaviour and how this was mainly caused by her drug use, rather than focusing on life circumstances of social context (see Chapter six):

“What I learned in there was the destruction, the consequences for other people and that’s what stuck out the most. The impact of what I was doing on others. They told me this was not in my control, and I struggle with that like, because you have the idea you can’t stop, and I wasn’t sure. I was confused in treatment because I’d used and drank for so long it was second nature to me like. There was no amount of 3 or 5 months that was going to break through to someone like me. There were 40 odd in the treatment centre one time and I’d to go down and peel poppies67 and that cause they wouldn’t let me interact with people. Even just me being there was enough for people . . .”.

As the above interview excerpt suggests, the focus of those in the treatment centre largely eschewed discussing the context of the participant’s life, her experience of domestic violence, and how this may have caused her suffering, which may underpin

67 This refers to peeling potatoes

194 her drug use. This is even more problematic given that the participant claims that state services were aware of extreme child neglect in her family home when growing up68, and that she had been the victim of psychological abuse by representatives of the Church in secondary school. It has to be said that the tendency for treatment centres based on the Minnesota model, to de-emphasise social context (see Reinarman, 2005) and to overtly focus on the harm drug users cause to others, seems quite punitive and stigmatizing, particularly in cases where people have suffered abuse.

This tendency contains troubling echoes of how penitents in the Magdalen laundries would have been told that their incarceration was due to their moral defects, their own behaviour, how their actions were harming their family and those around them, and that through work (similar to the participant’s potato peeling), and prayer they could be returned to normal society (see Smith, 2007). The fact that the treatment regimens use the language of character rather than moral defects, focus on the harms of drug and alcohol use rather than the harms of sexual or moral promiscuity, and encourage the participant to take responsibility and repent for her behaviour69, all the while ignoring her life history (not to mention the broader social context – she like the penitents came from a socially deprived background), can plausibly be interpreted as a secular reconfiguration of a traditional religious, socio-cultural logic for dealing with problem populations (i.e. disadvantaged women). This mirrors Woods’ (2008) research findings, which argue that society typically views drug-using women as as unfeminine, unclean and immoral then it is difficult to disagree with a female social worker quoted in Woods (2008: P. 287) who argues:

68 The participant received her social care report file after filing a freedom of information request 69 I also noted in the previous chapter that there is a similarity between the 5th step and the Catholic doctrine of exterior association.

195 “I think that [drug using] women get a harder time. I think once they come to the attention of [drug] services, we have ideas as to how women ought to behave in our society and if they slip from that, from being like the Virgin Mary, they’re gone! They’re like the Mary Magdalene’s aren’t they?”

Indeed, the findings of the current study mirror the work of pioneering feminist drugs researcher Elizabeth Ettore (1992; 2007). Her work is premised on the view that it is impossible to understand female drug users without understanding the social construction of women’s role in broader society. Indeed, according to Ettore (1992; 2007) the general view of female drug users is that they not only harm themselves but also harm their family. In this sense, they are seen as “doubly deviant” (Heidensohn, 1987) in that they violate both the criminal law (by using drugs and becoming addicted) and their gender roles as females and sometimes mothers.

We see among all female participants, to varying extents, submission (significantly coerced) to structural, social, and institutional norms in relation to how women should behave and respond. All of these women attempted to break from traditional gender norms, but upon entering a world where they could find no viable alternatives to forming a valued sense of self, they ended up in abusive relationships and institutions and eventually in treatment centers which individualised their problems. Interestingly this occurred regardless of social class, and certainly demonstrates the limitations of the social deprivation/addiction link (even if social deprivation compounds this gendered suffering). Finally, by drawing on the historical parallels in the treatment of two separate groups of marginalized women, we see the importance of not only highlighting common experiences (I.e. seeing domestic violence and or sexual violence as a positivist indicator associated with addiction), or simply contextualizing these experience by placing it within sociological contexts (e.g. risk environments), but ultimately the necessity of

196 placing these experiences in the social and long-term historical context wherein powerful groups have constructed and responded to those groups of females deemed to be problematic to the social order, and recognising that these harms are built into the socio-cultural structure of the social world rather than a result of exclusion.

Lack of symbolic capital

All of the participants expressed the view that they never quite felt like they “fitted in” across multiple domains in their lives. This is perhaps most obvious in Donnchadh’s interview, and is most accurately captured in his difficulty in understanding what I meant when I asked him to describe the community he grew up in:

“Community in [area Cork City]? Fuck it I don’t know what’s community like?” I probed further and asked him to describe the type of area to someone who had never been, he replied : Say up until 12 my sense of place or where I belonged to was my house, on that street, and there were alright two kids next door who moved in, when I was 9 or 10 and I didn’t really get to know them. They were a rough crowd, as me ma put it. And the father was a drinker and the mother used to be sitting outside in the driveway with her friend in the car for hours and me ma would be looking out the window commenting on them. And all those little comments would build up a picture in my head, that they were “n’eer do wells”. They were grand like, but me ma didn’t think so”.

Donnachadh believed that this was due to his parents having come from West Cork, a social field that would have been different in many ways to where he grew up in Cork City. This can be seen in the way he describes his parents and their social networks and

197 the way he describes the community where his parents grew up. He describes it to me as follows:

“I’ve trouble actually thinking what you mean by community, I know what it means in West Cork – and how they congregate around mass times and the Church and it’s regimented you could see patterns, but the only regular thing in [area Cork City] was mass. I’d say my mother would have had difficulty with that”.

This type of community is very similar to Irish society broadly speaking prior to the societal developments outlined from the 1960s onwards. In an important sense, Donnchadh was caught between the society which his parents had grown up in and a more pluralistic, individualistic, Ireland. Of course, his parents having to move to the city arguably needs to be placed in a broader context of the shift from an agricultural economy to an industrial one and within the processes of urbanisation and rural depopulation, linked to the decline in traditional industries, processes which were particularly pronounced in the late 1980s, early 1990s (see Ferriter, 2004) – the exact period this participant was in mid to late adolescence.

Furthermore, he perfectly captures the difficulties of navigating the cultural and social field of his parents on the one hand and his peers in school and the community at large on the other. This again mirrors the difficulties associated with rapid social change and urbanisation, of rural-based people adapting to an alien city environment. He sums it up as follows:

198 “Where I think this might be relevant to me though, is that the company my parents kept would have been . . . Irish speakers, professional people. . . there’s a certain kind of a sub- culture or a certain kind of grouping. We didn’t realise there was anything outside it, but when we did realise you kind of start to see the warts in it. It’s a bit close minded, it can encourage or foster an attitude of us and them. In my mind, we are all Irish sure, but there is a tendency to superiority or elitism, oh we speak beautiful Irish and we congregate together. But that made me feel like more of an outsider both within that group and within the external groups that had nothing to do with it. I was kind of somewhere along the border do you know?”.

According to Bourdieu and Passeron (1977), a person will develop and deploy particular strategies and practices within a given field in order to attempt to attain a higher positioning within the social hierarchy. The practices or strategies that an individual applies will be based on their habitus and their relative position within social space, with a stronger or higher position denoting greater skills and understanding of the game or “practical mastery” (Bourdieu, 1992: 127). The “field of possibles” (Bourdieu, 1984: 110) is related to an agent’s position within social space. This might include understanding a certain institution, say third level education, as “for the likes of me”, or alternatively, as “not for the likes of me”. It is argued that practical mastery or a feeling that one is suited to a particular institution or field is, in part, a product of the level of symbolic capital that the person attains through the process of socialisation. All of the participants in the current study displayed a distinct lack of symbolic capital across numerous fields.

199 This can be partially seen in the reluctance of any of the participants to go to their parents for advice in relation to hobbies, school, intimate relationships, and friendships. It is also displayed in the deference that participants felt their parents showed to institutions, particularly in school. However, as this deferential attitude to institutions will be discussed later we will now focus on the participants’ reluctance to ask their parents for advice, which is demonstrated in the following:

“No, definitely not my dad anyway, but I don’t remember going to ask my mother for advice or being given it or anything like that no. That’s all I can really remember. I don’t really look at my childhood that much like, but I don’t think I really would have”” (Tracy).

“I didn’t really go to my parents because they were always kind of “people of authority are always right” you know and I rebelled against that. And even to this day I’m always kind of like but you always sided with them, but people in authority – teachers, or guards or whatever. But I suppose my parents were old stock. They had different views, compared to views that people would have had today. So ehm ya I had a fairce problem with authority and I relied on my brother a lot. Could I turn to my parents and say oh I have a problem with this? I did but it was brushed under the carpet “Ah you’ll be alright sort of thing”. (Patrick).

“I generally wouldn’t have went to him [father] for advice but he might give me bits of advice like that like. Like college and all the rest, I’d say I want to do this and they’d say “ya fine, are you sure, think about it”. I suppose they never went to college or anything like that, they didn’t even have a secondary education. The father left

200 with the inter cert70 and the mother didn’t even go to secondary school. But if I wanted it they’d be there, I just never went”. (Johnathan).

In large part, this reluctance to ask their parents for advice can be seen as due to their parents’ inability to advise them in a changed social, economic, and cultural context. Many of the participants’ parents showed deferential attitudes to institutions and authority at a time when such attitudes were becoming less prevalent. Furthermore, many of the participants’ parents didn’t have the educational qualifications or experience to give such knowledge. Given that third-level, indeed even second-level education would have been uncommon for their parents’ generation, this is unsurprising. In general, it seems the type of skills and practical mastery that parents tried to pass on to their children was unsuitable for this changed social, economic, and cultural context.

A final example of this lack of symbolic capital is evident in Tracy’s interview. Upon achieving a better than expected grade in her Leaving Cert (equivalent of A levels) in Maths she states:

“And even the day I came back with my Leaving Cert results and I ran in the door and I couldn’t wait to tell them because I’d struggled with Maths and I couldn’t wait to tell them and I went in with my results and they were both sitting there looking at me and my mother said “is that good or bad”. She didn’t understand. And I was like “Its brilliant, I got a “B” in Maths”!!. All this stuff, they didn’t understand, they didn’t go to school so they didn’t. But that was sad, running in the door all excited and not being acknowledged”.

70 Roughly equivalent to the British GCSE’s

201 The lack of acknowledgment turned what could have been potentially an opportunity to build a feeling of practical mastery in the field of education into a feeling of hurt, and a potentially positive experience into a negative one. Ultimately, her parents’ habitus was formed in a very different context, a context wherein formal education was irrelevant to the type of jobs people would have gone into. Thus, the changed context of the early 1990s meant her parents were ill-equipped to provide her with the necessary symbolic capital to enable practical mastery in the field of education.

Changing attitudes to authority and decline of the church

A common theme that emerged among the older participants (30yrs and older) was the social suffering which they endured while trying to traverse the field of religion in a rapidly changing Ireland. Most participants were either irreligious or had a view of religion that was nuanced and vaguely spiritual, and very much in contrast with more traditional forms of Catholicism practised in Ireland historically. Interestingly, the participants felt a sense of hurt and anger at what they saw as the hypocritical and abusive behaviour of representatives of the Church, and those who carried their teachings (parents in some cases), juxtaposed against their public veneer as the custodians of moral and social order. Yet, the participants were not able to fully break with traditional cosmologies71, and their attempts to find alternative frames through which to find meaning were fraught with difficulty. Initially, it seemed that their attempts to find alternative sources of meaning, in opposition to the tainted Catholic cosmology, seemed to provide a way to transition into adulthood and find a meaningful identity. However, it soon became clear that such strategies exacerbated their suffering. Luckily, this theme emerged in quite an articulate form in the interviews, so it is best exemplified by the participants themselves.

71 These are traditional ways of interpreting the world.

202 The suffering and abuse which the participants experienced at the hands of the Catholic Church are captured by Patrick’s account of his relationship with a Christian Brother:

“There was one particular brother, he was a Christian Brother, and he made my life hell. You know he really did because my self-esteem was low at the time and I hated going into school. I broke out in a rash because that’s the fear this brother put into me. I didn’t like school and one day he asked me to do a sum on the board and I did the sum and I got the sum right but in front of the whole class he smacked me across the face and you know I felt like a piece of chewing gum, a piece of dirt on the ground, and at that young age my self-esteem was knocked do you know. I carried that for a long time, and that story is only one example of that”.

Numerous other participants experienced similar abuse at the hands of the Church. For example, when I asked Collette about her experiences in school her first reaction was to discuss abuse at the hands of religious orders. She says her experiences in school were:

“Horrendous! My earliest memory actually is a nun. My mother used to give us banana sandwiches and I’m allergic72 to bananas to this day but they’d be black by lunch time like, so I’d throw them in the bin and that nun used to make me take them out and sit down and eat them in front of the whole class to humiliate me. So that’s my earliest memory of school, I hated school, absolutely hated it”.

72 The participant does not mean that she has a literal allergic reaction to bananas. This is Cork slang for having a severe aversion to something.

203 Other participants mentioned experiences ranging from emotionally and psychologically abusive, to a level of intensity that is difficult to capture with an adjective. In terms of the former, Donnchadh recounts a story that, though amusing, led to him being harshly interrogated without a parent present and excluded from formal education for months. The story is as follows:

“So we were in the recreation room and he [a friend] handed me the orange, and Brother Ned ‘the dean of discipline’ . . . was over the other side of the hall and he was furiously shaking and shouting at some first year some young fella . . . He had these big brown robes and he was throttling some first year so I caught the orange and I usually couldn’t hit snow off a rope but I walloped him. I threw it as far and as hard as I could and I got him right in the back of the neck. It exploded off his neck then. And there were 200 boys inside the hall, loud as you can imagine, and then all of a sudden silence! So he never caught me and could never prove it, but some first year squealed on me, but I’d never own up to it. ‘Nah didn’t see me, couldn’t be me’, I was toying with him like, and he just fucking lost the plot. “Get him the fuck out of here’. So I was suspended for months”.

At the extreme end of the abusive scale, however, is David’s account. He recalls a particularly traumatic experience involving sexual, physical, and psychological abuse as an inmate in one of Ireland’s industrial schools (see Chapter six). This suffering was often coupled with anger and exasperation at the contradictions between the expressed morality of the Church and their abusive behaviour in concrete contexts. This was expressed by Collette. I asked her to expand on her assertion that the Catholic Church was hypocritical. She responded by saying:

204 “I was like how are you supposed to learn how to live when you’re seeing that and being treated like that the whole time. I’m like they’re teaching us that we have to praise Jesus and be nice to everyone and I’m like ok so I’m getting murdered at home and I’m getting murdered at school and then when I act the way ye are treating me I get murdered again . . . I was just always thinking “ok what is the right way to act here like . . . “

Donnchadh provides a similar analysis stating that:

“There was one brother alright when we were in fifth class, I mean he was a nice man but he couldn’t cope with us, he’d lose his temper regularly and go mental, but that didn’t equate with the image of a man of God: calm, peaceful, knowing something that you didn’t know, connected to something that you weren’t. And then just behaving humanly, losing his head and clearly not able. It’s a weird message like”.

At least four other participants stated similar beliefs. In short, these all centred on representatives of the Church behaving in an abusive manner while claiming to be pious and morally righteous. This micro-level experience, however, must be placed within the broader historical context. These older participants lived through a tumultuous period in Irish history where the Church, Irish society’s moral and socio- cultural bedrock was being challenged for the first time. The fact that this challenge was occurring while their parents and other authority figures still insisted on the sacrosanctity of the Church, undoubtedly lead to a level of ontological insecurity

205 (Young, 1999), a process which was exacerbated by their failed search for meaning elsewhere and the abuse they suffered at the hands of the Church.

Initially, it seems that participants drew on alternative traditional means of finding meaning within Irish culture, albeit with a modern twist. When I asked Roisin whether religion played a big part in her life growing up she states:

“It would. You were made to pray every morning, mass every Sunday morning. And you weren’t allowed to eat if you were to receive the sacrament, and all these kind of rules. But like, we used to go over to Mass every Sunday morning and we would be hungover, having a laugh about the night before. It was all locals and we’d have drunk in the same pubs”.

Similarly, David describes his Sunday morning mass ritual as follows:

“When I was small alright I used to get sent to mass an awful lot. Me and my buddy [friend’s name] we used to get sent to mass and we’d get 2 or 3 quid each and we used put the money together and buy drink out of it. We used to get pissed on a Sunday morning and our parents used to think we were at mass [laughs]. You know, we were only young”.

Ultimately, these attempts to find meaning were unfulfilled, and actually exacerbated the participants’ suffering. It is argued that this is because these traditional forms of meaning-making had shifted. The widespread cultural change had fundamentally altered the doxa (Bourdieu, 1993) in these various fields so that they did not provide the

206 type of meaning that the participants had hoped. The pub (and drinking in general) culture in Ireland today is intimately tied up with consumerism and provides a sense of cultural identity, which is deeply commodified. Today the pub in Ireland is a site of consumerism, within the broader night-time economy, and has become untethered from its communal and traditional cultural mores, in Ireland at least (see Share, 2003). This makes it a poor alternative to the all-encompassing sense of meaning which religion provided in the past. Indeed, Roisin not find meaning in the pub or her community for long. In line with the experience of many in our current economic climate, she was forced to move for work. Indeed, she blames her constantly having to move to find work (flexible for the labour market) for much of the suffering she experienced, as we will see in the next chapter.

The other participants had similar experiences. David, more or less abandoned religion after the horrific abuse he had suffered. Yet he found meaning only in drug dealing and eventually became a homeless intravenous heroin user. Rather than emigration providing a sense of community in London (typically Kilburn or Cricklewood), work, and a release from a stifling authoritarian culture, Connor’s attempts to start a new life in London led to him being hospitalised for a cocaine overdose and eventually being sent back home to Ireland, where he ended up dealing cocaine and using significant amounts of the drug. Donnchadh also emigrated but expressed a sense of bitterness at not being able to find a valued sense of self abroad, and also at the abuse he received for attempts to craft a hybrid identity. He perhaps expresses this tension between abandoning religion and struggling to find a new identity and sense of meaning most clearly:

“I was struck because I was in [abroad] for a year and then [abroad] for a few months and sometimes when fellas would go and still have a really thick accent, like a fella from rural Clare and he’d be like [emphasis Clare

207 accent] ‘COME ON CLARE”. And I’d be like ‘Dude you’re 10,000 miles away, assimilate like, fucking let go, try and fit in. But then I’d be back here and I’d hear in passing “oh there’s your man sure he was over in the [abroad] for two years and now he’s back speaking like a [foreign accent]”. I used always wonder like ‘what’s wrong with that?’ And they’d be like [emphasis Cork accent] “Ah here boy your from Cork like, you have to keep your accent feen73”, that fella has no idea where he’s from. I’d be like, no, if I heard something in [foreign country] that was funny or whatever I’d tend to say it back in that manner or accent or nuance, so does that make me less? Or more adaptable, or does it make me very impressionable, or devoid of an identity? I don’t know the answer . . .”

While all of these participants had worldviews quite removed from traditional Irish cosmologies, it seems rapid modernisation in Ireland prevented the development of the sort of reflexive habitus, which Anthony Giddens (1991) argues is part of the late-modern citizen, that may have allowed the participants to form an alternative and valued identity to that offered by tradition. However, the places they looked to, to achieve this, were in essence, traditional social arrangements that had become untethered from their traditional social and cultural mores. This process, coupled with the abuse the participants suffered ,undoubtedly caused significant social suffering.

Social bulimia

A common issue among many of the participants from deprived areas was the inability or difficulties they experienced in trying to achieve culturally desirable goals, with insufficient access to the institutional or economic means of achieving those goals. Tracy, for example, grew up in a socially deprived community in Cork City, yet her aspirations growing up were

73 Cork slang for a male.

208 almost totally in line with the broader cultural expectations. She states that she: “ . . . Couldn’t wait to grow up and get out of the house and my dream was that I was going to . . .move out, have my own house, my own job, and all that sort of thing” . Furthermore, she mentions that as a child she placed a lot of emphasis on school and being “perfect”: “I’d always want to do everything right, and I’m a good girl, and get everything ready for school. Being perfect and doing everything right and maybe that was built on fear”. Finally, her career aspirations and hopes for the future (when she was a teenager) seem completely compatible with the dominant culture. She also:

“. . . Applied for the [name of college], for a secretarial course because computers were coming in then, it was 1999/2000, so I knew I needed those computer skills. I wanted to work in an office 9-5, go out at the weekends, and I was always planning when I look back. I did it myself, applied for it without the help of anyone”.

In summation, Tracy’s life expectations comprised of gaining independence from her parents by doing well in school, going to college, getting a job, working 9-5 and going out at the weekend, and buying her own house. These aspirations are certainly representative of the dominant cultural ideals, yet her positioning in the socio-economic structure of Irish society made achieving these aspirations quite difficult. The participant mentioned that her parents hadn’t finished school, had no formal education, and her father worked in a manufacturing firm.

Structurally, around the time she was finishing school, manufacturing jobs had all but disappeared from Cork City, and Ireland as a whole was moving towards a service-based economy (Moynihan, 2018). Unfortunately, within this context, many people from Tracy’s community were rendered unemployable due to a lack of formal education, or

209 as in her case, got relatively low paying jobs in precarious sectors of the labour market. This was due to their lack of social, economic, and symbolic capital, making it difficult to traverse this shifting terrain. Indeed, the field of third-level education and the service sectors was until recently virtually closed off to people from such communities (Ferriter, 2004). Ultimately, this precarious employment coupled with broader ontological insecurity (as mentioned) led this participant to retreat into traditional patriarchal structures, similar to those described above, which caused significant suffering. Jock Young (1999) has argued that the socially deprived are not excluded from “mainstream” society, but rather they exist in a bulimic relationship to the rest of society. That is, they experience massive cultural inclusion, which is accompanied by systemic structural exclusion. Indeed, Tracy and the other participants from deprived backgrounds seem to have experienced this bulimic social condition.

