Unequal Treatment: Class, Race & Addiction Recovery in American Life A Dissertation SUBMITTED TO THE FACULTY OF UNIVERSITY OF MINNESOTA BY Sarah Lynn Whetstone IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOHY Teresa Gowan, Douglas Hartmann MAY 2016 © Sarah Whetstone, 2016 Acknowledgements Thank you to the University of Minnesota Sociology Department for providing financial support, intellectual guidance, a truly collaborative work environment, and a fantastic community of scholars. A University of Minnesota Doctoral Dissertation Fellowship during the 2012-2013 academic year provided additional financial support that enabled me to conduct this research. I could not have asked for a more supportive graduate experience. To the many brilliant scholars, collaborators and friends who have been members of the “Addictions Team” or who have offered crucial support and feedback during various stages of the project: Kristin Haltinner, Dan Winchester, Rob Stewart, Zachary Binsfeld, Tanja Andic, Erin Hoekstra, Carolyn Fraker, Madison Van Oort, Lindsey Beltt, Janelle Rainwater, Sarah Kiminski, Karen Olson, Rachel Grewell, Kyle Green, Myrl Beam, Rahsaan Mahadeo, Veronica Horowitz, Erez Garnai, and Jack Atmore. To my dissertation committee—Douglas Hartmann, Joshua Page, and Arun Saldanha. Thank you for the coursework, advising, and conversations that helped me clarify my thoughts and find my voice as a sociologist. Arun’s “Race, Space, and Biopolitics;” Josh’s “Sociology of Punishment” and “Contemporary Theory;” and Doug’s “Sociological Research Methods” provided invaluable theoretical insight. To Teresa Gowan—advisor, mentor, co-author and dear friend. Your brilliance as a scholar inspired me, but your commitment to my personal growth kept me in academia. As it turns out, I think I actually do want to be here. I owe so much to your unwavering guidance and support, and I look forward to our future collaboration. To all the fearless women who have mentored me along the way—Thank you