Connor had also hoped to get a college degree, a job, and a place of his own. However, the trauma of growing up with an alcoholic father, the discrimination he faced due to his ethnic minority status, and coming from a community with no tradition of having worked in the service sector rendered these culturally sanctioned aspirations virtually unattainable. Essentially his community, like Tracy’s community, had historically been made up of labourers and those who worked in the manufacturing industry (Moynihan, 2018). Due to rapid and widespread structural changes left members of these communities vulnerable and practically unable to compete with their middle-class counterparts in the new and emerging service sectors. This led to the participant becoming involved in crime, specifically drug dealing, as an alternative means of attaining these culturally prescribed aspirations. Indeed, once he made money from dealing, he moved into his own home and bought an array of designer clothes.

210 Similar processes can be seen in my interview with David. Upon release from the industrial school, he very quickly attempted to find work in the labour market. He states:

“[…] I went straight into a job. My very first job was a trolley boy in [part of Cork]. That’s what I was doing until I was 18, and then I worked at [name of hotel] hotel. I did a couple of year’s chefing there. I have had numerous jobs over the years”.

However, the majority of the participants’ jobs were in the low waged, temporary, and precarious sectors of the labour market. Furthermore, David also had aspirations to meet a girl, fall in love, get married, and settle down with a family. Indeed, he attributes his escalating heroin problem to the breakdown of a valued relationship:

“Relationships I wouldn’t be big on them because I’ve been through a bad one like. She cheated on me about 6 months before our wedding and that drove me off the edge that drove me fucking mad, drove my relapse. Massively and that’s a big reason why I’m here today like”.

Finally, when I asked him what his hopes were for the future, he simply replied: “All I want for my life now man is a bit of peace, just fucking peace and quiet, just a quiet normal life”. It seems then that part of these participants’ suffering can be explained by the mismatch between their cultural expectations and their inability to attain them in the face of the structural forces which impinged on them. Certainly, the participants mentioned, and numerous others suffered due to their bulimic relationship to the society at large, rather than their exclusion from society.

211

Political-economic

The thesis will now turn to an examination of the political-economic structures, systems and developments which curtailed participants’ agency and caused them harm in terms of their experiences of social suffering. While the socio-cultural developments, structures and systems which caused harm were experienced by all participants (apart from social bulimia), the political-economic forms of structural violence and social suffering impact on participants in a manner which is class specific. For example, the socially deprived participants’ experienced alienation, state abuse and punitive social control, as well as political detachment in a manner not experienced by those from lower middle class backgrounds. Similarly, those from lower- middle class backgrounds experienced vertigo, which was not an experience shared by those from socially deprived backgrounds. However, it should be pointed out that though there are differences between socio-cultural and political-economic structures and developments which cause harm, they often interact with one another in complex ways in concrete contexts. The first violent political economic structure this chapter will deal with is alienation.

Alienation

Kalekin-Fishman and Langman (2006) argue that a person suffers from alienation in the form of powerlessness when she is conscious of the gap between what she would like to do and what she feels capable of doing. Indeed, this is an experience that was common among all participants from socially deprived backgrounds. This is best exemplified by quoting the participants’ experiences in what I call cascading intersections of alienation. This alienation begins in the family, cascades out into their experiences in school, with friends, and in the community. In a later section, it will be shown how this is further compounded

212 by the Government, its agents of social control, and political disenfranchisement. We will begin with Collette. When asked to describe her early memories she says:

“Well early memories . . . well there was addiction in my house anyway. My dad was an alcoholic. My mam . . . was very angry like with the situation. She was married young like, she was 18, six months pregnant with my sister and then she had me right after at 19 so there were two babies, a dad that was a raging alcoholic, so the early memories would be a lot of violence, a lot of addiction. I don’t have any good memories to be fair like . . .”

As it has previously been mentioned that this participant experienced abuse by Catholic nuns at school (making her eat rotting banana sandwiches in front of the class, which she tried to dispose of in the bin for e.g.), we will now examine her experiences in the community. When asked about her friends in the community and in general growing up she responded by saying:

“I was very isolated from the community like, as I said I didn’t have friends or I didn’t know that many people like. I would just have been aware of my own stuff really like”.

Furthermore, when asked to describe her community to someone who’s never been, she responded by advising me to:

“Stay away from it. It’s very clannish, very miserable like. You know, I kind of feel it in the town myself sometimes like the feeling of “oh get me out of here”.

213 Moreover, she discussed the Northside/Southside divide in the area as a point of violent confrontation and disorder:

“So, there was this Northside/Southside business . . . If you weren’t from a certain area you wouldn’t be able to go into that area like. There would be all these mad fights like. I’d be from the Southside of [name of area] then like. It was just a lot of fighting over that really, very violent. When we turned into teenagers it was just “oh they’re from the Northside get them” or vice versa it was mad”.

A similar process was evident in my interview with Ryan. Again, beginning with the family, we see contexts of suffering – historically conditioned - beginning to emerge. He states that:

“My mother’s an alcoholic. So, when I was growing up I started to realise there were problems. I was kind of confused, like what’s going on and all that kind of stuff. I suppose in my childhood there would have been a lot of fear. I’ve seen a lot of things I shouldn’t have seen. I created a lot of my own fear, it was fear of the unknown and then that fear became known because I knew what was going to happen I expected something. I picked up off my mam’s behaviours the way she used to do things. Like she did a lot of self-harming and things like that”.

He goes on to discuss him witnessing several attempted suicides by his mother, family break-up, at times not having any presents at Christmas, and general familial disorder. This was compounded by his experience in the community he grew up in. He states:

214 “I’m from [area Cork City]. So, I suppose that’s a pretty rough part of Cork like. There was a lot of crime around where I lived, a lot of robbed and burned out cars, a lot of I suppose domestic violence, all of that sort of stuff - anti-social behaviour, all that kind of stuff really”.

He goes on to describe his relationships with his friends as follows:

“We were getting in lots of trouble with the guards like, constantly attacking , throwing stones at people, putting in people’s windows, like, antisocial behaviour. If the people weren’t doing that I wouldn’t have been influenced like, if there were good people around me I’d have been influenced in a good way like. The bad influence was definitely there like”.

Finally, this participant describes his time in school as him constantly getting suspended, being in trouble, and due to his home situation, his academic performance slipping dramatically. However, it seems the school never inquired into this and seemed to punish him as if his behaviour was the result of some intrinsic character defect. He describes his relationship with the teachers and with the school in general as

“Not good, they’d have given out to me, sensed something was up, call my mam in, all them sort of things like.’ His behaviours are slipping like, he’s acting out of place’. They must have been thinking that there was something going on at home like. They never spoke about the reasons for that though”.

215

Again, the same process is witnessed in Connor’s interview. He states:

“Growing up my dad would have been a functioning alcoholic. So, there would have been a lot of emotional and mental abuse. There were a lot of head games going on with my dad and my mother. My earliest memories are all arguments. My mother hated drink because her parents were alcoholics. My mother rarely drinks, if she does it’d be once a month. She might have one or two glasses of vodka and that would be her night out. She can do that. But my dad used to drink morning noon and night and work two jobs, while drinking to get the money to fund that. My earliest memories growing up would be my dad drunk, there was lots of arguing, and then there’d be head games and mind games with my mother. He was very gifted with his hands he was a tradesman. So, he’d tamper with the car so it wouldn’t work, he’d hide the wedding ring for months on end. He’d put double locks on the door so he could lock her out. All this stuff went on at an early age. There would be a lot of verbal abuse as well”.

In terms of his community, he describes it to me as follows:

“Where I’m from is very tribal . . . The area I’m from is fighting with the areas all around and vice versa. There was a lot of fighting, and to make it more confusing if you’re dealing in one of the areas you’re dealing in all of them, so how are you going to get your product out, to places like [name], [name], and [name]. . . the settled travelers in [area] would be shooting at you if you tried to deal, or dragging you out cars, which has happened quite a few

216 times as well, which is awkward because you’re trying to make money to get more drugs but yet you’re fighting with everyone you’re selling to so it’s very hostile”.

In a similar vein to Ryan, he also experienced significant disadvantage at school and became involved in friendship networks where crime, heavy drinking, fighting at teenage discos, and gang violence was the norm. While there is not enough space here to demonstrate this, David (see Chapter six) and Tracy also experienced virtually identical levels and kinds of suffering. Indeed, all of these participants came from families where at least one member was a problem drinker, and where there was a significant amount of familial conflict arising in part from alcohol abuse. However, this must be interpreted within a broader historical context of social suffering within such communities, and within the context of inter-generational trauma. Indeed, it is no coincidence that these experiences occur among people who belong to similar populations. These participants lived in social housing estates74 and came from populations that had historically suffered multiple waves of devastation.

In the first instance, those who first settled in these estates were rehoused from urban centre tenement slums, where extreme poverty, infant mortality, death from diseases such as TB, emigration, and institutionalisation in Ireland’s archipelago of carceral institutions, was the norm (see Ferriter, 2004). While work was scarce, from the late 1950s onwards employment in the dockyards and manufacturing firms increased, and while this did not lead to anything close to prosperity, common employment and the cohesive impact of a shared communal faith (Catholicism)

74 These were, in the main, constructed between the 1930s and 1950s, while a second less intensive wave of building occurred in the 1970s/1980s

217 bred a sense of solidarity in what were largely homogenous communities (Moynihan, 2018).

However, with rapid modernisation and socio-cultural change (as discussed), coupled with deindustrialisation, economic recession, and mass unemployment in the late 1970s, early 1980s, the situation in these communities deteriorated rapidly (Moynihan, 2018). Given that the Irish economy gradually came to be based on the need for highly educated workers in the service sector, and that free secondary school education had only been introduced in the late 1960s, it was unreasonable to expect communities with no tradition of secondary school education (let alone third level), to be able to compete in this changed context. This is not simply a cultural issue. Numerous Irish social commentators have noted that the cost of remaining in education is less attainable for those from lower-income groups, whose parents are unable to provide the financial support required.

As Kirby (2001: 8) points out such differences cannot simply be attributed to differences in intelligence or capabilities, rather, it is said that inaccessibility of resources (supplementary tuition and extra-curricular activities), can have a marked impact on achievement levels, particularly for students from disadvantaged communities. These historical and educational disadvantages both condition and are compounded by high levels of gang violence, crime, and addiction. As mentioned, the late 1970s and early 1980s witnessed soaring unemployment due to macro-level economic processes. This, coupled with tenant housing policies that encouraged the better-off sections of the working class to move out to the suburbs, created a political vacuum within which local gangs become more prominent, and addiction, crime, and disorder thrived (Hourigan, 2015).

218

The participants in these communities come from a background of extreme historical suffering. Indeed, sociological research has demonstrated that populations subjected to these levels of historical abuse have disproportionately higher levels of addiction (Duran et al, 1998; Alexander, 2008). Furthermore, psychological research has delineated the mechanisms through which this trauma is transmitted inter-generationally (Abrams, 1999; Coyle, 2014). This is compounded by the impact of systematic educational exclusion, which relegates them either to emigration, unemployment, or precarious employment and community breakdown due to the fear associated with drug dealing, gang violence, and general disorder (typically referred to as anti-social behaviour). It is difficult not to see these participants as victims of extreme levels of structural violence, and indeed this comes through in all of their interviews.

Vertigo

In the final book of his trilogy Jock Young (2007) outlines his thesis on the “vertigo of late modernity”, a term he uses to describe a pervasive fear of falling down the social structure, which he argues is becoming increasingly prevalent among the middle classes. In his words:

“I have talked about how insecurities in economic position and status, coupled with feelings of deprivation in both spheres, engender widespread feelings of resentment both in those looking up the class structure and those peering down” (Young, 2007:P. 12).

However, Young does go on to make a distinction. While this feeling of unsteadiness permeates the structure of society, it is particularly pronounced among the lower middle classes. As we have seen, it is more a sense of alienation that permeates

219 disadvantaged communities as (to be blunt) they do not have far to fall. In contrast, the lower middle, in the sense of everyone from middle-level manager to the skilled worker, lives a lifestyle that is almost totally dependent on their standard of living (see Young, 2007).

For those people the fear of falling is a fear of total loss, it threatens their life narrative, their sense of personal progress in terms of marriage, career, owning a home, and living in a community of their choosing. At the same time, there is increasing pressure on the middle classes in terms of longer hours and insecure contracts (Young, 2007). In sum, insecurity of identity, economic uncertainty and the tight constraints of work has led to a state of malaise and uncertainty among the lower-middle classes, a malaise Jock Young has named the “vertigo of late modernity”. This theme was certainly evidenced in the interviews. This can be seen in Roisin’s loss of status upon marrying her boss. She states that she needed the job to maintain her lifestyle but she:

“. . . felt like and [was] perceived to be just “[husbands name]’s wife, I had my own identity, I’d worked for years, built my own career and then all of a sudden everyone was like she’s only in a job because he’s the HR director . . . I was [her name], and then that identity was gone, and I was bang back into being lonely, and disconnected”.

Furthermore, as previously mentioned, Roisin had a particular vision of how her life would unfold, which was frustrated due to her needing to constantly move for work (see Chapter six). In terms of securing housing and a stable future, she also experienced vertigo. Consider her meditation on the economic collapse and the impact this had on her housing situation and the future of her family:

220

“With timing too, I suppose though we got stung with the boom and bust, the loan for the house fell through. We went for a house that was 450,000, mightn’t be worth half that now. We barely got 170,000 in the end. So financially, we’re tied to the house. It’ll do though. We have a young fella in a private school we can afford, a good lifestyle. It could have been better and I often feel, it’s my guilt, that if it hadn’t of been for [moving for work and changing houses] it probably would have been”.

Finally, Roisin also expresses some remorse that her marriage didn’t work out, something she had thought would last for life. She states that:

“At work my boss, I did go to her and told her about me and [husband’s name] separating. I didn’t go into too much detail, or tell too much. things. I’m glad I’m private, not many people know I’m separated from my husband either, that’s the way I’m coping”.

It seems clear then that Roisin is suffering from the loss of status, real and potential, that comes from her divorce, economic situation, and her addiction, events that were certainly not part of her ideal life narrative. A similar trend emerged in my interview with Siobhan. She described sustained uncertainty and dissatisfaction with the identity her mother tried to fashion for her. She mentions that her mother tried to encourage her to be polite, genteel, and “lady like” (see changing gender roles and patriarchal structures).

221

This experience mirrors that of Donnchadh and Roisin whose parents also had serious reservations in relation to them socialising with their more working-class peers. This seems to be a class-specific (to the lower middle) issue which prevented these participants from more fully immersing themselves in their community. Indeed, it is hardly a coincidence that all these participants had parents who were originally from rural Cork and who moved to more urban areas due to the slow urbanisation from the 1960s onwards. Schisms based on class, compounded by urban/rural divide, then, seem to have made it more difficult for these participants to form and maintain friendships.

In terms of marriage and relationships, Siobhan also expresses regret that her past relationship didn’t last as she had expected: “The problem was I couldn’t leave him, I thought I could never be happy without him”. Furthermore, she expresses significant regret at the almost total loss of narrative that her heroin problem has led to:

“Up until 21 or 22 everything was fine. Well it wasn’t fine, there were lots of problems, but to be honest I hadn’t used very many drugs until that point, not hard drugs anyway. In college, there were very few signs that things would end up like this, I studied hard, worked a part time job, was part of the running club, I had a long-term boyfriend. Apart from a few occasions I didn’t even ever blackout or get massively drunk. It was just a lot of things hit me at once and with bad luck then and my own stupidity I got into trouble with hard drugs . . .”

222

She also expressed throughout the interview a degree of uncertainty in relation to her career path, even prior to addiction:

“I was still thinking at this stage about what I wanted to do, I was 90% it was teaching but I wanted to take another year out because I felt I was too young to be doing something so serious and permanent. If I started a teaching masters, I’d be on placement teaching 18 year olds, and I’d be only 22 like. So I said I’d take another year out and do teaching after”.

Finally, and most dramatically, is her elaboration of the discontinuity between the imagined ideal narrative her parents had set out for her (and she had internalised to an extent, she mentioned becoming violently ill with worry over exam results at one stage), and the actual state of her life currently. If Roisin expresses fear of vertigo Siobhan demonstrates the all too real nature of that fear realised:

“She [her mother] had all these plans for me growing up, I’d play the , be a teacher or a doctor or something like that, marry a nice guy and settle down. The hard reality is her daughter ended up a junkie who injects heroin, sleeps in tents and squats, and sells her body for drugs”.

223 It seems certain that both of these participants experienced what Jock Young called vertigo, a fear of the loss of status and material wealth (anticipated or realised). In Ireland, more generally, there is certainly ample evidence for the existence of vertigo among the lower- middle classes. Firstly, stable lifelong careers, to the extent that whereby many first-time buyers are not only struggling to purchase their own homes but due to inflated rents are being priced out of the rental housing market as well. This coupled with the meteoric rise in people falling into negative equity due to the crash of the property bubble (Kennedy and Mcindoe Calder, 2011), and the new phenomenon of the “hidden homeless” (Hoy and Sheridan, 2017), makes the notion of home ownership, let alone home ownership in a community of ones choosing, seem like a flight of fancy. Finally, if the available statistics are a reliable guide, it would seem that people, in general, are marrying later and getting divorced at record rates75– undermining the last tenant of the modern meta- narrative of progress through one’s lifecycle.

Political detachment

A significant theme that emerged during the interviews was an almost total disconnect from political life and political institutions among participants from socially deprived backgrounds76. Given that it has previously been argued that these participants experienced a high degree of alienation from society and community, this issue only served to compound their suffering and meaninglessness. None of the participants, or their families it seems, expressed any affinity with, or support for, politicians or political parties. Furthermore, virtually all of the participants expressed a reluctance to engage in the political process, which was deemed to be a futile exercise. This was most commonly expressed in the form of disdain for the current government, particularly in terms of their policies being seen as exacerbating suffering among ordinary citizens. For example, when I asked Ryan about his views on Irish society today, he replied:

75 These statistics are available on the following website: https://www.cso.ie/en/releasesandpublications/ep/p-cp4hf/cp4hf/ms/

76 With the exception of one participant (Patrick), who was a left-wing Irish Republican.

224

“Well I suppose for me the one thing I’d kind of look at is the homelessness, the homeless like that’s ongoing, there are a lot of people homeless I suppose they are going on about it years that they are going to solve it. They are saying this and they are saying that, but they don’t seem to be putting any effort in, or not as much effort into it as they say they are going to like. They said they would and they didn’t like, so why would I believe them this time like?”

Tracy also expresses a similar sentiment. Though she voted in the recent marriage referendum and expressed her support for the repeal of the 8th amendment prohibiting abortion in Ireland, more generally she felt that participation in the political process was pointless. In her words:

“I only voted, the first time I voted in politics was the marriage referendum. I had no interest in it, none of it applied to me, but the marriage referendum. I mean I’m married to a man, but if I have kids and what if they’re gay I wouldn’t care, how dare people say they can’t get married. That’s the only reason I voted, I’ll vote when it impacts me, whoever gets into government here doesn’t give a shit. That’s my opinion, they all look after each other, but with the marriage referendum it was important, so I voted in favour. If they have an abortion referendum I’ll also vote. I did vote in the last election but I spoiled all my votes”.

225 Other examples include Patrick who states: “Well ya, I was very angry, angry with the Government. And the way the country was run”, or Ryan’s condemnation of the Government’s failed regeneration project in his community:

“Oh regeneration whatever like well show all the people this is what we are doing to kind of like pawn them off like do you know to give the impression that we are making big, big changes like when they’re not really. So I guess I kind of see it as a distraction from what’s really going on like. That’s how I’d see it anyway like. It’s more for their own image than to make any impact like”.

In general, this sense of political detachment further compounds the sense of alienation felt by participants from disadvantaged areas. Not only do they experience socially and historically conditioned suffering at home, in school, and in the community, but there is a pervasive sense of disconnection from the perceived power structures in society. This has the effect of making it seem like things will never, and can never, improve. Thus, it seems that these participants’ sense of alienation is compounded by a sense of despair, twin processes which create a toxic atmosphere of social suffering in such communities.

State abuse and punitive social control

While many participants had been to prison or otherwise institutionalised, they also experienced punitive measures at the hands of the police and the state’s social service bureaucracy. For example, in the case of Collette, it’s clear that the attitudes and institutional norms that pervade the social services in Ireland, both by sins of omission and commission, greatly exacerbated her suffering. In the first instance, as a child, the state services failed to intervene in what was quite clearly an abusive home environment. She describes this as follows:

226

“I do know that social workers got sent to us though from secondary school because of the career guidance teacher . . . but she knew that something was up with me and my sisters. . . but social workers came in, said nothing ignored us and walked out again. . . she [the social worker] came in did a quick assessment and left. They never did anything about it. Anyway in recent years my sister actually got the files under the freedom of information act and it said in the files ‘it’s very apparent that something is going on in the house’. That it was apparent my dad’s drinking was a huge problem in the house. So I was like ‘why didn’t they do anything”.

This failure to protect a vulnerable child was compounded when the participant became a mother herself in later life. Not only did the social services fail to offer her sufficient support, but they also adopted overtly prejudicial attitudes towards her. In particular, they insisted that her child was not on the autistic spectrum but was actually suffering due to bad parenting. This can be seen when I asked the participant what support was offered to her when she struggled as a young single mother with little support. She replied:

“Well . . . my oldest daughter would have shown from a very young age that she wasn’t like other kids. I thought there was something going on and I used to say it to the social workers, and there was a woman in the social work department and I’d say that to her and she used to teach people stuff. So I went to her and said my daughter doesn’t listen to me and I don’t know why. I told her my history and said look I don’t know how to be a mam can you come out and show me. I always kind of knew the difference between right and

227 wrong like and tried to do better. So the social worker insisted that what was wrong was my parenting and I said ‘look I don’t think so’.

I then asked Collette if she was offered any support to deal with these issues, and she replied:

“No they weren’t [didn’t offer help], and in terms of that I stood once outside my house in [part of Cork] and I begged her, crying into her face for respite, something please get me a break. She was so full-on like. This was undiagnosed for so many years, there was no intervention gone into her”.

This type of negligence can also be seen in the case of David. Despite telling police officers that he was being abused in foster homes and in Church-run industrial schools he received no support and was actually returned to the homes and institutions by the police. He states:

“I wasn’t sexually abused myself but I was seriously physically and psychologically abused and I did witness a lot of sexual abuse of others, on more than one occasion. I got a lot of beatings for witnessing this. I told all this to guards and social workers and the whole system knew, they just kept hush and it was a taboo subject to talk about and to an extent it still is”.

Furthermore, like Collette, this abuse was compounded in later life. While the police and state services had failed to protect him as a vulnerable child, early in his recovery

228 from heroin abuse, David claims the police tried to recruit him as a paid Garda informant. However, he refused, arguing that the amount of money on offer would have jeopardised his recovery:

“There are a lot of cops too that would stitch you up like. I was only approached a couple of weeks ago and offered 500 euro a week to become a garda informant. I said to the guard ‘you are willing to give a heroin addict 500 euro a week to give you information on heroin dealers?’ So basically I asked how many heroin addicts have you killed by giving them money”.

Finally, a similar process occurs in Ryan’s interview. In the first instance, Ryan saw the states social services not as a potential source of support, but rather as a coercive force which was a threat to his family. He states:

“I didn’t want anyone finding out what was going on at home because you know anyone could have got involved – social services, the guards and I didn’t want that to happen to my family so I had to put on a brave face and make it seem like everything was alright at home to keep my family together I suppose”.

Indeed, if we view this comment in a historical context, it makes quite a lot of sense. Up until the later 1970s/early 1980s disadvantaged communities were routinely monitored by the “cruelty man” in Ireland. The “cruelty man” was the NSPCC (later ISPCC] inspector who was charged with committing poor children, whose families couldn’t or wouldn’t look after them to Church run industrial schools (Buckley, 2016). Given that Ryan came from a disadvantaged community it hardly seems surprising that he would be weary of state intervention, particularly given his stated concern for the welfare of his siblings. As Ryan had experienced quite a traumatic upbringing, as mentioned, and developed a drug

229 and alcohol problem quite young, his incarceration at ages 18, 19, and 20 seems particularly punitive, especially given the fact that his crimes were often directly related to his use of alcohol and drugs77.

In sum, then, it seems these participants experienced quite a significant level of abuse from the state and its social control mechanisms, whether by sins of omission or commission. This has undoubtedly exacerbated suffering among the study participants. Loic Wacquant in two of his seminal works, Punishing the Poor (2009) and Urban Outcasts (2008), conceives of the typical neoliberal state as inherently penal, developing punitive containment as a governmental technique for managing deepening urban marginality. He argues that the increased emphasis in the “west” on the benevolent market has the effect of translating economic injustices such as poverty, inequality, exploitation, and unemployment – into social problems which are addressed by police action and penal treatment. While Wacquant’s argument is persuasive in many regards he has, quite rightly, been criticised for his over-reliance on the United States and its penal system. As John Pitts (2012) has argued this ignores crucial historical, political, and cultural differences between countries. However, it is argued that the spirit of Wacquant’s argument can still be usefully applied to the Irish context. That is, the view that punitive social control extends beyond the prison, was certainly supported in the findings of the in-depth interviews in the forms of abuse the participants’ experienced at the hands of the police and the state’s social service bureaucracy.

Symbolic violence

While the structural mechanisms which limit the participants’ agency, and cause harm and suffering have been delineated, it will now be necessary to demonstrate how the participants fail to see the objective structures which cause them suffering and instead see it as natural,

77 His convictions were mainly for drug possession, public intoxication and petty theft.

230 inevitable, and their own fault. Furthermore, it will be necessary to outline the micro-level systems and strategies which transmit the dominant ideologies and discourses from the macro- level context into the participants’ life-worlds. Finally, it will be demonstrated how the participants come to embody and enact these dominant discourses and ideologies, and ultimately “do the work of the dominant”. For that, we turn to the mechanisms of symbolic violence as elaborated by Pierre Bourdieu (1989).

Misrecognition

As mentioned, misrecognition is the process whereby power relations are perceived not for what they objectively are but in a form that renders them legitimate in the eyes of the beholder (Bourdieu and Passeron, 1977). This was evident throughout all of the interviews. In the case of the female participants, this could be seen in terms of their views, that the difficulties they faced in forming a valued female identity were normal and natural parts of life, and also in some cases blaming themselves for their experiences of coerced institutionalisation, sexual assault, and domestic abuse. This can quite clearly be seen in the case of Roisin. When I asked her what impact her sexual assault had on her, she replied:

“It threw me, it really knocked me, It killed me actually because [name of husband] my only partner up until then and I thought , man I’ve fucking ruined it, I felt ruined. I felt awful. Of course, that was drink related like, I drank too much, and too be actually falling asleep on somebody’s couch like, then to be that out of it. I never told [name of husband], I should have told him straight away. He’d have killed your man like, so then, when we were asked to move I was gone, I ran up to [other part of Ireland]”.

231 Despite being a victim of a sexual assault – an act which if placed in a structural context, is the result of sexist and patriarchal social norms (Dworkin, 1974; 1987) - Roisin misrecognises the origin of her suffering. Rather than her sexual assault being seen as resulting from objective patriarchal structures and social arrangements (or even the fault of the perpetrator), she sees it as being due to her having drank too much and being her own fault partially:

“… I thought man I’ve fucking ruined it…. “Of course, that was drink related like”.

Indeed, a discourse that places the blame on a victim having consumed too much alcohol78 is quite prevalent in Irish society. Furthermore, as mentioned Roisin was coerced into attending treatment, by her then husband, for her substance abuse problems, however, she saw this as the natural outcome of her substance use:

“[Husband’s name] brought them down on a Sunday. The first week I struggled, because I didn’t want to be in there and I missed the kids. Plus, I missed [husband’s name] and I knew when I came out that we weren’t going to last, I knew. Somebody asked me in there about it and I knew in my heart and soul, and I had different feelings and stuff came and I knew if I was going to be totally honest and get over it I had to go the whole hog. Otherwise, it would just happen again. So I knew my marriage was over, and I felt guilty for my kids that I wasn’t able to keep the marriage together. When I look back now, sure that wasn’t true. They’re fine though, it probably was the best thing”.

78 See www.rcni.ie (Rape Crisis Network Ireland).

232 If we turn to the interview with Tracy, we see an almost identical trend. In terms of her abusive relationship with her first boyfriend, while she does not blame herself for the abuse she suffered, she does put it down to her immaturity. She states:

“I was very young like too, I met him when I was 21, you’re very young at that you know, and I was like, so all that went on. I know he said a few times “oh you shouldn’t drink that” and then he was the one who introduced me to wine. He saw his friend’s girlfriend drinking wine and she looked classy so he thought I should do that, and all this fucking shit like. I drank wine though long after we broke up so it wasn’t all his fault either like”.

To recap, symbolic capital consists of the resources available to a person, based on honour, prestige, and recognition (Bourdieu, 1989). It is socially and cultural recognised and usually results from the internalisation of norms, values, and ways of being from parents in the context of high social standing. In the section entitled “lack of symbolic capital” (P. 12) it was argued that Donnchadh lacked symbolic capital. However, he did not recognise this or any other objective reason for his suffering. Instead, he believed it was due to some character defect. This can be seen in the comparison he draws between himself and his brother:

“He’s [brother] very calm, he’s deep as well like. . . So I used to look at him like, ‘ah sure look at that fella he’s like a cat if he fell off the telly he’d land on his feet like’. He went to school across the road like, he’d leave 2 minutes before school and wander over and like just land, and everything would be fine. Whereas I was just like ran from pillar to post’ rush, rush, rush. I used to always look at him then and be like ‘look at him he’s so

233 fucking lucky” he always lands on his feet. But in hindsight now I’m looking at him 30 years later going “no he’s not anymore lucky than anyone else, you just kind of have to be available to catch the ball when it bounces, he stood still, whereas I just ran around like fucking Tazz64”.

Clearly, Donnchadh feels that his inability to take opportunities in life and attain the type of outcomes he desired, was due to his inability to remain calm, composed and “catch the ball”. This is seen as an intrinsic limitation of his, rather than his lack of symbolic capital. Indeed, it was clear from the interview that for whatever reason his brother had internalised his parent’s norms and values fully, perhaps accounting for his much greater level of symbolic capital, or ability to “catch the ball”. As mentioned, none of the participants felt they could go to their parents for advice, a process which, according to Bourdieu and Passeron (1977), is vital to achieving practical mastery (a vital component of symbolic power/capital). However, very few of the participants felt that this had disadvantaged them in any way, and instead, they believed that going to their siblings, friends, or figuring things out themselves was an adequate substitute. This can cleary be seen in David’s experience. When I asked him whom he went to for advice growing up, he replied:

“Well with women anyway that was more or less self-taught really… I trusted more than other kids where I grew up. Like when I was 15 years of age there was a drug dealer up the road and he was giving me a [significant quantity of ecstasy tablets] to mind for him like. A [specified amount] euro worth of pills like and I was told to mind them. So, I buried them not far from me house like. I was trusted with them, and I made an absolute fortune off that like”.

234 It should be pointed out that it’s not being argued that the participants should have seen these objective structures, or that their parents were in any way wrong. Rather, the argument is that symbolic capital is transmitted much more smoothly among powerful groups than the powerless. Among powerless groups, it is quite difficult for parents to transmit it to their children if they do not possess it themselves (see Bourdieu, 1989). Furthermore, economic capital can never substitute symbolic capital. For example, while parents can provide money for extra tutorials, they cannnot purchase the level of confidence and self-assuredness that comes from being high in symbolic capital and being of high social standing (see Bourdieu, 1989) .

In terms of the suffering and abuse participants experienced at the hands of the Church and religious institutions, similar processes of misrecognition are apparent. Despite receiving vicious beatings by the Christian Brothers, Patrick continuously stressed how he was partly, or sometimes almost completely, to blame. If we recall the incident where the Christian Brother smacked him across the face, he reflects by stating that:

“I carried that all the way through school, my self-esteem, my self- confidence, I felt worthless really. These things really stand out for me do you know. I was very frightened, I was a nervous child. I was full of fear, I was full of anxiety. I had to accept that, and I played my part in that too”.

Similalrly, Donnacadh minimizes the abuse he received at the hands of representatives of the church in secondary school:

“Nothing that really stands out, it’s not like the Artane boy’s band or

235 anything79, nothing really abusive. Some fellas got leathered alright like. I kind of plateaued form the point of punishment, I didn’t mind taking a wallop, it was like, “ok, so that’s all you’ve got’. There was one brother alright when we were in fifth class, I mean he was a nice man but he couldn’t cope with us, he’d lose his temper regularly and go mental”.

While vertigo (Young, 1999) is quite a complex process, there is still quite strong evidence form the interviews demonstrating processes of misrecognition in this respect. If we recall Roisin recounting that she had been “stung” due to the effects of the economic collapse on her and her family’s lifestyle, it is clear that she fails to attribute this to her precarious position in the lower-middle class and instead internalises it as guilt. She states:

“We went for a house that was 450,000 thousand, mightn’t be worth half that now. We barely got 170,000 in the end. So financially, we are tied to the house. It’ll do though. It could have been better and I often feel, it’s my guilt, that if it hadn’t of been for [her addiction and moving around] it probably would have been”.

Similarly, Siobhan fails to attribute her suffering to patriarchal structures, her precarious positioning within the middle-class and her mother’s unrealistic expectations, and bad luck stemming from contingent events80. In terms of vertigo, she normalises81 her mother’s unrealistic expectations throughout the interview:

79 This refers to an infamous case where Catholic clergy sexually abused members of boys band at the Artane Industrial school in Dublin.

80 She suffered a serious injury as a result of a fall. This led to her being prescribed opiates. She argues that this, along with the high levels of mental anguish she was experiencing, led to her heroin addiction.

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“I don’t want to give you an impression of a bad childhood or teenage , I had some problems and worries but the ones I had were very much like your typical teenage girl, my mother was a bit over-bearing but many mothers are like that, she meant well. There was basically nothing in my younger years that would suggest I was going to be a drug addict”.

Furthermore, numerous times throughout the interview, Siobhan expressed the view that it was normal (among her friends), and therefore inevitable, to go from short term job to short term job. Ultimately, however, she blamed herself almost completely for ending up homeless and addicted to heroin: “It was just a lot of things hit me at once and with bad luck then and my own stupidity I got into trouble with hard drugs. And that’s where I am today really”.

The misrecognition of the effects of alienation can be seen in Ryan failing to see the damage that growing up in a disadvantaged community had on him. When asked whether his life would be different growing up on the Southside of the city (more affluent), than on the Northside, he replied that it was all down to the individual. He states:

“Well I think it’d definitely depend on the person. Yeah it’d definitely depend on the person. Some people like would be scared and frightened definitely like.

81 The point is not to blame her mother, rather to argue that unrealistic expectations can harm the lower middle classes.

237 They’d know that the Northside is a rough place, if they were from the Southside and all that. They’d think oh there are dangerous people up there be careful, try and get out as quickly as you can. Other people would be like “I don’t care” like do you know so like depending on the person”.

The misrecognition of alienation is, however, much more pronounced in the case of Collette. In a previous section, I described the cascading intersections of suffering that this participant experienced. Ultimately, she fails to directly link this to her addiction and instead blames herself, or the fact that she: “just didn’t know how to act”. In a later section, some of the nuances of this will be drawn out and instances where participants resisted dominant discourses and ideologies will be discussed. For now, suffice it to say the participants’ misrecognised alienation as a source of their suffering in most contexts Interestingly, none of the participants misrecognised political detachment or state abuse and punitive social control as a source of social suffering. Indeed, these were seen as issues that went beyond their individual lives and were expressed as social concerns.

Of course, it should be highlighted that there are other ways of interpreting the experiences of the participants. For example, it does seem inevitable that people will discuss their experience of addiction through the prism of their life history. Importantly, misrecognition does not occur simply on the basis that individuals discuss their addiction in this way. Rather, misrecognition occurs as such discussions lack any significant reference to social and political exigencies, in the context of the macro-level tendency (see Chapter four) to portray addiction as an actually existing problem of pathological or disordered individuals. Indeed, if one accepts the argument that this portrayal has obscured social context (see Chapter four) in society generally, one would hardly expect individuals to significantly deviate from this trend.

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In summation, if the individualisation of addiction and its expression as an actually existing disorder of atomised addicts serves to obscure - at the macro- level - the socio- cultural and political-economic systems and structures, which are violent and cause suffering, then misrecognition serves as a concomitant micro-level mechanism which leads participants to blame themselves and view their suffering as normal, acceptable, and inevitable.

Condescension

The previous sub-section was intended to elucidate how the structures and systems which caused suffering among the participants were misrecognised. In the next chapter, it will be demonstrated how drug use within this context of suffering can become problematic. Indeed, it is not difficult to see how drug use within the context of bulimic, alienated communities, politically detached, and suffering under punitive and coercive governmental and social service regimes, could become harmful. The same could be said for drug use within the context of an insecure and over-worked lower-middle class, suffering from a loss of narrative and fearful of falling down the social structure. If misrecognition serves to obscure this structural context at the level of the embodied addict, then condescension serves to convince them that their suffering is not only their own fault, natural and inevitable, but is caused almost solely by their compulsive drug use, and can only be relieved by their entering into treatment regimens and becoming sober.

In short, condescension is the micro-level manifestation of the macro-level tendency to impose a stigmatised subjectivity on populations of addicts. In an apparent act of reaching out, treatment regimens (i.e. AA/NA and government funded treatment centres) temporarily suspend the power hierarchy and attempt to help the powerless,

239 suffering addict. While, undoubtedly this act of reaching out helps some individuals, ultimately by ritualistically eschewing talk of social context (Reinarman, 2005) the power hierarchy is reinforced, and the structures and systems which produce social suffering go unquestioned and are actually shored up, as limited numbers of individuals cease taking drugs. It is not so much that treatment providers are devoid of an understanding of the social context of drug use, indeed many recognise the constraining impact of issues such as adverse childhood experiences (ACEs) (see Mate, 2008).

However, in the final analysis, treatment providers are committed to the cultural norm of individualism82. In this way, social factors are considered important, but only ever in terms of their impact on atomised individuals. Within this context, the focus is placed firmly on helping the individual to develop resilience to social forces in order to overcome them. Thus alienation, social bulimia, and other systems that subject populations of addicts to similar forms of social suffering are not challenged. Finally, as a number of individuals succeed in developing resilience to social forces, violent structures are shorn up as individual forms of treatment gain cultural acceptance.

This point will be demonstrated by reference to the role of treatment centers, Alcoholics Anonymous, and Narcotics Anonymous, in the field of addiction treatment in Ireland and the participants’ experiences discussed during their interviews. The 12-step ideology of Alcoholics Anonymous and Narcotics Anonymous will be dealt with simultaneously as they are virtually identical. In terms of the study participants, this manifested itself in the retrospective tendency to explain virtually all of their suffering by reference to their disease and the 12-step ideology more broadly – this will be called “12- step speak”.

82 Evidence of this can be found by examining any of the websites of treatment providers in Ireland.

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Take Patrick for example, when asked about the role of religion in his family growing up he responded by saying that his family had taught him to: “be nice to people, do nobody no harm, don’t hurt them”. However, he goes on to say:

“So that was the way I was brought up but sometimes that didn’t happen because as I say my defects you know what I mentioned earlier came through a lot and I wasn’t a nice person you know because I was a bit of a bully”.

Twelve-step ideologies then encourage adherents to focus on their own part in the chaos and suffering in their life and to focus on acknowledging the role their own character defects play in producing the same (Wilson, 1939). In Patrick’s case, 12-step speak serves to retrospectively de-emphasise the abuse he received at the hands of religious orders as a potential factor in conditioning his tendency to act like a “bully”, and instead view it as due to an intrinsic character defect.

In an even more overt manifestation of this, Patrick goes on to overtly blame his disease for the loneliness and despair he feels. He states:

“The despair that I feel and the loneliness are unreal. I could be in a room full of people and I’d be the loneliest person. That’s my disease. I could talk about my defects of character. I can elaborate on a lot of things”.

This can be seen amongst numerous other participants. When I asked John to explain the 12-step programme to me in his own words he responded by saying:

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“So I try to hand my day over to my higher power . . . Then you’ll make a list of people you’ve done wrong to and you’ll share that with a sponsor or someone else, and try and make amends to them. You’ll then try and see what your character defects are, you’ll make a list of them and go through them and ask for them to be removed and try and work on those character defects. I’d be very arrogant, I’d not have much humility, and I try not being like that today. And then you’d be constantly going over your day and admitting your faults, and then prayer and meditation. Then finally you’ll be trying to give back what you’ve gained to still suffering addicts”.

Notice that John’s programme for recovery contains an almost total focus on his own internal character defects and his role in creating chaos and suffering in his life. Interestingly, throughout the interview, John readily shared stories of suffering and despair linked to his father dying suddenly, and the meaningless and despair he felt at a young age. However, when we spoke about recovery and the 12-steps virtually nothing external to the participant was discussed, and he seemed to blame himself and his character defects for all the suffering in his life, retrospectively at least. For example, when I asked him if it was difficult to constantly focus on his own character defects, he replied: “Challenging, very challenging but it has to be done because I’m very, very, very self-centred, most addicts are. Everything was for my gratification…”.

Similarly, for Donnachadh, the 12-step ideology seemed to provide an answer as to why he was suffering, something which he was never quite sure of. Throughout the interview, he described his sense of suffering to me as a vague sense of emptiness, articulately expressed in the following quote:

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“I felt kind of, I heard someone describe it before like a ‘clanging bell’. This fucking vessel has a hammer in it, it rocks from side to side and makes a hell of a lot of noise, but there’s nothing in it. There’s just nothing fucking in it”.

However, the 12-step ideology seemed to provide the answer that he had so long been searching for, even if initially he was suspicious of it. This can be most clearly observed when I asked him what he thought of the disease theory of addiction:

“I’d heard of the disease paradigm before and I was like ‘ya whatever bollix’. Because of course I would my big fat intellectual head, thinking I knew it all ‘Sure how could that be a disease ya bunch of drunks’. But then they kind of kicked some of that shit out of me in [12 steps group location]. A lot of it isn’t logical from a book point of view but a lot of it is, it shows you that actually you don’t know as much as you think you do. I never thought I was an alcoholic until I went in there and then I thought “fuck I am”. First meeting I ever went to I went “Oh Jesus these are all my fucking problems”. The disease idea I understand that it was come up with and it had to be understood in that particular way so that it would be insured and treatable. You know it had to be something tangible so the WHO would call it something so insurance companies would insure people for treatment and so on. But I didn’t think it fit. And then they explained it more and broke it down said it was a “dis-ease”. And were like ok the characteristics of a disease are, something which is chronic and something else, and I went ok when you put it that way it does fit into that. Before I thought it was a load of bollix and then somebody explained it to me in that manner and I’m sure there are other ways of looking at it, I just accepted it and went “ok the part of me getting better is me doing things I didn’t do before,

243 and before I didn’t accept anything without explanation. In my mind, I could still poke holes in that explanation, but I just leave it the fuck alone. . . “

This is perhaps the clearest example of condescension that one could provide. Donnchadh was clearly suffering in various ways throughout his life, however, he could never quite figure out the exact source of this suffering. While he was initially quite skeptical of 12-step disease theories, he was so desperate to alleviate his suffering he was willing to admit his intellectualism was a character defect and submit totally to the programme against his better judgement. This is a strategy of condescension as the power hierarchy is suspended and the powerful groups who promote the 12-step ideology benefit by having the ideology reaffirmed and the power hierarchy shored up. The participant benefits by becoming sober83 and obtaining an explanation for and potential route out of suffering. However, ultimately the social basis of suffering is obscured and individualised and the violent structures which perpetuate this suffering go unchallenged. Furthermore, as we will see in the next section, participants who are understandably grateful to have alleviated some of their suffering, become “ambassadors of the dominated” and go on to embody, enact, and rearticulate the dominant ideology and thus shore up violent structures and the power hierarchy.

Condescension can also be seen in Ryan’s interview. When I asked him about NA and if he considered it an important part of his life he replied:

“I’m in the fellowship now and I’m IN the fellowship, 8 months and I’m doing service and I’m helping newcomers and I go to five meetings a week. It’s the best thing I ever did like. I think addiction is a disease like but it’s your head like your mistaken beliefs”.

83 He was sober roughly a year at the time of interview.

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Again, we see the 12-step ideology operating as a retrospective explanation for the suffering in his life. Rather than focusing on the cascading intersections of suffering he experienced, his character defects and mistaken beliefs instead become the main focus. However, as we will see in the next chapter, this participant and two others did display a degree of ambivalence and resistance to this type of retrospective explanation, whether implicitly or explicitly. Condescension was also observed in the participant’s experiences in various treatment centres, invariably based on the Minnesota model (O’Carroll, 1997; Butler, 2016), which, as mentioned in the previous chapter, represents the institutionalisation of the 12-step ideology operating alongside counselling and meditation. Consider Patrick for example. When I asked him to talk me through his experience in treatment he states:

“I came to [treatment centre], and thank you for asking me, I had crutches, destroyed in bruises, battered, hair all over the place, like a tomato. And the pain I was going through, my father was after passing away, head melted. Bate84, fucked, destroyed . . . I had a great counsellor, very nice and patient, peeled me like an onion to find out what kind of a person I really am. This place saved my life, I have no qualms in saying it. Got stuff sent home, “What was [his name] like when he got a few drinks in him” – my wife had to fill out. Counsellor was there read it out. And I cried like a baby. That’s the real me you know. I had to go through all that like. What I put the wife and kids through, what I put my mum through, my family, close friends. Came to [name of treatment centre], head destroyed, physically destroyed, mentally destroyed, spiritually destroyed. I could see no way out. Met brilliant counsellors, peeled me like an onion to get layer by layer. From a young age all the

84 Cork slang for exhausted.

245 way up. All my defects of character, angry, impatient, arrogant, cranky, snappy, I have all them, you know, I still have all them today”.

As can be seen, the focus is firmly placed on the chaos and suffering which the participant had caused for himself and his family. In other words, he is seen as the problem. The violent structures and systems which caused him suffering are de- emphasised and obscured in favour of a focus on his character defects and all of the wrongs he had committed throughout his life. At this juncture, it is perhaps important to make clear that there are plausible alternative interpretations. For example, there is no doubt that the treatment centres, and the counsellors, are compassionate and dedicated to helping people improve their lives. Furthermore, it is clear that having spoken to Patrick for over two and a half hours that he is correct to say that it saved his life. Indeed, the current author has absolutely no problem with AA/NA as voluntary peer support groups85. Moreover, it is certainly not being argued that treatment centres or support groups should be political engaged in tackling issues such as alienation, social bulimia, etc.

While it should be obvious that these acts of compassion and help occur at an individual level, they also occur within a nexus of power relations. It is within this nexus that condescension occurs. Indeed, it is only when all the cases, arguments, and instances outlined are considered as a whole and addicts are seen as a population rather than individuals that condescension can be claimed to occur. Put simply, the argument is not against people improving their lives through means which this study finds problematic in their totality. However, though the treatment and counselling are compassionate, it still offers individualistic explanations for

85 The issue is with their institutionalisation in government funded treatment centres. Indeed, providing services to treatment centres based on the Minnesota model seems to violate one of the twelve traditions – not getting involved in outside controversies.

246 addiction which convince people to retrospectively interpret all their suffering through this lens, thereby benefiting those who adhere to the dominant ideology and accruing them advantage through the gratitude of the treated participant(s).

Moving on, there are a number of other interviews that further illustrate the point just made. For example, Tracy not only blamed alcohol for a lot of problems in her life retrospectively, but she also blamed alcohol, drugs, and addiction, for a lot of problems in contemporary Ireland more generally. She states:

“Like a lot of stuff is caused by addiction, without a shadow of a doubt. If you hear someone got stabbed in an estate in Dublin, sorry now, but there were two young fellas in an estate up there last week shot each other at 14 like, who has a gun at 14? What are the chances they’re involved in addiction? Or something that’s linked, a house party at 2 a.m. I bet there’s something there. A lot of people who are in Jail are in there because of addiction, maybe if they weren’t out robbing to feed their addiction, they wouldn’t be in there”.

Collette also retrospectively puts most of the suffering she experienced throughout her life down to her addiction:

“Well ya see and we’ll get to this later when we talk about addiction but I never learned how to act growing up which was only something I realised in treatment, I realised oh hang on this is not normal. I never respected any property I was given, any house I had. I never respected anyone. For me it was all take what I can get and don’t care about anyone”.

247 If we analyse this statement in tandem with her story, previously analysed, in relation to how she was forced into isolation in treatment because “her behaviour” was too extreme for other clients, it becomes clear that strategies of condescension are at work. The pattern which emerges is the treatment centre attempting to convince her that her suffering is, in the main, caused by her character defects and mistaken beliefs and that by working on those she can live a better life. However, as mentioned this serves to shore up the power hierarchy and violent structures by individualising her problems, and validating 12-step ideologies.

Finally, the concept of 12-step speak, which serves to retrospectively explain much of the participants’ suffering and drug use by reference to their internal character defects and mistaken beliefs, is very similar to the conclusions drawn in a study conducted by Summerson-Carr (2011). In her analysis of a US treatment programme for homeless women (also based on the Minnesota model), she points out the remarkable emphasis the staff placed on language and talking. She argues that the programmes aim of endowing people with lasting sobriety was primarily about reconfiguring the client’s relationship to language and training them in particular ways of speaking about the self. She calls this mode of speaking the ideology of inner reference (this is equivalent to my 12-step speak), an ideology which presumes that healthy language refers primarily to phenomena that are internal to the speakers. The demand for honest inner referentiality, as opposed to mistaken beliefs and character defects, produces the client’s addicted subjectivity as fundamentally a problem of self-deception and filters out social and institutional critique.

Similarly, as has been argued here, condescension (in conjunction with misrecognition) serves to filter out social or institutional critique in favour of an almost sole focus on the chaos and suffering caused by active drug and alcohol use. The final stage in the process is complicity/consent, and it is to this we now turn.

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Complicity/consent

Complicity/consent relates to the way that the social order is inscribed on the body of individuals through the learning and acquisition of dispositions. According to Bourdieu (1992: 168), it is neither a “passive submission to an external constraint” nor a “free adherence to values”. To give an example, through the symbolic power structured on gender, disapproving looks and emarks made by a male partner can convey the message that a woman is not behaving the way she should be. Consequently, through misrecognition of her own behaviour as, for example, not being “feminine enough”, the woman may change her behaviour and thereby comply with the exerted domination. In referring to consent, however, it should be emphasised that the point is not that individuals are willingly and knowingly putting themselves in positions where they may be open to abuse.

The point is that ways of conducting life are almost always perceived, even by the dominated subjects, from the limiting and reductive points of view of dominant perspectives. The official discourse imposes a point of view – that of the institution(s), which is recognised as the legitimate vision of the social world (Bourdieu, 1989).

This is clearly the case with individualised understandings in relation to addiction. The previous chapter demonstrated the process through which individualised understandings of addiction gained prominence. Therefore, treatment providers can draw on this culturally sanctioned understanding, and their own symbolic capital, to convince addicts

249 that it is their own “mistaken beliefs” and “character defects” (Wilson, 1939), which cause their drug use and general suffering. Consequently, through misrecognition, addicts attempt to change their behaviour in line with the instructions of the treatment provider and come to embody and rearticulate dominant understandings of addiction. The final step of this process is complicity/consent. That is, the official addiction ideology becomes inscribed in their body in terms of feelings, perceptions, and dispositions. They come to accept the official explanation as regards their suffering and drug use and come to embody and rearticulate this ideology. In doing so, they unknowingly help reformulate, or at the very least obscure, violent structures, systems, and ideologies. This is readily apparent in the interviews.

The first area in which it can be seen is in the participants coming to accept the disease theory of addiction and carrying this message to the “still suffering addict”. Consider Tracy, for example, though she was initially reluctant to admit that she had the disease of alcoholism:

“I was in a group and I was thinking “Why me” [emphasis] all this fucking drama, because again it came back to my dad, again I am not the alcoholic he is. I refused to turn out like my dad, I was really bitter like”.

However, she was eventually persuaded into accepting this identity:

“So I got feedback from the group sessions and all, and one day anyway there was a lecture, and this day I happened to be fighting it really hard, “I’m not an alcoholic”, so they explained it like and I was like, I remember saying to one of the lads “I think maybe we have a miracle here, the penny is dropping”. I did kind of think maybe it is. Admitting it is one thing, I can admit it no problem but, I’ve

250 only accepted being an alcoholic probably in the last 12 months maybe less. It took me a long time to accept it I didn’t want to, even when I came out I kept thinking people would tell me I wasn’t one, I was waiting for it like, and nobody ever did”.

Moreover, once her perception of herself changed and she came to view herself as an alcoholic she began to carry the message to other addicts:

“I was very grateful then for aftercare and stuff like that. With [name of treatment centre], they let us do it for ages and stuff, but I love AA. I just absolutely love it, that is just my experience of it, and it’s just really helped me. I have a great sponsor, and I’m helping someone myself at the moment. It’s just great, I love it, that’s just me”.

This pattern of acceptance and re-articulation can also be seen in Ryan’s case. When I asked him if he believed addiction to be a disease he replied

“I think addiction is a disease like but it’s your head like your mistaken beliefs. Some people will say oh you had a choice and you picked up [but I’d disagree]”.

Furthermore, this participant is now firmly embedded within the fellowship. As he puts it:

“I’m in the fellowship now which is really important, but back then after I came out of [name of treatment centre] I was told that I needed to go to meeting and

251 I didn’t like. I’m in the fellowship now and I’m helping newcomers and I go to five meetings a week. It’s the best thing I ever did like”.

Another example can be seen in the case of Connor. When I asked him to describe his understanding of his disease he replied by explaining to me in detail his understanding of the NA programme and how it has coloured his perception of his suffering, his alcohol, and drug use, and his potential life trajectory, past, present, and future:

“I first started doing the steps with my sponsor. The first step is about powerlessness and unmanageability. So, you’re powerless when you first use or drink you want more and more and everything goes to shit and that’s what happened with me. Towards the end of my addiction I had nothing, I was squatting in a caravan, in an abandoned caravan outside the town. I’d put on the nice clothes then and pretend everything was ok even though I had no house to go to. I think it was good in a sense but it was horrible to go through. Yeah, my mother was asking me about addiction because she wanted to learn more and there’s Al-anon and the one for addicts and I got her a few leaflets from [name of aftercare facility] and [name of treatment centre], because she’s very curious about it. So, she asked me the same question “if I wasn’t involved with my cousins would I have been the same way”. I said more than likely yes, but it would have been so far down the line I could have been married with my own family and then shit would have hit the fan and it would have ended up like you and dad’s relationship like. She was like “but you wouldn’t have been around the drugs” and I was like true but the drink is just as bad for me as the drugs. It caused me to do the same things. So, it might have been once every so often but then it would have got more and more regular as time went on. Because when I was 17 and 18 I

252 was in the pub every day. When I was 19/20 then I didn’t have the money to sit in pubs so I’d be robbing litres of vodka from the shops. When I was 17 I’d be sitting in the pub everyday with fellas in their 60s and 70s and you know something is wrong there like”.

As can be seen from the examples given, the participants’ perceptions, their actions, their understanding of their suffering, and the actions they take in terms of helping other addicts and rearticulating the disease theory, are all in line with dominant discourses and ideologies. This is complicity/consent. In a similar vein to the previous sections, it should again be highlighted that there are alternative ways of understanding these issues. In particular, one might point out that practically everyone would embody an ideology which assisted them in overcoming a serious difficulty they were facing. Indeed, it is difficult to see how one would institute such radical change if not for engaging in novel practices and rituals, while also embodying the logic which underpins them in terms of perceptions, behaviours, and emotions. Therefore, in order to discontinue a pattern of harmful drug use, one will likely have to engage in many different practices over a significant period of time, and it is certainly the case that the 12-step programme offers one way of achieving this.

In short, complicity/consent does not occur due to individuals practising techniques, and supporting ideologies which they found helpful, nor does it occur simply because they encourage others to do likewise. The key difference between this and complicity/consent is the issue of power and social context. That is, powerful groups (treatment centres, etc.) tend to portray 12-step approaches, and other individualised approaches, as panaceas. Therefore, it is this portrayal of such approaches in the near absence of any discussion of the social and political dimension, which leads to complicity/consent. This in effect creates a self-fulfilling feedback loop, whereby most people struggling with substance abuse will receive individualised treatment, while those who become sober

253 will then embody and rearticulate the ideology of that very treatment regime, thus bestowing it with legitimacy.

Complicity/consent can also be seen in the phenomenon of identification. This occurs in 12- step meetings where addicts are encouraged to ignore the differences and focus on the similarities in each other’s stories (Wilson, 1939: p 446-452). While this has the beneficial effect of encouraging social solidarity among suffering and ostracised individuals, it occurs within the confines of disease theories and disease understandings. Ultimately, the identification has to occur within the parameters of what the 12-step ideology finds permissible. Indeed, participants who mention social context as a potential causative factor for their addiction are often told to focus on themselves and their character defects. Thus, identification can be seen as a form of complicity/consent as it colours people’s perceptions, actions, and narratives almost solely in terms of disease theories. This comes through continuously across numerous interviews.

Consider, for example, Donnchadh. I asked him what was the most important part of the 12 steps for him, and he replied:

“It’s the identification of one spirit or soul with that of another through a shared wretchedness. Then the fucking wretchedness isn’t remotely as bad. That’s fine, I thought I was the worst most rotten human being in the world but so did he and so did she. So we are not. In fact then I learned a couple of very simple, yet very solid and practically helpful lessons in [treatment centre] from that meeting [….]. We read a bit of the start of the book, and nothing about the meeting or the

254 literature is imposed, it is actually faultless if you want it. Nobody stuffs it down your throat. But you hear it and go “I want that”. Some people hear it and go “oh no there’s too much about God and this and that”. No hang on, that problem is me. They are only suggestions. It clicked and I went there’s something about this that is unlike anything I’ve heard in my entire life and I doubt that there’s anything similar. This works, I don’t know how it works, and I don’t need to”.

Another example can be seen when I asked John to recount his first experience of a 12- step meeting to me. His response captures the point being made about identification and complicity/consent quite well:

“Initially, I was taken to a meeting down the road and I walked in and there were people laughing and joking and mucking about and it kind of registered with me hang on these people aren’t all miserable and depressed sounds like they’re having a good time. So I sat down and listened to what was being said, I kind of didn’t take much of it in but I identified with what the person was saying and what other people were saying about their experience and it kind of felt like they were talking about my experiences as well, so I thought that that would be a good start. So I went to a few meetings when I was in here and that’s my home group today and when I came out I just threw myself into it, I went almost every day to a . . . meeting and tried to share my experiences, and I got a lot of help, people talked to me, were pleased to see me, which wasn’t happening before. After a while I was trusted with running the meeting, given the keys to the cash box, which was like “you’re giving me the keys to the cash box are you mad” and you know it’s just gone from there. I’ve got myself a sponsor and I’ve gone through the 12-step

255 programme, and my life has turned around, I’m definitely a different kind of person today than the guy before”.

Finally, when I asked Collette what the most important aspect of the programme was for her, she also highlighted the power of identification:

“There would be a huge amount of identification in those rooms like. I don’t know if I ever came across anyone I didn’t understand or get where they were coming from. Normally they [their share] . . . and you’re like “that’s me”. I’ve never heard people say something I’ve never got”.

It has been shown how the official addiction ideology becomes inscribed in participants’ bodies in terms of perceptions and dispositions. It has also been shown how they come to accept the official ideology as an explanation for their suffering and drug use and how they participate in rearticulating it. This sub-section will close by demonstrating how the official ideology becomes inscribed in how they feel about their past and present. In short, recovery has become everything to these participants. It is seen as one of the most important aspects of their life. Their feelings then are in large part determined by their success or failure in this domain.

Consider the effect Tracy’s relapse has had on her:

256 “I relapsed after 15 months like and I’m telling you 2014 all happened in 5 days. 5 Days [emphasis]. I relapsed in 2015 after 15 months and it was October, I was drinking for 5 days only and it was like 2014 all over again. I didn’t leave the house for 5 days. I stocked up on drink, I didn’t shower, and everything happened all over again. Everything, and more stuff that I’m not going to go into, things that didn’t happen before that, that you’d think would have in 2014 but no it happened in 2015, so I know it gets worse. Like when I started drinking after 15 months why didn’t I go back clubbing? I didn’t, I went back to the home drinking, and I was online again buying drink. If I drank right now do you think I’d be going in clubbing? I’d be at home drinking, closing the doors and god knows what would happen. You don’t go back, you go back to where you finished off or where you were supposed to finish off. Like if I have a drink, I’ll be drinking, and drinking and drinking. I don’t go back to 17 down the laneway, having the craic like, those days are long gone. If they were still there, if I was still able to drink the way I did in my 20s having the laugh and having the craic and get up and go to work and live for the weekends, do you think I’d be sitting here? I’d be having a great time. But my drinking progressed like […] I needed to be on the couch pissing myself, not showering for 8 weeks, for me to get “oh you’re not fucking well girl”. I needed to be in those horrors”.

This was clearly a defining moment for Tracy. The memories of this relapse, filtered through the lens of 12 step ideology, now colours her perceptions, emotions, dispositions, memories of the past, and plans for the future. She doesn’t trust her memories of her childhood “I don’t trust my thinking either like”, due to the 12-step notion that addicts have “mistaken beliefs” (Wilson, 1939). She works four days a week and dedicates one day entirely to recovery. While most of her friendship groups in the area she lives are fellow members of Alcoholics Anonymous.

257

A similar theme can be seen in Johnathan’s interview:

“I didn’t stop properly until November 2015. I’d gone through [name of centre] at this stage and I thought I’d hit my rock bottom, but it took another go. I was in [name of treatment centre] once, but the last time I relapsed was November 2015. I’ve sworn I’ll never go [back into addiction] after that and I haven’t, touch wood I never will. But I ended up in my mother’s bed, back home in [large town in Munster] curled up like a child balling my eyes out.”

Finally, David’s emotions and perceptions are often filtered through his understanding of himself as an addict. This can be seen in the following quotation:

“Some days I’m walking down the road and I’m feeling top of the world, and it’s true what they say, I’m feeling 110% that’s the best time to go to a meeting, because when you’re feeling good you can relapse easy. You think sure I’ll have one and then before you know it you’re back in the thick of it, that has happened me countless times. I’ve learned a lot going through this like, I’m still learning. It’s something I think I’ll be living with the rest of my life and I’ve come to terms with that a long time ago too like. It’s just a matter of trying to apply skills I learn every week in counselling, trying to use basic common sense in life to make things easier you know”. This is the final process in participants “becoming addicts”. It involves their acceptance of themselves as “particular kinds of people” (Hacking, 2007), and their embodiment and rearticulation of dominant understandings of addiction.

258 Conclusion and discussion

In conclusion, it is perhaps useful to restate the main claims of this chapter, outline how they relate to the previous chapter, and specify what needs to be done in the next chapter in order to present a novel approach to drug addiction. The first substantive claim made in this chapter is that there are objective structures that cause conditions of social suffering among the study participants. These structures are either political- economic or socio-cultural in nature, and though they have been treated separately, they often interact in every-day contexts. The next claim is that these structures and the suffering they cause are violent, and are not seen by participants for what they actually are. Instead, participants view their suffering as their own fault, natural, and unavoidable. Within this context treatment centres and 12-step groups, in an apparent act of reaching out to help, convince participants that their suffering is almost entirely caused by their drug use, is an individual problem, and that they have an incurable, progressive disease. Finally, participants come to embody this ideology in terms of their dispositions, perceptions, and emotions, and participate in re-articulating it in various ways.

These claims relate to the previous chapter in numerous respects. In the first place outlining the violent structures which cause suffering is intended to counter the tendency to portray drugs and addiction as a corrupting influence in an otherwise well- functioning Irish society, and also highlights that the problem is the political-economic and socio-cultural structure of society rather than exclusion from it. Furthermore, the mechanism of misrecognition is the micro-level manifestation of the macro-level discourse which portrays drugs, and addiction as a corrupting influence in an otherwise well-functioning Irish society. Participants come to see drugs and addiction as a central corrupting influence in their own lives, in large part disconnected from the social context within which they live, much like how the broader society views both as corrupting its

259 functioning, largely disconnected from the societal context (rapid modernisation, cultural change, near economic collapse) within which harmful drug use occurs.

In the previous chapter, it was demonstrated how groups high in symbolic power have the ability to determine which drug use is problematized and which is not. Furthermore, the process whereby a stigmatised subjectivity is imposed on groups of addicts has been outlined in the previous chapter. Condescension demonstrates the micro-level strategies utilised in treatment centres and 12 step support groups, which convinces addicts that their suffering is almost all the result of their drug use, thereby convincing them to adopt this stigmatised subjectivity. Finally, complicity/consent is intended to demonstrate how addicts “do the work of the dominant’ and participate in rearticulating the problematic processes, structures, and ideologies that have been outlined and analysed. They come to embody the ideology in terms of their perceptions, dispositions, and emotions. However, there is a central issue that has not been addressed in this chapter. The violent structures and systems which have been outlined, undoubtedly impact on a broader population, and cannot be claimed to be limited to drug users.

Therefore, an account is needed of how drug use in the context of suffering becomes problematic for some and not others. Of course, the issue here is the structure/agency debate. This chapter has, in the main, been focused on the structures and systems which harm the study participants, cause them social suffering, as well as the mechanisms which lead to the misrecognition of these objective structures and their embodiment. Importantly, the participants were not passive recipients of structural or symbolic violence. They attempt to build lives and find meaning within this context. However, this attempt to find meaning is inadequately accounted for by any of the theorists mentioned in this chapter.

260

While Bourdieu is not a structural determinist, he does tend to emphasise structural issues much more prominently. In his famous book “The weight of the world” (1993) Bourdieu paints an extremely bleak picture of those suffering under the weight of structural violence (though he doesn't use that particular concept). While this chapter has attempted to traverse similar ground, it does seem that at times Bourdieu's approach is too bleak and pessimistic in light of the full context of the participants’ lives. Despite the enormous struggles participants faced, their lives did not completely resemble a Hobbesian nightmare (nasty, brutish, short). Indeed, some of the participants completely turned their lives around in spite of these structural impediments. Furthermore, even those that did not manage to achieve this still succeeded in resisting dominant discourses, ideologies, and systems, in limited respects and managed to salvage some sort of meaning.

However, this does not mean that one should follow the approach of theorists such as Anthony Giddens (1991), who, while acknowledging the limiting impact of structure, places much more emphasis on reflexive agency. In short, even those participants who completely turned their lives around did so with extreme difficulty, in the face of quite unfavorable odds. As the next chapter will demonstrate, bringing Clifford Geertz’ (1973) notion of webs of significance, in the context of contingent events and decision making, to bear on the work of Bourdieu (and indeed Galtung, and Kleinman and colleagues), can give a more comprehensive account of how the participants in this study “came to be drug addicts”, and indeed how they resisted this process, and at times partially escaped it. Furthermore, it is intended to serve as a general contribution to the structure vs agency debate (see Measham and Shiner, 2009 and literature review), in that it seeks to reformulate Bourdieusian approaches by paying more attention to meaning-making and highlighting the role it plays in agency, without positing thoroughly reflexive and dynamic

261 agents, as theorists such as Giddens (1991) have done (see literature review for more detailed discussion). Therefore, Geertz’ notion of “Webs of significance” (basically meaning built around friends, family, and community) will be elaborated in the next section in order to provide an account of how in contexts of social suffering some people develop harmful relationships with drugs, while others do not. It is to this task we now turn

262 Chapter Six

A Novel Approach to Drug Addiction

Alternatives to current theories and dominant problematisations.

This chapter will integrate the claims made in the previous two, with Geertz’ (1973) concept of “webs of significance”, as well as an account of participants’ decision making and contingent events. This will enable a successful resolution of the structure/agency issue (see Measham and Shiner, 2009 for an overview) outlined in the literature review, and the conclusion to the last chapter; and which is required to present a novel approach to drug addiction. It has thus far been demonstrated that particular political-economic and socio-cultural systems, and developments are violent and have caused social suffering among the study participants. This chapter will now demonstrate how drug use within this context of suffering becomes problematic for the study participants. In short, despite the levels of suffering the participants faced, to a greater or lesser degree, they succeeded in creating what Clifford Geertz has called webs of significance (Geertz, 1973).

The next section will introduce and elaborate this concept more comprehensively, for now, it will suffice to explain these webs, as the symbolic structure or narrative of existence which serves to guide action, provide meaning, and counteract suffering (Geertz, 1973). These webs are most typically built by drawing on a deep cultural reservoir and within the context of families, close friendship groups, and in communities and work. It is when these webs are shattered or significantly undermined, in the context

263 of social suffering, and when this process is misrecognised as the participant’s own fault, natural or inevitable, that drug use becomes problematic and exacerbates suffering.

From here, strategies of condescension operate to convince participants that their suffering is almost entirely caused by their drug use, is an internal problem, and that they have an incurable and progressive disease or disorder. Finally, depending on how successful these strategies of condescension are, participants come to embody and rearticulate the dominant understanding of addiction to a greater or lesser degree, thus bestowing it with increased legitimacy, and “become addicts”. This is a sketch of the novel approach to drug addiction, which will be presented in this chapter. It will be elaborated more comprehensively through the use of four case studies. That is, I have chosen four participants from diverse backgrounds and will demonstrate how this model can help explain their harmful drug use and general suffering. The participants will serve as empirical coat hangers (Inglis, 2014), from which to elucidate and elaborate the novel approach to drug addiction presented. These particular participants were selected for a number of reasons.

Firstly, participants were selected to allow engagement with a wide-range of different violent structures, thereby demonstrating the explanatory power of the concepts of structural violence and social suffering86. Secondly, two females and two males were selected in order to ensure a gender balance. Thirdly, Jakub was included to demonstrate that the concept of structural violence is analytically broad enough to account for the impact of violent structures (cultural dislocation) beyond those engaged in the previous chapter, and can, therefore, provide an analytical scaffolding for future research of this nature in Ireland (and indeed elsewhere). Fourthly, Roisin was included

86 For example, some of the violent structures engaged with in the case studies are: alienation, vertigo, patriarchal structures, social bulimia, etc.

264 to demonstrate the importance of the mechanisms of symbolic violence being successfully applied (it was not obvious in her case they had), in the process of a person “becoming an addict”. This demonstrates the importance of the current study’s commitment to “dynamic nominalism”, and the limitation of the axiomatic realist position assumed in all Irish addiction research to date. Finally, as the events (both dramatic and cumulative), which shattered participants’ “webs of significance” are quite diverse, the case studies also allow for contingency and agency, as well as demonstrating the explanatory power of the concept itself.

The first case study participant is Collette. As mentioned, she had struggled for many years with heroin use. The second case study participant is Roisin, who primarily used alcohol in harmful ways, but also ecstasy and cocaine to a lesser extent. The third case study participant is David, who had used opiates (mainly heroin and methadone) for many years. Finally, the fourth case study participant is Jakub, a Polish male in his 30s who had struggled primarily with amphetamines, alcohol, and cannabis. These participants have been chosen because they used a diverse range of substances, differed according to age, socio-economic status, and gender. Most importantly, however, their social suffering resulted from both similar and distinct forms of structural violence. Therefore, examining these cases in-depth can demonstrate the comprehensive nature of this concept, when compared with a narrower concept such as social deprivation.

In short social deprivation, as mentioned, cannot explain the influence of patriarchal structures, social suffering among the middle-class, and the cultural and social dislocation of new immigrant groups. Therefore, these in-depth case studies will not only introduce meaning-making, decision-making, and contingent events, (Geertz, 1973) as a means to overcome the structural/agency issue, but will also more fully demonstrate the utility of

265 the concepts of structural violence and social suffering. Before examining these participants’ experiences in-depth, however, it is necessary to outline the notion of webs of significance. As mentioned in the literature review, the concept “webs of significance” has the potential to address the tendency of Bourdieusian and Foucualdian perspectives to reduce meaning-making to the effects of structural developments. It can, therefore, help explain how drug use within contexts of social suffering becomes problematic for some and not others. Before the concept is applied to the participants, it will require some careful elaboration, and it is to this, we now turn.

Meaning: Webs of significance

As mentioned in Chapter two, these symbolic structures constitute our worldview and guide our actions. They can be seen as a cohesive narrative of existence, a kind of mental text which functions, in much the same way as a geographical map, as a guide to the terrain of life. From them, we generate ideas, interact with people, and perform other activities we would be unable to do without a framework in which to interpret the world and make decisions. In a day to day context, this involves talking and listening to others, recounting stories and eliciting responses (Geertz, 1973). This then produces a “daily interactive communicative process that reaffirms people’s sense of themselves and gives meaning to their lives” (Inglis, 2014: P. 35). Crucially, the use of Geertz is intended to overcome some of the limitations identified in the approaches of other theorists who have attempted to reconcile realist and nominalist approaches, most notably Phillipe Bourgois (2009).

In his critically acclaimed ethnography of homeless heroin injectors in San Francisco, Bourgois’ attempts to reconcile structure and agency, He achieves this through his conception of “lumpen abuse” which combines Marxist class conceptions, with Bourdieu’s concept of symbolic violence, and Foucauldian Biopower (Foucault, 1977), in order to redefine class as subjectivity. He recognizes the structural impediments facing the homeless – labour market restructuring,

266 the retraction of the welfare state, the war on drugs, the gentrification of San Francisco’s housing markets, racism, sexism, stigma, all of which creates “lumpen populations”. The use of symbolic violence is intended to link these structural forces to embodied emotions. While Foucault’s concept of Biopower demonstrates how power, capillary-like, flows in every direction to entrap the Edgewater87 homeless in a stigmatised lumpen subjectivity. However, this conception falls into the same trap as Bourdieu (1993). That is, the lives of the population under study are portrayed as those of a Hobbesian nightmare (short, nasty, brutish). While undoubtedly, both Bourgois’ and Bourdieu’s subjects live in contexts of extreme social suffering, their analyses of the meaning in participants’ lives leave the reader with little hope that things could improve without the intervention of some outside benevolent force. This underestimates the ability of people, even in the most desperate situations, to mobilize and resist the forces which oppress them. Furthermore, the lack of attention to the meaning the Edgewater homeless may have had in their lives prior to finding themselves living under a busy highway intersection in San Francisco, portrays them as phantasmagorical characters who have always haunted “Edgewater”, and never had lives rich in meaning.

This lacuna is typical of approaches that draw on Foucault and Bourdieu (see Inglis, 2014) and fails to analyse meaning-making across participants’ lives. However, while all of the participants in the current study were victims of structural violence, and suffered immensely, their actions, and crucially, their attempts to find meaning and purpose through the construction of webs of significance, were in many ways unique. The concept of webs of significance then helps us to strike a balance between viewing the participants as puppets, controlled and determined by forces outside of their control, and on the other hand, viewing them as agents who are completely free to choose any future they wish, i.e. it can resolve the structure/agency issue. Indeed, it is the ability to create and sustain meaning within the confines of forces outside of our control that makes humans different from other animals. Culture, social forces, and institutions shape people’s

87 This is the name Bourgois gives to the homeless encampment where his participants live

267 knowledge of themselves and the world around them, but at the same time, people creatively and continuously use culture to relate themselves as individuals, to enhance their opportunities in life, and to pursue pleasure and happiness (Geertz, 1973).

This attention to meaning-making is vital and is the reason for the elaboration of Geertz’ concept. Typically, Foucauldian and Bourdieusian approaches, equate meaning with structure, in an overly deterministic way. Geertz’ then will prevent the current study from explaining away the participants’ experiences by reference to structure, while at the same time recognising the constraining and propelling impact structure undoubtedly exerts in their lives.

Case Study 1: Collette

Collette is a female in her 30s, from a socially deprived community, just outside of Cork City. In the main, she attributes much of the suffering in her life, to the trauma she experienced due to a difficult family upbringing88, which was compounded by the abuse she received at the hands of religious orders in secondary school. According to her, this led to an inability to form friendships, a valued identity, and a general difficulty in understanding how to relate to people, or act appropriately in social situations. In her words:

“[At home] it was just hate, hate, hate. None of us ever felt loved in that house. We wouldn’t have learned how to live, in a sense, you know, any morals from her [her mother] other than anger and hate like. You know so it was hard to relate to people”.

88 Collete’s Father was abusive and had an alcohol problem, while her mother suffered from serious mental health issues and was also abusive.

268 If we recall the previous chapter, it was demonstrated how Collette experienced what I have called “cascading intersections of alienation” beginning at home and continuing out into the community, school, and friendships. However, in line with Geertz, she was not a passive recipient of structural violence. Indeed, she drew upon a largely accepted, and historically sanctioned cultural norm from which to form an identity and find meaning – i.e. she found a partner and had a child. As she states:

“I got pregnant […] I was about 6 months pregnant when I got my own house and stuff in [area she’s from]. My oldest girl will be 17 now this year, but her dad would have also been an alcoholic so I was attracted to, sure my dad was a role model for a male growing up, and sure I didn’t know any better. So, he was 7 years older than me, and I thought he’d be this big protector. Oh my God everything is going to be fine now we’ll have a family and it’ll be great and this bollix fairy tale you believe in”.

As Tom Inglis (2014) and others (Daly, 2004; Canavan, 2011) have demonstrated, one of the few generalizations we can draw about meaning in contemporary Ireland, is that most people expect that they will at some point meet a partner and have children. In other words, despite widespread structural changes, the family is still of paramount importance. However, despite Collette attempting to find meaning and a valued identity through socially and culturally sanctioned means, the webs of significance (spun around her partner and her children) soon came under threat from patriarchal structures and then the state’s social service bureaucracy. In terms of her partner she experienced significant violence: “He was very violent towards me as well. Just before I had her actually I remember being in Cork and getting a barring order and protection order from him. It was just chaotic pure chaotic”.

269

Furthermore, as mentioned in the last section, the state’s social services refused to provide the participant with support despite her struggling to cope with motherhood, and eventually, her children were taken into care. Importantly, each of these events, which significantly undermined her already thin webs of significance, coincided with a significant escalation of her drug use. The domestic violence she experienced coincided with her being hospitalized due to stimulant abuse “I would take ecstasy for months at a time until I literally collapsed at house parties and had to be taken to hospital and this was at a young age 18 or 19”, while the loss of her children coincided with her becoming homeless and with her most challenging period of heroin abuse. In her own words:

“Anything to do with benzos or opiates it’s a whole new level. You go down so fast, the lack of control that comes with this. Your whole life becomes from the second you wake until the second you go to bed about when, where, what and how. That’s it, that’s it. You’ll step over any one, you’ll kill someone just to get it. Within two years between the tablets and then the heroin I was – kids in care, house gone, job gone, and living up here on the streets”.

Crucially, in many ways, it seems the participant blamed herself for the loss of her children and, in some respects, for the domestic abuse. In terms of the loss of her children, she attributes this largely to her benzo and opiate abuse, as demonstrated above. Furthermore, as we have seen, she blames the domestic abuse situation for her adherence to a socially sanctioned “fairytale”. This final point is a theme that emerged in terms of all of the other female study participants’. Thus, we see drug use becoming problematic when webs of significance are undermined, in the context of social suffering, and when strategies of misrecognition convince the participants’ that their suffering is their own fault, or else an inevitable part of life.

270

In terms of strategies of condescension, while they were largely successful, in convincing this participant that her suffering was caused by her drug use and that her addiction was an individual problem, she did resist the dominant discourse in many ways. In the first instance, the treatment centre she attended, succeeded in convincing her that it was her, and her drug use, that was the ultimate source of her troubles:

“It was my own behaviour like. I suppose I didn’t learn a lot, I just started to see ok maybe this is the drugs, the alcohol, maybe it can be different. They kept saying your behaviour is off the wall. There were two counsellors down there who took me under their wing because they’d say “she actually doesn’t know”. If we thought you understood we wouldn’t have you in here but the fact we believe you’re blind and don’t even see what you’re doing. I think it was 15 or 16 weeks of them constantly onto me about my behaviours and what I was doing to everyone that I finally threw in the towel like”.

However, while she accepted that her suffering was almost entirely caused by her drug use and her own behaviour, she rejected the idea that addiction is a disease and at times highlighted her traumatic background as a causal factor. In a particularly contemplative statement, she admits to:

“Struggling with that like. The only thing I struggle with. I do not believe addiction is a disease […] I do not believe we have a disease of the mind that tells us to do something and takes us over. If you sit down and look at say my own history, for example, it’s there in black and white. Basically, I medicated myself for as long as I did because I wasn’t able to deal with my reality, I hadn’t

271 the tools and I just couldn’t cope with it. That’s my concept of it. I do know on any given day my behaviour can be mental. But I don’t think that’s my disease, I feel that’s a cop out. You just learn to live the wrong way as a coping mechanism for the things you are going through, you just have to live the right way and cope through that, that’s how I use the steps anyway”.

This demonstrates that dominant discourses are only ever imperfectly realized. While she did not believe that she had a disease and highlighted the impact of her traumatic background, she still believed that she had a disorder (of coping mechanisms) and ultimately individualized her suffering, in terms of her learning the “wrong way to live”. Importantly, as we will see in the coming case studies most participants employed disease understandings in limited ways, mainly as a means of arguing that addiction was not a free choice and that they could not, under any circumstances, use drugs in a moderate manner.

In that sense, she was in line with others in that she believed that if she had a drink

“right now by 12 o clock tonight I will have a bag of heroin. I won’t ease back into , for me it just brings me straight there like. It breaks down all the inhibitions, you’re aggressive, and it just breaks down all the inhibitions”.

Ultimately, the participant’s habitus is that of an addict. Her understanding of her past, her suffering, and to some extent her future is conditioned by her understanding of herself as a type of person who has developed disordered coping mechanisms and is unable to use drugs in a moderate manner. This can be seen in a number of instances.

272 For example, she was particularly hurt by what she sees as negative stigma towards addicts:

“Stigma, oh you’re an addict, an alcy, a junkie. Huge stigma, nobody will for addicts, no politician will back our cause. I actually came off social media over this like. I would have seen videos of a girl on the train out of her head with a baby besides her, but with the judgement, I know it’s bad, but the pure judgement. It’s bad for me to look at it anyway because of my own negativity. If you’ve never been through it, nobody chooses to go out and stick a needle in their arm, or sleep on the street, it’s a progression, it doesn’t happen overnight”.

As is obvious, her perceptions of how others view her are deeply filtered through her understanding of herself as an addict and how the dominant societal discourse views addicts. In terms of dispositions, as we have seen Collette views herself inherently as an addict, as someone who cannot take drugs due to her having disordered coping mechanisms. Furthermore, she is intimately involved in NA. The identification she receives in her meetings is, in her view, the main factor which convinced her that she was an addict (see Chapter five “condescension”). As previously argued, this strategy of condescension is particularly powerful.

Due to the levels of social suffering, and other factors mentioned, the study participants often found themselves extremely isolated, and living an existence they perceived to be basically meaningless. However, the NA ideology by discouraging talk of social context creates strong bonds of belonging among members. While this is undoubtedly helpful, it does cut participants’ off from others who may be suffering for similar reasons but not using drugs in a similar manner. Ultimately, for this participant, it convinced her that she was a member of a disordered community of individuals who could not use drugs and

273 needed each other and the NA fellowship to live a meaningful life and avoid suffering. Regardless of whether this will be successful in the long-run, it represents the final “step” in her “becoming an addict”.

Case study 2: Roisin

Roisin is a woman in her mid-40s from a lower middle-class background. She grew up in a large town, roughly 20 KMs from Cork City. In the main she attributes her problematic drug use (mainly alcohol, but also ecstasy and cocaine) and suffering to difficulties she experienced growing up, the dislocating impact of her constantly having to move home for work, having married too young, and the devastating impact of having been sexually assaulted by a work colleague she trusted. In many respects, this participant is quite similar to the previous, yet prior to her sexual assault, it seemed that the webs of significance she had spun were relatively strong and meaningful.

From talking to this participant, I became convinced that the initial source of her suffering was a sense of ontological insecurity (Young, 1999) she experienced in attempting to form a valued sense of female identity at a time when what it meant to be a woman in Ireland was changing rapidly. This can be seen in terms of the contrast she draws between herself and her mother and between her idealized future (as an adolescent) and her future actualized. Early in the interview she quite clearly drew a distinction between herself and her mother:

“[…] my mother then I probably didn’t get on so well. I understand now being a mother myself that it was a different era, different times. I’d say she was sort of thrown into housewife stuff and had six kids, whereas I suppose these days we all work”.

274 This contrast in role expectations and role fulfilment, it seems, caused the participant suffering in two ways. In the first instance, she saw her mother as being bitter at not having had the opportunity to live the life that modern Irish women can live.

She states that:

“She came from a family of 11 and she had her own issues. I do feel like there was a bit of jealousy with my mother as in the 4 of us all went out and worked, and had husbands, and had kids. But we didn’t have to give up everything. So, the generation difference […]. More explicitly, she recalls her mother “[…] making a comment like ‘oh ye don’t know how lucky ye are’ and she has often said over the years that she would blame my father for her loneliness, because he didn’t allow her to have friends”.

The second instance in which this rapid change in female role expectations and fulfilments caused the participant suffering is more complex. While in the era she came of age (1990s), the political-economic structure of Irish society became more open to females in terms of educational and vocational opportunities and expectations, it seems the socio-cultural ideals outside of the domain of work and education, remained rooted in more traditional forms. In simpler terms, while women could work and get an education, and were no longer seen solely as mothers and housewives, outside of these domains there was little option but to enter traditional relationships and adhere to traditional social norms - if one wished to find meaning and avoid suffering. Indeed, despite the participant going to college and gaining employment she still felt lonely and disconnected.

275 In many ways, this participant’s experience is symptomatic of the failure of the media and the market to provide anything like the level of meaning that was previously provided by religion. Indeed, while she did describe herself as religious, often times this was in a rather ambiguous way. Unfortunately, it seemed the ideals presented to her by the market and the media were a poor substitute. In terms of the media this is quite explicit in her disappointment that her life hadn’t turned out like the ideal she had been presented with from popular television:

“As I said to my doctor over the years I thought we’d be a bit like Emmerdale, grow up together and my kids, I’d know the parents of their friends and all that sort of thing. I lost all that when I left. I was sad at that. Looking back on my life there were huge periods where I had to go through grieving, and leaving, and being sad, nothing was ever effortless. It was like oh now you have to leave where you’re from, then your friends, and your family, then you move up somewhere else for a few years, get in there, just get happy and you’re off again. It couldn’t just be fucking leave us alone, leave us stay here […]”.

It seems the life she had expected from her exposure to the media when faced with the reality of having to be mobile in order to meet the demands of the labour market, caused a disconnect which led to her suffering a great deal. Similarly, the contemporary cultural ideal of owning a nice house, and having a family, and job, failed to provide her meaning, in the absence of friends and community. Indeed, although she moved to a bigger house, and a better paying job in a different part of Ireland, this coincided with her most intense period of suffering and an escalation in her drug use, as we shall see. However, despite these structural and historical developmental impediments, for a time this participant’s life was rich in meaning. She speaks particularly fondly of her relationship with her father growing up and being part of a rich and vibrant pub culture in her family owned pub, in her home town. In terms of her father she recounts a loving relationship:

276

“Well my father was a family man, and Sunday was family day. So, six of us would go off, with both parents. There would be particular songs played in the car. I was at my sisters 50th actually a few weeks ago and the songs were played, we’d go to [part of cork] to my grandmother, to the “merries89”, or the funfair. So, it was always fun related and it was always nice. There would be food and whatever. That was a Sunday now and it was definitely driven by my father”.

The importance of community in Roisin’s life has already been stressed, however, the pub her family-owned and the broader nightlife in her home town was particularly important in terms of meaning and belonging:

“[speaking of the pub] my dad did up the building and it was great. There was a great sense of [community] I often thought, shit that’s what I should have done [purchase it from her father]. But sure, I might do it someday. A lot of my friends then wouldn’t drink in the pub because it was an older crowd, because the [profession who frequented the pub] were a bit older and their girlfriends, all the girls drank there. But it was there 10 years and all of a sudden other pubs and stuff started opening up, and bands started and that was great, even though my father was never into that sort of thing. Nightclubs began to open up then and our pub would clear out at 10 or 11 because everyone would go to the nightclub. Looking back, it was great, we’d have been proud of having a business and the sense of community was great”.

In terms of her friends she also spoke fondly “I had some close friends too, I was lucky”. Furthermore, her marriage and the birth of her children also provided her with a sense of

89 Cork slang for an arcade

277 meaning, belonging and purpose. As can be seen, then, despite the structural and historical developmental impediments which caused this participant suffering, she was still able to create relatively rich webs of significance. Unfortunately, her sexual assault coupled with her almost immediate relocation for work shattered her webs of significance leaving her in a state of near meaninglessness and intense suffering:

“Something terrible happened to me in Cork actually before I went and again it was drink related if I’m to be honest. It was a work night out and I was married 12 or 18 months maybe and we went on the night out, [husband] wasn’t around he was up in [part of Ireland]. Anyway, unfortunately I fell asleep on somebody’s couch, and unfortunately the next morning I woke up and there was a guy on top of me. You know, the dirty bastard really like. It was something I didn’t deal with at the time. He was actually a work colleague. I suppose now you’d call it rape or sexual assault or whatever. I did nothing about it. I felt so bad and thinking about [husband] and the guilt. It being an early marriage and all. I do remember that being the first time I drank to numb out a pain or a memory. It was a case of I didn’t want to go there so I drank. The guilt Jesus, it was horrible. I didn’t deal with it as I should have, and I brought that with me to [part of Ireland] then”.

This also coincided with Roisin’s first experiences, and extremely negative experiences at that, with drugs: “That’s where I was introduced to drugs then really. I mean Jesus Christ I had nobody to protect me”. She also mentions that her experiences with ecstasy and cocaine led to a level of suffering she had never previously experienced. For example, when I asked her how her experience with both of these drugs differed to alcohol she replied:

278

“Well I’d feel way worse after drugs, the come down as I said was horrendous, I’d be borderline suicidal. It was secretive, very few people knew, whereas the drink was much more social in Cork, maybe not in [part of Ireland she moved to]”.

Roisin’s experience quite clearly demonstrates the explanatory power of the approach to drug addiction presented. In the first instance, she experienced a degree of social suffering due to violent structures and developments outside of her control. While this caused her to suffer, and limited her agency, she was nonetheless able to form webs of significance that gave her life meaning and purpose. It was only when she was sexually assaulted and had to relocate for work shortly thereafter, that her webs of significance were shattered. Left alone in a strange place, her husband working long hours, distant geographically from friends, family, community, and with a young son, this participant’s alcohol and drug use became quite harmful. Crucial to this process, however, is the misrecognition of her suffering and its internalization as guilt and shame.

In Ireland, a dominant and damaging, discourse is promulgated in the media which blames sexual assault, in whole or in part, on a woman having consumed too much alcohol90. As we have seen the current participant, while angry at her attacker, did blame herself and felt guilt over what happened. While she never specified exactly why she felt guilty, and it would be unfair to speculate, it is clearly linked to her husband and their marriage. The point, however, is that rather than seeing sexual assault and rape as acts entangled in a patriarchal nexus of violent norms and attitudes towards women, the dominant societal discourse blames women for having consumed too much alcohol, or having dressed “promiscuously” (Dworkin, 1974; 1987).

90 www.rcni.ie (Rape Crisis Network Ireland).

279

In line with our approach to drug addiction, strategies of condescension can be seen operating in Roisin’s story, which individualized her suffering and convinced her, in part, that it was due to her drug use. The first example of this occurring is when she attended a treatment centre for the first time. She mentioned that she was convinced there that she was a “typical addict” because she believed once she received counselling for “issues” she could resume drinking in a moderate fashion “I’m like the typical addict, in my head I was like that because all these things happened and someday when I deal with them I’ll be able to go back to it again”. She mentioned that the biggest lesson she learned in the treatment centre was that she was an addict for life and even if these issues could be dealt with, alcohol and drugs were the source of suffering and would only lead her to “Jails, institutions, and death”.

However, she resumed drinking when she returned to Cork and eventually ended up in a treatment centre in the Munster region, under pressure from her husband:“It was a Wednesday night, and I had drank that day, and ended up in bed. Next thing [husband’s name] said look it’s either the drink or me, and I chose the drink, and that was it he locked me out of the house that night. The only way I was getting back in is if I promised to go down to [treatment centre] and I did”.

Throughout the interview, Roisin was uncertain as to whether or not she was an alcoholic:

“Am I really an addict or an alcoholic? Well I still question that I can’t drink anymore. Definitely not the other stuff because of where it took me in the past, but I question am I an alcoholic. I think it was down to situations and circumstances”.

280 However, under coercion from those in the treatment centre and her husband, she accepted that she was. This can be seen when I asked her how she fared in treatment. She replied:

“It was a life-saving experience […] when my aftercare came up I said I wanted to do it in [treatment centre] because I wanted to keep my foot in there and I liked the counsellors, and I loved seeing people getting well”.

Yet she still wasn’t sure if she had “the disease of addiction or not”. She states: “Myself and [roommate in treatment] used to sayit’s an awful pity that there wasn’t a test or a pill you could take and then “Bing” it’s obvious you’re an addict”. We see here then strategies of condescension operating only partially in Roisin’s case. Ultimately, it is unclear whether she now considers herself to be an addict or not. She attended 12-step meetings for a while but found fellow attendees invasive91. Eventually, she stopped going, and while she has since consumed alcohol, she doesn’t seem to have returned to harmful alcohol or drug use. Furthermore, while she does rearticulate the dominant discourse in relation to addiction in some respects, she is also unsure whether or not to call it a disease, and at times argues it was life circumstances that caused her suffering. Crucially, she told me that she had undergone extensive psychotherapy and training in meditation to address the trauma related to her sexual assault.

In conclusion, it can plausibly be said that Roisin has yet to “become an addict”. However, I would speculate that if she does at some stage return to harmful drinking she would accept the dominant discourse almost completely. This is due to her belief that she has to some degree dealt with the trauma linked to her sexual assault, and this

91 She mentioned that she would sometimes meet them in the streets and they would openly discuss AA. She feared this would “out” her as a drug user.

281 has coincided with her return to occasional, moderate drinking. In this important respect, and many more as we have seen, she is resisting dominant discourses. A return to problematic drinking, or drug use, however, would likely lead to further treatment and would make it difficult for her to maintain that her harmful use was linked almost entirely to life circumstances. Case study 3: David

David, as mentioned, was a male in his late 30s. He had struggled with numerous substances throughout his life. Initially ecstasy, then cocaine, before moving onto opiates after he had a heart attack at 25 due to cocaine use. In terms of social suffering, his life reads like a Greek tragedy. David was born in a socially deprived community in Cork City, and his family life was extremely volatile due to his father’s alcohol consumption. By age five his father and mother divorced and his father, due to a lack of work, emigrated to England bringing half of his siblings with him, the rest (including himself) staying at home with his mother. In his own words:

“See my father left my mother when I was about 5 and that’s what set me off on my path of destruction. I just acted out like any child would really asking questions like where’s my dad and all that. See my dad was an alcoholic. I kept asking the questions as to where he was”.

This suffering was compounded by the extraordinarily punitive systems of social control which operated in Ireland at this time to contain “disorder” among poor families. Unfortunately, David grew up just before more welfare-oriented systems replaced the Church dominated institutions of social control. His father’s departure, coupled with his mother having to care for her elderly father, who had dementia, meant that this family existed in an incredibly precarious situation. This was the case even within the general precarity of socially deprived communities. He attributes his

282 father’s departure to his “falling in” with a group of older kids, who encouraged him to rob bottles of vodka. Ultimately, these repeat offences led to the courts sentencing him to reside in Ireland’s infamous industrial schools (O’Sullivan, and Raftery, 2001). Within these institutions, he suffered sustained psychological and physical abuse. He recalls:

“I used to dread going to the swimming pool though after what I witnessed there in the dressing rooms. I used to dread that and for a while they had us going 5 or more times a week like, especially when Brother Burn was around. He wasn’t there often they’d send him away for 6 months or so and then he’d be back for six months and he was a fucking nightmare so he was. Thank God the cunt is dead you know he was a nasty man. He really did beat the shit out of me like. So, I witnessed him making a young fella give him a blow job”.

Due to his having witnessed this act of pedophilia, the Christian Brothers singled him out for particularly barbaric treatment:

“Ya he beat the shit out of me like and during it he’d say “keep your fucking mouth shut or else”. Then I’d get “slap, slap, slap” full force punches, full force kicks into the stomach and back and belts of sticks off him. He’d beat me to a pulp basically like. There’s not a bone or mark on my body that, that man hasn’t hurt like, you know”.

This suffering was compounded by the police and civilian authorities within the schools who he said colluded in this abuse. He tried to run away numerous times, and when

283 captured by the police he was always returned to the institutions, despite informing them of the ongoing abuse. He recalls:

“I said it to the cops over the years too and nobody wanted to know about it like, they’d just bring me back. Then it was pure silence, everything was swept under the carpet. It was a taboo question back then. Even say in the industrial schools, the civilian staff working there knew about the abuse going on but they did nothing, they didn’t want to know. The staff would have known of the vicious beatings I was getting, they were well aware like”.

This essentially left the participant in a state of despair, without hope that things could ever get better. Furthermore, after leaving these institutions he was at a further disadvantage due to the inferior level of education provided, and a lack of access to good quality jobs as a result of this, and due to reluctance in society to hire former inmates due to stigma (Raftery and O’Sullivan, 2001). Despite, these enormous structural disadvantages, David did manage to create webs of significance, at least initially. He held down a number of jobs, as mentioned in the previous chapter. He was an avid pitch and putt player “I was a champion P&P player, so that’s probably what they would remember me for I’d say”. He also met a girl and became engaged, had a daughter, and had a number of friends. Ultimately, however, the webs he spun always seemed to be thin and to be in danger of being shattered. He put this down to his inability to escape the suffering he had endured in the industrial schools:

“I found it hard to adjust to society alright when I came out of there like. You’re lost, you don’t know what’s going on in your area, even though

284 your home every second or third weekend, you think you know what’s going on but you don’t like”.

While he did have a number of close friends and, as mentioned, worked at many jobs, the friendship groups were built around drugs, and he blamed his drug use for the loss of the many jobs he had been employed in. From analyzing the transcript of our interview, it seemed that David’s life, up until his mid-20s, could have gone in a more “positive” direction – marriage and work, or descended into meaninglessness and suffering. Indeed, just as his drug use was beginning to escalate he received a job offer to work in Spain. Had he accepted this offer it seems likely his life would have turned out quite different. As it turned out he rejected it, in order to stay with and become engaged to a girl he had fallen in love with. Unfortunately, the relationship broke down due to her infidelity, she succeeded in legally restricting his access to their daughter, and the thin webs of significance he had built were shattered. He explains as follows: “She cheated on me about 6 months before our wedding and that drove me off the edge, that drove me fucking mad and that’s a big reason why I’m here today like”.

This coincided with the participant initially experimenting with heroin, and within 6 months becoming a homeless heroin user and dealer. Again, we see drug use escalating to the point it becomes extremely harmful, within the context of a shattering of a person’s webs of significance, and the attendant meaninglessness and suffering. Crucial to this process, as highlighted throughout, is misrecognition. While David was clear that he attributed a lot of his suffering to the abuse he received in the industrial schools, misrecognition was also clear in other areas. For example, he mentioned that his placement in the industrial schools in the first place was partially his own fault, and partially the result of falling in with a bad crowd. In the first instance, he claimed that as a child he was:

285

“I was a good thief, I was a little demon. I’d be sneaking in dressing room windows and, I was influenced by older fellas too, they’d be the ones lifting me in the window like. There would have been a lot of shit like that like”.

Misrecognition is apparent here as he fails to recognize the “objective conditions and structures” which caused suffering – i.e. social deprivation. Furthermore, as mentioned earlier he continuously questioned his mother as to his father’s whereabouts after he left for England. However, rather than recognizing the silence regarding family trouble, endemic in Ireland past and present, as the objective social condition causing suffering, he blamed himself “I was a prick of a child basically”.

Finally, David seems to have internalized the sense of humiliation, loss of meaning, and hurt at the breakdown of his relationship, an event which as mentioned shattered his webs of significance. This event now represents one of his greatest regrets and he blames himself to a large degree for making the decision to pass up the job opportunity in Spain to stay. However, it seems that David was heavily influenced here by a societal discourse that idealizes romantic love, over all other pursuits. Ultimately, he fails to recognize the impact of this discourse and his failure to attain the ideal is internalized as remorse and self-blame. Thus, it is a shattering of webs of significance, in the context of social suffering, and when the source of suffering is significantly misrecognized - that drugs use escalates to the point of becoming extremely problematic. Strategies of condescension can be seen in terms of David becoming convinced, through numerous counselling sessions that he can never again possess more than minimal amounts of money. While in a strictly pragmatic sense this helps him to control his drug use and is advice undoubtedly intended to help him, by ignoring social context it helps shore up

286 power hierarchies by obscuring violent structures and developments. Indeed, David sees this strategy as vital:

“If I have a tenner in my pocket enough to get me through the day and tobacco, I’m happy out you know. If you put 500 quid in my pocket my head will race “oh, I could get this or that”, most of the time I’ll just go away and get drugs out of it like. I’ve come to realize this through numerous counselling sessions, which I keep up to this day because they’re a massive help like”.

Furthermore, the counselling sessions seem to focus on his immediate situational “triggers”, such as not being allowed to see his daughter, without reference to the broader context of suffering in his life history. As he explains:

“I’m aware of my triggers and downfalls, people and places to stay away from, it’s just about implementing all these like. The skills like. I try to keep the negativity out of my life. I know you can’t be positive all the time but I try to keep the negativity away like”.

Finally, condescension can be seen in David coming to believe that going forward he has to apply “common sense” and practical skills in order to reduce suffering, avoid drugs, and find meaning. As he states:

“I’ve learned a lot going through this like, I’m still learning. It’s something I think I’ll be living with the rest of my life and I’ve come to terms with that a long time ago too like. It’s just a matter of trying to apply skills I learn every week in

287 counselling, trying to use basic common sense in life to make things easier you know”.

In terms of coming to embody the addict habitus through the final “step”, “complicity/consent”, the participant is most clear when speaking about his close friend. He mentions that he is extremely concerned about his friend:

“His own sister told me, and my heart is broken over him, but there’s nothing I can do like, I can only look after myself which is hard enough. I said to him “Look boy the only one who can help you is yourself”. You need to get off your arse and start doing more things”.

While this is undoubtedly intended to help his friend, it does mirror the dominant addiction ideology in terms of putting the onus for recovery firmly on the individual to be active in learning skills to improve their own lives. Another example can be seen in terms of David’s view on whether or not addiction is a disease. While he doesn’t like the label disease, preferring disorder, he mirrors disease understandings “You chose to take a drug first but then you’re left with no choice but to continue on with it once your addicted. But I still wouldn’t call it a disease like”.

As we have seen his understanding of himself as an addict not only heavily influences his perceptions but also his understanding of his emotions and his actions. When he is upset, over not seeing his daughter, for example, he attends meetings in order to not use drugs. When he is happy he also attends meetings so as not to allow his positive mood to convince him he is “cured” and can drink or use drugs moderately. How he relates to and helps his friends is also intimately influenced by notions of personal

288 responsibility in recovery and other concepts associated with the dominant understanding of addiction. Finally, he believes that he will be “living with addiction the rest of my life and I’ve come to terms with that a long time ago too like”. Thus, he has, in a very real sense, “become an addict”.

Case study 4: Jakub:

Jakub is in his 30s, of Polish origin, and living in Cork City. As mentioned, his drugs of choice were amphetamines, alcohol, and cannabis. In terms of comparisons to the other participants’, it seemed that he came from a more disadvantaged social and economic background in Poland. He described his life in Poland to me in the following socio- economic terms:

“In Poland if you work hard and have a job you pay for flat, but you can’t have food. It’s a different life, much harder. That’s why I’m sitting here in Ireland. I worked in a cancer hospital in Poland, I got 300 euro for one month’s work. So, you can imagine how hard it is. We lived in my wife’s mother’s flat in one single room”.

Jakub describes his community as consisting of a variety of youth gangs who would attend discos, fight, steal cars, and take drugs. In his words:

“The biggest problem for me was when we did everything together. So, when we did alcohol, cannabis, and amphetamines all together. We would start to steal cars and fight with other people because speed is no good for the brain. So, then we would start drinking a lot smoking cannabis a lot”.

289 Furthermore, emigration is a norm in his community due to a lack of opportunity, often exacerbating community breakdown. He mentions that all of his friends are living abroad:

“They go to Belgium, Holland, England, Ireland, and Germany. I have friends in Ireland, Germany, and Belgium. It depends on who emigrates first, where there is money. So, for example, I came to Ireland because my brother and his friends were here. My friend went to Holland because his friends were there”.

Jakub’s suffering was exacerbated by the cultural and social dislocation he experienced upon moving to Ireland. In particular, he seems to have found the language barrier quite difficult “I found it very hard because the only English I knew was “fuck off”. However, his problems did not end there. He found it very difficult to be away from friends, family, and community. Furthermore, when he gained employment in Ireland it was right before the economic collapse, and he was particularly vulnerable as he was employed in an extremely precarious sector of the labour market. This was compounded by his inability to comprehend Ireland’s social welfare system, and his lack of capital in every domain (cultural, social, economic, symbolic):

“The first three years were very hard to exist in Ireland because I had very little English, no friends, no family. It was a problem. It was hard work. I was happy though because I found a job within one month of moving here. I stuck with that job until the boom went down and there were reductions so I had to go to the dole. It was very hard for us because we didn’t know about social help or anything like that. When you don’t know, you have no money and you have to pay for food, a flat, look after your family. So, then you do bad things”.

290 The concept of webs of significance is particularly instructive in Jakub’s case. Prior to moving to Ireland, though he had experienced drug issues, the threat of losing his wife and kids eventually led to him becoming sober. Indeed, it seems the worst of his drug problems in Poland were short-lived and he was able to keep his suffering at bay, through the rich webs of significance he had spun around community, marriage, and family. However, as all his friends began to leave Poland, so too did he, and the aforementioned social and cultural dislocation, coupled with the economic precarity he experienced, significantly undermined the meaning he had in life. This coincided with an escalation in his drug use and also legal trouble due to drug possession charges. When I asked him to describe to me how these types of issues had impacted him in Ireland, he replied: “Yes it has affected me. Too be honest I stopped smoking last July. So I quit everything, because I had a problem with the law. My decision is to stop doing bad things and to start doing good things. So I found this organisation and they helped me stop smoking. So in July I will be clean for one year again”.

Misrecognition can be seen in Jakub believing that it was his inability to adapt to Irish society rather than the lack of services in Ireland, and indeed a level of racism, for and towards immigrants. This is most clearly expressed in his view that his trouble with the law was down to him making bad decisions, as can be seen in the quote above. Furthermore, his involvement in NA has convinced him that he is “sick” and taught him to focus on himself rather than the wider social context:

“When I started with the group I was thinking after one or two months what am I doing here my problem is not very deep”. So, I think I waste money and I waste time because the cost of travel is very expensive. But after a few more months I

291 started understanding that the biggest problem is that you have to know that you’re sick. I didn’t think so at the start but now I do. I find it helpful now”.

As alluded to, strategies of condescension can be seen in Jakub’s involvement with NA and in counselling which has convinced him that he is sick, and it is his drug use which is the main source of his problems. This can be seen in his view that if he continues to avoid drugs and do “good things” that he can avoid suffering and live a “good, happy life with my family, good job, and good friends”. In short, strategies of condescension have served to de-emphasize the impact of social and cultural dislocation and his precarious economic position as contributing factors, and crucially convinced him that going forward it will be his own decision making, rather than these factors which determine the type of life he will live. This can be seen most clearly when I asked him about his future. He remarked:

“When you start doing bad things, things will start to go bad. My thing is if you do something do good, not bad. If you start doing bad things, it’s better to stop. If you do too much drugs, then after 10 or 15 years you wake up in institutions or prison so. If it’s up to me, I had contact with drugs, now I feel better cause I don’t”.

It seems clear that Jakub has come to embody the addict habitus. His view of himself as an addict is the primary filter through which he perceives, feels, and acts. He perceives his past in large part through what he views as the poor decisions he has made. He views himself as the type of person who cannot drink or use drugs, and he also uses this filter to advise his friends:

292 “So, I see someone I knew with a big alcohol problem or with drug problem I try help them to change their life, got them a job, but they went back to it again. They have to want to be helped, for themselves, make their own decisions”.

He has then, like the previous participant, become an addict.

Conclusion

This chapter had addressed the unanswered questions posed in the conclusion to the previous chapter and presented a novel approach to drug addiction. Firstly, it was not clear from the previous chapter why social suffering leads to harmful drug use in some people and not in others. Indeed, the population of people subjected to structural violence is far greater than the drug-using population, problematic or otherwise. In this chapter, four case studies have served as empirical coat hangers through which to foreground the role of meaning, in addressing this issue. In short, it is within the context of a shattering or significant undermining of webs of significance, and when participants misrecognize the source of their suffering, that drug use becomes harmful.

However, given that such a shattering or undermining is a cataclysmic event in the participants’ lives, there seems no necessary reason that drugs and drug use would become the main focus of intervention. It is only when strategies of condescension convinces people that their suffering is significantly linked to their drug use that the focus narrows on drugs and addiction. Crucially, however, even at this stage, the person still isn’t an addict. As we have seen with Roisin, there are ways in which people resist this ideology, and find alternative means by which they can reduce their suffering and address past traumas. Indeed, she is ambiguous about whether she is an addict or not and has returned to moderate, occasional drinking. If a large number of people who

293 currently, or in the past, had experienced problematic drug use in the context outlined, refused to rearticulate the dominant ideology or embody the addict habitus, It would cease to dominate. Thus, it is only in embodying and rearticulating the dominant discourse that participants’ finally “become addicts”, even if such a process is only ever imperfectly realized. This is the necessary complicity the dominated must give the dominant in order to reproduce power hierarchies, and rearticulate dominant ideologies

294 PART THREE

Conclusion

295 Chapter Seven

CONCLUSION

The way forward – some conclusions and principles for change.

The main aim of this final chapter is twofold. Firstly, to close the thesis by providing an overview of its main findings derived from the project as a whole, and offering some suggestions for future work, and relatedly some very tentative suggestions related to how the plight of those using drugs in harmful ways may be tackled. In terms of its main aims, the current research has successfully demonstrated the limitations of both the disease model and the social deprivation/addiction link in an Irish context. This has been achieved by demonstrating the historically contingent epistemological foundations upon which both models are based, and also demonstrating that they lack validity. Both of these points have been elaborated on in the literature review section and in the subsequent critical historical, and interview chapters. Furthermore, by examining the intersection between conceptions of the self and conceptions of addiction, the current research was successful in advancing a plausible new approach to drug addiction. Crucially then, the current research has problematized and deconstructed the epistemological terrain upon which the addiction field in Ireland is structured, and contributed towards a new way of examining these issues.

296 Substantive arguments and conclusions from the research study

It was noted in the introduction to this thesis that the core motivation for undertaking the current research was a deep dissatisfaction with the way in which addiction is conceptualized and responded to in Ireland today. An initial motivation for this undertaking was the simple observation that addiction and related problems were rapidly worsening despite the Irish Government’s adoption of seemingly more progressive harm reduction measures (Butler, 1991; 1999; Irish Government, 2017), and the rise of social explanations in the form of the social deprivation/addiction link (O’Gorman, 1998; Irish Government, 2017). This was the first indication that drug addiction – its understandings, responses, and policy framing – may not be as self- contained and separate from broader societal concerns, as the general thrust of the literature may suggest.

A further motivation was the firmly established link in the Irish literature (see Butler, 1991; 1996) between the acceptance, and suppression, of academic research findings based on non-epistemic interests (political expediency, socio-economic and cultural contexts, power struggles between claim-making groups, and contingent events). It was also observed from an examination of the available literature on Irish drug policy that the field of addiction in Ireland today contained numerous contradictions. Some examples include: (A) The Government’s explicit policy commitment to harm reduction and social explanations of causation, sitting alongside their funding of drug treatment centers based on the Minnesota model92, and (B) Their stated view that addiction was a problem of the deprivation of a minority of extremely marginalized communities, which seems to be in contradiction with the shift towards a neoliberal inspired austerity

92 The Minnesota model is explicitly committed to the view that addicts come from all social classes rather than disproportionately from the poor sections of society

297 agenda, which predictably worsened the deprivation and marginalization of these very same communities93.

These are contradictions as one cannot consistently claim to accept the social basis of harmful drug use and seek to reduce harm, while simultaneously financially supporting ideologies which deny the social basis of harmful drug use (Minnesota model), and supporting economic austerity policies which deepen deprivation and drug-related harms. It seemed then that the first task should be to deconstruct the field in order to lay bare the non-epistemic interests which have historically and contemporarily conditioned our understanding of what addiction is. This was vitally important as a failure to highlight and critique these interests would in all likelihood, have led to the current research unconsciously adopting a priori assumptions and problematic conceptualizations based on these interests. In short, in order to contribute to a new way of viewing these issues, one cannot proceed without significantly problematizing the epistemological terrain upon which knowledge claims in relation to what addiction really is are advanced. To do so would be to accept implicitly the epistemological assumptions and premises, the current research sought to critique.

The first claim advanced in the current research is that the disease model and the social deprivation/addiction link are untenable and lack validity. In relation to the disease model, the claim that it lacks validity was made in the literature review. In short, it was argued that the disease model advances a reductionist and philosophically naïve conception of self, deterministically reduced to the brain’s neurochemistry. This reduction means that social, economic, and cultural forces which various research 93 88. From a critical perspective, austerity is incompatible with attempts to tackle drug addiction, if you believe that drug addiction is significantly linked to social deprivation. Moreover, it is inconsistent to argue that you believe social deprivation is linked to addiction, and at the same time support an economic system which disproportionately benefits Multi-national corporations and more wealthy sections of society, at the expense of the socially deprived

298 literature have demonstrated are contextually important to addiction causation, have been reduced to a set of positivistic risk factors which may render the brain’s neurochemistry vulnerable to addiction. Furthermore, drawing on the work of Lewis (2015) it seems that the disease model is even untenable at the level of neurochemistry. Basically, the structural and functional changes associated with addiction are not representative of brain dysfunction, but rather are representative of a process of deep learning, which occurs in any activity one engages in on a regular basis (see Chapter 2).

In terms of the social deprivation/addiction link in Ireland, the lack of validity argument can be found explicitly in the literature review, and implicitly in Chapter five. The literature review critiqued the link on the grounds that it was biased in terms of social class (largely ignored middle-class drug addicts). Furthermore, it insufficiently outlines exactly what is meant by the term “social deprivation”94, it adopts a realist position axiomatically, is Dublin-centric, and has reduced the research literature demonstrating a social and spatial clustering of drug-related harms (see O’Gorman, 1998), to a set of positivist indicators intended to advise pragmatic managerial governmental policy structures95. Furthermore, Chapter five argues by demonstration that social suffering and structural violence have far greater analytical and explanatory purchase.

94 Indeed, as chapter four demonstrates social exclusion is an example of “liberal othering”, and reinforces to tendency to view addiction as the corruptor of otherwise well-functioning societies. Furthermore, chapter five demonstrates that deprived communities are not excluded so much as they exist in a bulimic relationship to the rest of society, and experience social suffering due to the impact of a multitude of violent structures.

95 An exception to this is O’Gorman (2016), who draws on the concept of structural violence (albeit briefly), and this study represents a tentative beginning in attempts to overcome the issues highlighted in this paragraph.

299 For example, regardless of social class, all of the women in the current study had experienced domestic violence and/ or sexual abuse, which clearly underpinned their harmful drug use. Furthermore, it seems quite plausible from the interviews that the middle-class participants were suffering under the effects of what Jock Young (1999) has called vertigo, as well as numerous other structural issues. Finally, the Eastern European participant seemed (see Chapter six) to be suffering much more from cultural and social dislocation, even if this was compounded by his working in an extremely precarious sector of the economy, in and around the time of the economic collapse. In short,

Chapter five demonstrates that the disproportionate and reductionist focus on social deprivation has prevented sustained attention being paid to issues related to gender, immigration, historical institutionalization, structural factors impacting on the middle- class, and the impact of the state’s social service bureaucracy and police, in driving addiction-related problems in Ireland.

In terms of epistemology, the argument can be found in Chapter four. This chapter demonstrates that the addiction as disease, or problem of social deprivation, concepts emerge not from the slow accretion of scientific evidence and improved academic argumentation, but rather from a host of non-epistemic factors. These non-epistemic factors include socio-cultural and political-economic developments, power-struggles, and contingent events. Importantly, these non-epistemic interests have epistemic significance both historically and contemporaneously. That is, both of these ways of conceptualizing addiction are supported as much by non-epistemic factors as they are by the evidence and arguments that can be marshalled in their favour. This has serious implications in terms of how one might challenge these understandings and advance new ways of looking at these issues.

300 Importantly, if one wishes to challenge the disease model, one must challenge the cultural trope of individualism, to give one example. Simply put, without the view that the self is an individualized entity, the notion of addiction as a problem of a diseased individual, would not be possible. Furthermore, the view that alcoholism is linked to population consumption levels is as much a consequence of Neoliberalism and the medical profession’s ability to advance a public health agenda, as it is the accretion of scientific evidence. In short, the task of advancing a novel approach to drug addiction is not simply one of conducting research and advancing convincing arguments, though that is of course important.

Crucially, it is also a political, social, and cultural task that will involve highlighting and critiquing the non-epistemic interests that support these addiction understandings and advancing a programme that is academically convincing and based on alternative non- epistemic interests. Fundamentally, this would involve viewing the issue of addiction as being inextricably linked to border political-economic and socio-cultural struggles, even if the effect of its portrayal has had the effect of representing addiction as a discrete policy area. This research has also examined the effect of dominant representations on drug using populations. The effects of the representation of addiction as a problem of individual or community pathology have been that an incredibly damaging discourse and subjectivity have been propagated over time. In the first instance, the notion that addiction is a problem of pathological individuals or communities has enabled numerous claim-making groups to argue that addiction causes a whole host of social problems, rather than addiction and other social problems being caused by problematic social structures and systems.

This has been demonstrated in Chapter four by reference to a discourse that portrays addiction and addicts as a corrupting force in an otherwise well-functioning Irish

301 society. Secondly, this discourse has led to a focus on the characteristics, pathologies, and dispositions which render addicts problematic, rather than the problematic characteristics and arrangements of broader society which render addiction and addicts possible. This has been called “imposing subjectivities96”, and its effect is to create a sharp distinction between addicts and non-addicts, and addiction and normal- functioning. This enables addicts and addiction to be seen as a major social problem, obscuring social forces, and creating the need for systems and techniques of normalization (treatment regimes, counselling, AA and NA), which convince people that their suffering is individually caused (linked to their drug use), rather than socially conditioned, but that they can be returned to normal functioning and normal society by engaging with these techniques and systems. Thus, having deconstructed and critiqued the addiction field on epistemological and validity grounds, as well as demonstrating the effect its portrayal over time has had, it was necessary to suggest an alternative way to view these issues, via the presentation of a novel approach to drug addiction.

The first claim this approach makes is that some of the very social systems and structures, obscured by the portrayal of addiction in individualistic terms, are violent and cause harm to the study participants. This argument can be found in full in Chapter five. These violent structures include patriarchal norms and discourses, cascading intersections of alienation, vertigo, a lack of symbolic capital linked in part to urbanization, social bulimia, the Catholic Church and institutionalization, and the state’s social service bureaucracy and the police.

Chapter five has presented evidence from in-depth interviews, combined with a broader structural analysis, which indicates that these structures are violent

96 A subjectivity is an all-encompassing, unidimensional sense of self. Examples include, addict, schizophrenic, etc

302 and have caused social suffering among the study participants (as well as limiting their agency). However, in Chapter six it was argued that even within this context of social suffering, participants were able to develop “webs of significance” which served as a bulwark against the impact of violent structures. This notion of webs of significance, borrowed from Geertz (1973), enabled the research to advance an argument in relation to why some people may use drugs in harmful ways, while others do not, within similar social contexts. On this view structure does not cause behaviour in an unmediated manner, but rather, when the webs of significance agentic individuals have spun, are shattered or undermined, they become incredibly vulnerable to the impact of violent structures. Within the context of these webs being undermined, populations who use drugs and have been subjected to structural violence seem likely to find themselves in an extremely harmful relationship with these substances. However, it should be pointed out that the relationship between initiation of alcohol and/or drug use, and experiences of social suffering is not unidirectional. Rather, this is a highly complex relationship, whereby experiences of social suffering and alcohol and/or drug use reinforce one another. For example, experiences of social suffering will often predispose people to harmful relationships with alcohol and/or drug use (particularly when ‘webs of significance’ have been shattered or undermined), however, harmful patterns of alcohol and/or drug use can also lead to more intense experiences of social suffering.

As Chapter five demonstrates, even at this stage, it is not inevitable that people will “become drug addicts” (i.e. come to accept and adopt the addict habitus). For that, mechanisms of symbolic violence are required. In short, the person must first misrecognize their suffering as natural, inevitable, or their own fault, rather than the cause of social suffering linked to violent structures or something similar. However, even at this stage the person may blame an event or a person rather than adopt the addict habitus. Crucially, when mechanisms of

303 condescension, in the form of treatment centers, counsellors, and 12-step groups, convince them that their suffering is not only natural, inevitable, and their own fault, but is by and large caused by their drug use.

The final step then involves the mechanism of complicity/consent. This involves the participants coming to view themselves, their emotions, dispositions, actions, and perceptions, as intimately linked to their addiction. In a very real sense, at this stage participant’ have become addicts. They constantly monitor their thinking, their emotions, and their behaviour according to the precepts they have learned in treatment and in 12-step groups. This retrospectively explains past actions, current predicaments, and conditions goals for the future. At an everyday level, it involves partaking in particular practices and rituals, but most importantly, it leads to participants viewing themselves as addicts, a way of thinking which pervades their very sense of self. In short then, it is when webs of significance become undermined, in contexts of social suffering, and when mechanisms of symbolic violence successfully individualize suffering, that the participants “become addicts”. This is the novel approach to drug addiction that this research seeks to make a contribution towards. Crucially however, it will also be necessary to offer some tentative suggestions and principles around which non-epistemic interests may come to support this alternative view of addiction. This will, however, be limited given that it is beyond the scope and remit of this research to outline a substantive programme for change. Indeed, as Foucault (1980) has argued, the role of the intellectual is to provide an analysis and suggest some principles which may be useful, it is for those who are oppressed to do the fighting. Finally, the following flowchart should serve to visually illustrate the novel approach to addiction that this research has advanced.

304

Experiences of Structural Violence and Social Suffering

Initiation of Alcohol and/or Drug use

305

Drug use Escalates – Webs of significance Shattered/undermined

Mechanisms of symbolic violence applied, embodied, and enacted.

Addicted Habitus Adopted – Person becomes an addict

306 Tackling structural violence: New principles to support non-epistemic interests

Helpfully, the Irish Sociologist Kieran Keohane (2006), drawing on the work of Walter Benjamin, has suggested a way in which some principles which may come to underpin movements to resist structural violence might emerge. According to both theorists, the task of the critical scholar is to find historical examples which can provide intellectual resources in order to “. . . illuminate the present and provide value by which our fortunes in the future may be transformed” (Keohane, 2006: P. 150).

These historical examples, though in one sense very particular and local, have gained crystallised meaning that has become a sign overdetermined with revolutionary significance, which can and indeed has been, appropriated on a global scale. If groups oppressed by structural violence are to effectively resist this oppression, it is these signs, and the principles derived from them, to which they will have to look. Keohane (2006) provides the example of the Cork hunger striker Terrance McSwiney and his resistance to British rule in Ireland. MacSwiney, from Corks Northside, was arrested and imprisoned in Brixton London, for his role in the Irish War of Independence against Britain. MacSwiney gained international attention for the revolutionary movement during his hunger strike, which eventually resulted in his death after seventy- four days without food. MacSwiney’s actions later inspired Indian revolutionaries, including Mahatma Gandhi, who counted MacSwiney as his biggest influence. MacSwiney’s refusal to consume (Keohane, 2006) and his sacrifice of self for the collective good, stands in stark contrast to the rapacious consumerism and radical individualism which underpins social bulimia today. Similarly, if we are to challenge the structural exclusion and violent cultural norms which underpin bulimia we could look to the radical economic and social tradition in Cork City exemplified in such historical events as the

307 Cork Harbour soviets (Dineen, 2017)97 and in the historical persons of Northside women Mary Harris Jones (a militant trade union organizer) and Mary Elmes (radical social reformer and Irish Red Cross Advocate) (see Moynihan, 2018).

Ultimately, the point that the current researcher is making is that large scale political- economic and socio-cultural restructuring of society is necessary to overcome the harmful impact of the violent structures which this research has linked to drug addiction. While O’Gorman (2016) has correctly argued that neoliberal governments have increasingly employed a social deficit model to address social issues related to inequality (and ignored the structural arrangements which cause these harms), the argument advanced here is that an effective programme to tackle drug addiction will need to go far beyond O’Gorman’s (2016) suggestion that we add a social inclusion pillar to the National Drugs Strategy (see Irish Government, 2017), or ensuring the drug and policy proofing of public and social policies which could help identify potential policy harms before they are implemented (though I support these measures). This is because as Allen (2007) has argued, the Irish political system is now organized increasingly around the needs of corporations and financial capital, and these needs are fundamentally at odds with the interests of the socially deprived (and indeed the lower-middle classes). What is needed is a bottom-up movement to challenge violent structures (which avoids being co-opted by statutory bodies98), rather than an attempt to work within the confines of these structures and offer more benign solutions99. That is, while community development programmes and the

97 This involved Cork dock workers forcibly overtaking the dock yards and setting up a workers co-operative 98 See Butler’s (2007) description of the social partnership model’s co-option or less radical elements of civic society, and the marginalisation of more radical elements. This is why I am skeptical of involvement with statutory bodies.

99 I should point out that I do support community level services and am against the centralization of such services in the HSE see O’Gorman, 2016). I am also in favour of harm reduction and increased access to treatment. However, I argue that without fundamental political-economic and socio-cultural restructuring these services cannot make a significant or lasting impact, though they are beneficial.

308 work of innovative groups such as Citywide and the Local Drug Task Forces (LDTF) can build community capacity to respond to a particular instance of social harm (i.e. drug- related harm/harmful drug use, which is produced by structural violence, this approach is unlikely to overcome structural violence itself. For this, broader social and political movements which tackle structural violence in general, as a means of tackling harmful drug use specifically, will be required. In short, community development approaches attempt (successfully in many instances) to address the effects of structural violence (social exclusion, harmful drug use), these broader social and political movements will need to address their source in the political-economic and socio-cultural structure of Irish (and indeed global) society.

While the suggestions provided are indeed tentative they do “point the way” to an approach that may provide some principles which could inspire radical social movements to challenge structural violence. Indeed, pioneering social and economic movements who resisted the seemingly insurmountable power (at the time) the British army and empire seem an ideal place to look when attempting to resist the diverse and seemingly intractable sources of power and social suffering in Ireland today. While such principles will no doubt require reconfiguration for a radically altered social and historical context, they do represent a promising place to start.

Limitations and final thoughts

To close the thesis some limitations and final thoughts will be offered. In the first instance, the nature of the thesis is rather general, and therefore, it certainly suffers from a lack of specificity. Furthermore, the critical historical chapter is rather too brief given the scope and breadth of sources engaged with. The justification for both these limitations is a lack of pre-existing scholarship on these issues in Ireland. Similar to how a geographer would first need to get an idea of the general topography of a particular land

309 mass before understanding the intricacies of the soil, waterways, and forestry, the exploratory nature of this research meant that it could only ever offer a bird’s-eye view of the addiction field in Ireland. Furthermore, since deconstruction was a central aim, the critical historical chapter was not conducted for its own sake, but rather to contribute to the general deconstructive project. From the outset, it was only ever intended to offer a contribution to new ways of viewing the issue.

Furthermore, due to issues around stigma and difficulty with access, the current research did not significantly engage with addiction issues among Irish Travelers. Given that travelers are Ireland's indigenous people, and that research suggests (see Drummond et al, 2013) their levels of addiction relative to the settled community may mirror the differences seen between indigenous and settled people in the US, Canada, and Australia, this was a clear limitation. It was particularly a limitation given the suitability of structural violence and social suffering, as well as this study’s theoretical orientation in general, to examine these issues. Certainly, this is an area in which future research must engage with. Future research should also examine addiction in a wider variety of geographical areas in Ireland, particularly rural areas. Furthermore, more extensive socio-historical research will need to build on the starting point this research offers. The current author would like to see more genealogical studies which examine whether the ancestors of “harmful drug users” were more likely to reside in workhouses, industrial schools100 and other institutions, or be the victims of structural violence in general. Perhaps most importantly, while the approach to drug addiction offered in this study is plausible and convincing, more detailed study is required if it is to succeed in comprehensively rethinking how we view addiction. Finally, it is hoped that

100 These were Catholic run institutions for poor children whose parents could not or would not look after them. Furthermore, boys convicted of minor criminal offences would also be sent to these institutions. They were infamous for systematic physical, sexual and psychological abuse.

310 other researchers101 will examine these issues using different research paradigms in order to satisfy Stinchombe’s (2013) call to proceed by “deepening analysis”.

In conclusion, we should come back to the immediate concrete context in a practical way. The Irish Government’s (2017) most recent policy document: “Reducing harm, supporting recovery – a health led response to drug and alcohol use in Ireland 2017:2025” contains provisions for supervised injecting centres and the expansion of other harm reduction type measures. These should be supported on a practical basis. To be blunt, there is very little chance that any of the arguments or general principles offered in this research will be successful102 in the short to medium term. In the meantime, the most practical way to help people using drugs in harmful ways is to keep them alive. Crucially, the natural recovery literature demonstrates that aging, or maturing, out of addiction is extremely common (see Sobell et al, 2002 for overview). Therefore, any measure which minimizes the risk of disease, death, or deteriorated health, should be supported. This would involve opening a supervised injecting centre in Cork (and elsewhere) as quickly as possible. Furthermore, it would involve expanding needle exchange services, and other health care and harm reduction provisions. This will require political pressure in order to secure funding, and social campaigning to allay public fears.

At the same time, the current research would favour increased access to counselling services based on a narrative therapy framework (see Combs and Freedman, 1996). This type of counselling is supported as it is the least intrusive and least symbolically dominating form of counselling. Basically, it involves meeting clients and helping them

101 This is required to provide further support for the arguments advanced here, and to offer alternative perspectives.

102 I.e. it is unlikely that in the short to medium term we will see radical socio-cultural and political-economic restructuring

311 achieve the goals they set, on their terms, and using whatever language, concepts, or ascriptions they feel comfortable with. This could be offered within the pre-existing Local Drugs Task Force. Finally, O’Gorman (2016) has suggested that the government should drug and policy proof public and social policies so that potential policy harms are identified before they are implemented. Though I’ve already mentioned that this does not go far enough, it is a promising start and would certainly be helpful.

Such an approach could operate according to the principle “nothing about us without us” which comes from disability activism (Charlton, 2000). The slogan is used to communicate the notion that any political, economic, or social policy should only be developed and implemented with the full and direct participation of those likely to be impacted by that policy. This closely mirrors one of the central principles in the Irish mental health policy document: “A vision for change: Report of the expert group on mental health policy”, which views the mentally ill as “experts by experience”. Indeed, placing addicted persons at the centre of any policy or decision-making process which directly affects them has the potential to tackle the historical silencing, structural violence, and symbolic domination they have been subjected to. These measures coupled with the advancement of the principles offered and research agenda outlined offer the most practical yet ambitious way to conceptualize and respond to “addiction” in Ireland today.

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361 APPENDICIES

APPENDIX 1

TOPIC Guide

Research goals for the interview

What can the relationship between understandings of “self” and understandings of addiction tell us about the aetiology of drug addiction?

INTRODUCTION: Overview of research and formalities: (5- mins approx.)

Welcome. (Re)introduction of the researcher and the research project

Summary of the participant information sheet.

Go over the consent process again.

Make sure participant understands all previous and is ok to begin the interview

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Begin the interview.

Section one – Life history (25-35 mins approx.)

Ok so the first section is about life history, just basically about your life prior to addiction or drug use.

1. Childhood/family

Open question: “I’d like to start by talking about the period before drugs and addiction; the early period of your life; could you take me back to your earliest memory or memories what were they like?

Probe-anything that seems interesting/relevant

363

Open question: “If someone were to ask the people you grew up with – say your parents/relatives/caregivers what kind of a person you were growing up what do you think they’d say?”

Probe – any specific characteristics to uncover events/reasons for it being mentioned and explore, thus placing the characteristic in context.

Probe – probe anything that seems like it may be common to wider community, etc.

Probe – see if this changed over time – how they came to believe this? When do they remember the change occurring? , ask stories of examples to clarify.

Open question: I’d like to talk a little bit about how you saw yourself growing up broadly; What do you see as having been your strengths/weaknesses?

Open question: So tell me a little bit about your family home…….”

Open question: I’d like to talk a bit about your relationships with your family members/caregivers; who would you say you were closest/least close to?

364

Probe – anything general to get specifics; for e.g. “I was close to my brother” – In what way? How is that relationship different to one with sister – “We were just very similar” – in this case ask about specific events/incidents/stories which may clarify. How are other family members getting on now? explore

Open question: in terms of advice in school, hobbies, university; did your family help you out much there?

Open question: “Is there a particular memory which stands out above the others?

Probe – general to specific.

Probe - Best memories/events/stories.

Probe - Worst memories/events/stories.

Open question: “Could you tell me a little bit about your extended family – Grandparent’s, cousins, aunts, uncles.

365 Probes – Occupations, characteristics, etc.

Probe– Differences generationally.

Probe – any relationship descriptor which is general - clarify by asking participant to expand or illustrate with story/specific example.

Open question: So I’d like to talk about any traditions in your family; you know kind of things ye used to do together regularly that was specific to just ye?

Open question: I’d like to talk briefly about “the holiday’s” – Christmas and summer holidays; What were they like?

Probe – are there any particular stories or memories that stand out?

Relationships open question (romantic) ;did your family talk to you much about that sort of thing growing up?

Probe: maybe they still do?

Open question: “So I’d like to explore health related issues briefly; could you talk a bit about your experience with that growing up, you know doctors, hospitals, that sort of thing?

Open question: “Was your household in any way political growing up?”

366 So next I’d like to talk about the community you grew up in; where did you grow up?

2. Community

Open question: “Could you talk a little bit about the community you grew up in? If clarification needed – probe relationship with neighbours; participation in community based organisations – youth clubs, GAA, Sporting and hobby related events.

Probe/prompt: In general attempt to pick up general things and flesh out specific linkages. i.e “there was a great sense of community and we always felt a part of that”. Ask participant to expand on that a little more; ask for a story which shows community spirit Open question: “If you were to describe your community to somebody who’d never heard of it or visited what would you say?”

Probe – General to specific again, look for instances/stories to put characteristics into context

Prompt – If description is excessively positive ask about any negative aspects and vice versa.

Also use if description is excessively vague.

367

Prompt – draw on information about organisations (GAA, youth clubs etc) to tease out relationship of community/area to other communities/areas.

Prompt – Would it be different if that happened to you in opposite area? How so?

Open question: “Do you think you’d be different in anyway if you hadn’t grown up in “X”

Probe – anything that’s mentioned in relation to the person being potentially “better off” discuss if this is something they feel should be/could be changed In the community

Probe – Anything they mention about them being worse off if they hadn’t lived in “x” explore if it’s something they think other areas could learn from/become more like –

Open question: I’d like to talk about how you view Irish society at the moment – to get your views on how things are going in general”

Probe - to get examples of characteristics - and also to see how person places themselves, their family, friends, and community within the broader society.

Open question: “In general what types of professions or what kind of things do people in “x” do when they leave school/college/whatever?

368 Open question: “What is the general political view of people in the community? Ok so I’d like to move on to talk a bit about school; did you go to school in “Area X”? (Same questions for primary first/secondary next/relationship can be explored later).

3. School

Prompt – if went to school in the area ask if there are other schools in the area

Probe – reasons for one school over another in same area; reasons for going to school outside of the area – parents vital here.

Probe - differences between schools in the area/differences between school outside/inside

Open question: I’d like to talk a bit about your time in school more generally, could you tell me a little bit about how you got on in school

Probe – what kind of student they were; how they considered themselves – when they can remember first noticing this.

Probe – Explore what explanation the person has for positive or negative experiences (whether linked to internal factors i.e. “intelligence”; “hard-work”; or external – teachers were strict, poor performance due to poverty based constraints etc).

369 Open question – Ok so if I was a new kid in your secondary school; say I’m 15 years old and I’m tired of having teachers throwing me out all the time; I’m looking to put my head down and just get on with things; what would you tell me to do?

Open question: “Favourite teacher, Teacher you liked the least – how did they think you’d do? “

Probe – ask for specifics and examples to illustrate points and get bigger picture – how did the teacher think the class in general would get on in future; how they did get on; explore discrepancies if relevant

Least favourite year in school – “I want you to imagine you’re sat in that class at 9am on a Monday morning; talk me through what that’s like?

Open question: What was your favourite subject/class?

Probe – example of time they first noticed they were good at/enjoyed it– ask to expand, what specifically was it about the subject?

Probe – did the participant pursue the subject further? How far? If not, what got in the way?

Open question: So what was discipline like in your school?

Probe: why do you think they thought this type of discipline important?

370

Open question: “What were your friends like in school?”

Probe – get specifics in relation to what the reason for them getting on better with some people rather than others is; general group characteristics (sporty; musical; overtly academic, etc.); how did their life turn out; explore differences in life outcomes among friend group;

Open question: What was the transition from primary school to secondary school like for you (if they did go to secondary school – explore what they did instead and compare that to school).

Probe – get specifics about the transition/reasons for leaving – ask for clarifications/illustrations where necessary.

Open question: Did you prefer secondary or primary school?

Probe/prompt – What specifically – what were the major differences?

Open question – Junior cert/leaving cert period around that as a means of talking about how they got on; how it impacted social life/relationships /family etc.

Probe/prompt – again for specifics.

371 Open question – College if applicable explore same issues; favourite subject/module/experience of transition, whether lived out of home or not, friends/romantic partners, stresses etc.

Open question – “Do you have a memory which stands out/some lesson learned or something that sticks out in your mind from your time in education?

Probe – explore to get specifics – material for expanding on meaning.

Open question: So we’ve talked a lot about school! I just want to finish off by asking you to take me back to the end of your education; when you finished ; What were your expectations then? What did you think the future was going to be like?

Probe – How did they come to think like that; what experiences of school brought this thinking on.

Probe – familial expectations

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Open question: “Throughout your schooling did you ever feel excluded or left out?” Probe – was it only in school you felt this way?

How do you think your parents experienced your time in education?

Probe-relationship to teachers etc

Open question: “Ok what happened after school then? Probe – get a picture of what happened between this period and full blown addiction

4. Peers

Open question: Could you tell me a little bit about your friends growing up?

Probe - anything to do with shame anger; lack of direction, violence, unrealistic expectations, not fitting in etc.

Probe – specific characteristics; especially important to ask for examples Probe – Lost friendships/fallings out.

Open question : “What did ye do for fun?

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Probe - Sports/hobbies; most memorable moment, best story. Worst story

Open question: “How did your group fit in in the community, what were ye like compared to other groups friends?

Probe/prompt - reasons for differences similarities/anything around conflicts etc.

Open question: Ask about occupations where are they now? are you in touch with many of them?

Probe: When did they lose touch; what happened?.

Prompt: If you could pick one of your friends growing up that typified the sort of group ye were who would it be; Can you give me an example of that; a story that illustrates it perhaps?

374 Probe prompt

Prompt: Who would you say is most successful/least successful? Explore - Is there anyone youd like to see again, maybe not see again? Explore

Open question - “Who was/is your best friend –

Probe – what is it about that friend . Friends characteristics in general (i.e not just best friend)

– Ask for stories as illustrations.

Open question: “So previously we talked quite a lot about your family background, would your friends have had a similar type of background?

Probe – use answers to probe.

Probe – so you said your family had ”X” values – would you say your friends shared this? Explore how they know and the why.

Open question: “Would you meet your friends often now?” Probe – What sorts of things would ye typically do? – looking for norms values

Open question: “So which of your friends would you consider to be the most successful?

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Probe – each of the developmental stages “I want you to think back to secondary; primary; college; what skills or strategies enabled them to…

Probe – friend’s relationships with persons family and their own. SECTION 2 – Experiences with addiction (25 -30 mins).

Intro: so now I’d like to talk about your experiences with addiction if that’s ok? Open question: “When did you first use drugs? Probe – What was that like?

Probe/prompt – more specific info

Open question: Ok, can you talk me through the development of your drug use from that point then?

Probe – get more specific information in relation to areas mentioned – i.e “When my family first mentioned it” – broader view of context around that time.

Open question: “At the time how did you first notice you were having a problem controlling/limiting your use?

Probe – More specific info – what specifically about this realisation was problematic – e.g. what specifically about not being able to go a set period of time without drugs was troubling; what is it about social disapproval that was most troubling for participant?

Open question: “Did you ever think about getting help (period before sought help)?

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Probe – did you think it would help? Have an idea about what sort of help? If participant never thought about this, Explore.

Open question: Could you talk about what a typical day using drugs might be like (have been like) say from when you get up in the morning until the end of the day?

Probe – get an idea of what type of drugs/legal prescriptions they get.

Open question: “Can you talk a little bit about what it’s like to use heroin as opposed

to the prescription drugs/benzos/methadone/SSRI’s etc.

Probe: areas in relation to anything that’s insulting, demeaning, makes them anxious upset,

377 worried, they don’t like; stigma, angry; etc. These are likely areas where we will see symbolic violence. Also important to probe areas where they describe themselves their everyday practices in individualised terms.

Open question: I’d like to talk a bit about the stigma surrounding drug addiction? You know the negative opinions and ideas people have around it; could you talk a little bit about your experience of that?

Open question:

I’D like to talk a little bit about your opinions on or experiences with difference types of drugs; so what are your thoughts on any similarities or differences – that type of thing – between coke, weed, heroin, benzos.

Open question: Is there anything from your experience with drugs that you feel has had a positive impact on you?

Prompt: friends?

Prompt: Partners?

Open question: I’m trying to get a sense of how the community of people using drugs operates would you consider it similar to say non-drug using communities like maybe GAA; or just general communities where people live?

Areas to discuss:

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Experiences with

Harm reduction facilities – chemists which dispense needles, for example. Gp’s;

Addiciton counsellors, treatment centres, detox facilities; A&E services, staff, service users

General public – their view of the general public (currently or while addicted/using drugs)/how they think the general public view them/drug use in general. What their interactions with them in everyday settings are like

Doctors/medical prof/treatment Look for attitudes of “we can’t help unless you help yourself”

Negative experiences with officialdom. – Especially when stigmatised individualised

The junkie –drug addict label

Stories of negative experiences with the public, etc

Media.

379 With guards

Ask about any other experiences that they think are important things that really stick out

Disease theory and AA/NA.

Family – what did they think like? Why did they think you were using

Your friends?

People in the community?

Final question in this section:

Open question: I’d like to explore any experiences you have of feeling Shame/anger/confusion/ uneasy; putting yourself down.

Section 3 – Meaning and addiction – (25-30 mins approx.).

380 Ok, so now I’d like to move on to the third section – meaning and addiction if that’s ok Sense of self formed in the main through interactions in the following domains

Family – using the material discussed in section (1) as probes discuss how relationship with family developed over time prior to addiction; how they saw themselves within

family; compare relationships with family members to similar relationships among other family members. All the while reflecting and asking participant to tell stories. Then explore how this context was impacted by addiction and if relevant how recovery has changed that.

Friends – Largely similar to family; but important to reflect on potential differences in friend group composition, qualities, etc. throughout lifespan and in light of addiction. Always reflecting on meaning and asking participant what they think about these developments

Education/career – begin with earliest memory of what kind of direction they wanted to take; explore this development; impact addiction had on it; what the future holds.

Community – explore if many other people in the community became addicted; what it might mean if a lot/very few others did.

Society at large – What does being Irish mean to them? About being from Cork; explore how using drugs/being addicted to drugs relates to this Irish/Cork identity (as always using prompts from info in section one and 2).

381 Views on addiction in general; if you had to define or sum addiction up in one phrase what would you say?

Harm reduction facilities – injecting rooms, decriminalisation; etc – get their views on that and ask how their particular experiences with addiction have influenced the development of those views – probe for specifics.

General views on addiction and addiction policies – experiences of treatment centres/regimes – what they’d like done differently; how this relates to experience.

Hopes for the future – how have those hopes been impacted by experiences with addiction.

Using material gathered explore how issues to do with careers; hobbies; family, relationships, friends have developed throughout life including emphasis on addiction

– use material gathered in sec 1 and 2 for prompts

What would your life be like if you never used drugs – explore Ask what ideal future would hold – explore the tension between present and ideal future/barriers etc.

And finally before we finish is there anything you’d like to add?

382 Section 4 wrap up (less than 5 mins)

Thanks for participation

Explain where the research is going next; procedures regarding viewing transcripts etc.

Mention the services that are available if distress is felt in coming hours/days/months

Pseudonym

Give gift voucher

End interview

383 APPENDIX 2

Participant Information Sheet: V3 (18/09/2017)

Study title: “A [A social history of addiction and its causes] socio-historical

deconstruction of the term “addiction” and an etiological model of drug addiction”

Ethics committee ref.: 1377 Locality:

Ireland

Lead Contact phone number: investigator: 07724006218 Shane O’Mahony

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You are invited to take part in a study on drug addiction in Ireland. Whether or not you take part is your choice. If you don’t want to take part, you don’t have to give a reason, and it won’t affect the care you receive. If you do want to take part now, but change your mind later, you can pull out of the study at any time.

This Participant Information Sheet will help you decide if you’d like to take part. It sets out why I am doing the study, what your participation would involve, what the benefits and risks

385 to you might be, and what would happen after the study ends. Your treatment counsellor will go through this information with you and answer any questions you may have. You do not have to decide today whether or not you will participate in this study. Before you decide you may want to talk about the study with other people, such as family, friends, or healthcare providers. Feel free to do this.

If you agree to take part in this study, you will be asked to sign a consent form. You will be given a copy of both the Participant Information Sheet and the Consent Form to keep.

Please make sure you have read and understood all the pages.

If you wish to make a formal complaint or if you are not satisfied with the response you have gained from the researchers in the first instance then please contact the Research Governance and Integrity Manager, Research Office, Christie Building, University of Manchester, Oxford Road, Manchester, M13 9PL, by emailing: [email protected] or by telephoning 0161 275 2674 or 275 2046.

What is the purpose of the study?

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The purpose of the study is to contribute to an understanding of the causes of drug addiction in contemporary Ireland and to contribute to the development of more humane and effective treatments.

The study involves examining how addiction has been viewed across time in Ireland by different groups.

This study also involves examining addiction across different people’s lives in order to better understand addiction.

The study is to be undertaken as part of a Doctoral degree in Criminology.

387 I am based in the School of Law at the University of Manchester and I am originally from Ireland.

What will my participation in the study involve?

You have been chosen on the basis that you have experience with drug addiction.

The study will involve one, audio recorded, 90 minute informal interview about your life history (family background, schooling, community background, etc), experiences with addiction, and how you view addiction in the context of your life overall.

Any topic which you do not feel comfortable discussing will not be pursued.

Your data may be used in the form of “anonymized quotes” within the research.

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What are the possible benefits and risks of this study?

Contribute to the development of a more comprehensive understanding of drug addiction in Ireland.

Contribute to the development of more humane and effective treatment(s).

Risk: The potential for distress due to discussing

“uncomfortable” topics. In this case extra counselling and support will be provided as agreed with your key worker Who pays for the study?

You will not incur any costs due to your participation in this research.

You will receive a 30 euro “cash voucher” in recognition of your vital contribution to the research process.

The study is unfunded (apart from the vouchers which the researcher can “expense” from funds available to all PhD students in the Law school Manchester as part of their program of study)

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What if something goes wrong?

If a subject of discussion during the interview becomes too distressful, you can decide to take a break and resume the interview later (either in the day or at another time/date), move on to a different topic, or abandon the interview altogether. This is entirely up to you. Further counselling and support will be available in the case of increased distress. Furthermore, any topic which causes increased distress will be abandoned.

You will have the right to view interview transcripts once they have been transcribed (2-3 weeks after interview) and withdraw or clarify anything you have said. Once the audio files have been transcribed (this will take 10 days from time of interview at most) I will contact you and offer you the chance to view the transcript and remove or clarify anything you have said. You will have 10 days from the time I contact you to view these transcripts. After this I will destroy the audio files, and as all transcripts will be anonymized, it will not be possible to remove your “data” (what you’ve said in the interview) after this stage.

As mentioned, if at any stage you have any complaints regarding any aspect of your participation in this study you can contact one of the project supervisors whose details can be found at the end of this information sheet.

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What are my rights?

Participation is voluntary and you are free to decline to participate, or to withdraw from the research at any practicable time (prior to audio files being transcribed – estimated 2-3 weeks after interview) without experiencing any disadvantage

You have the right to access information about yourself collected as part of the study. If

requested I will provide copies of your interview transcript and the completed thesis.

All data will be kept confidential through the use of pseudonyms and anonymization. Full confidentiality is ensured except in the case where the researcher feels that the participant may be at risk of harming themselves or others. In this case the interview will be stopped and your key worker will be notified. However, the only person informed will be the participant’s primary care worker.

What happens after the study or if I change my mind?

You can withdraw from the study or withdraw the data you have contributed up until the audio files have been

391 destroyed (estimated 2-3 weeks after interview) and the interviews transcribed.

All data will be anonymized ensuring complete confidentiality.

All voice recordings will be destroyed once interviews are transcribed in full. Pseudonyms will be used on all transcripts and all identifying information will be anonymized.

You have the right to withdraw your participation at any stage up until the interview actually takes place, and can withdraw from the interview at any stage. Furthermore, you can withdraw the data you have contributed to the study at

any stage up until the audio files have been deleted (estimated 2-3 weeks after interview). Participants will also be offered copies of the finished thesis if they wish.

Who do I contact for more information or if I have concerns?

392 If you have any questions, concerns or complaints about the study at any stage, you can contact:

Mr. Shane O’Mahony, PhD Candidate, University of Manchester, School of Law Telephone number: 07724006218

Email: [email protected]

Prof. Toby Seddon, Professor of Criminology, University of Manchester, School of Law

Email: [email protected]

Dr. Lisa Williams, Senior Lecturer in Criminology, University of Manchester, School of Law Email: [email protected] Telephone Number: 0161275448

393 A social history of addiction and its causes”. CONSENT FORM (V3 18/09/2017) If you are happy to participate please complete and sign the consent for below Please initial box

1. I understand that my participation in the study is voluntary and that I am free to withdraw at any time (up until the audio files are transcribed) without giving a reason and without detriment to my treatment/service.

I understand that all information I share with the researcher is confidential; except in the case where information shared leads the researcher to believe that I will significantly harm myself or others. In this case only my primary care worker will be notified.

I understand that the interviews will be audio-recorded

I agree to the use of anonymous quotes (which may be viewed by the researchers supervisor)

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I confirm that I have read and am satisfied with the participant information sheet (V3: Dated 18/10/2017), I have had the opportunity to consider the information, ask questions and have had these answered satisfactorily.

I agree to take part in the above project

Name of participant Date Signature

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Name of person taking Date Signature

Consent

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APPENDIx

397 Interview participant tells the researcher directly that they are experiencing high levels of distress

•The participant begins to manifest behaviours indicative of distress - crying, shaking, etc.

•Stop the interview immediately (If either of the two 'forms' of distress occur).

•Ask the participant if they would like to take a break to get some water or speak to their counselor

•In the interest of personal safety, and in accordance with the University of Manchester Lone Working policy, if the participant becomes aggressive, leave the interview, speak with a member of staff, and contact supervisors.

If the participant feels able to carry on; resume the interview.

If not, see stage 2 responsDiscontinue the interview. With the participants consent contact a member of their treatment team for further advice or support. Follow participant up with a courtesy call (if they consent)

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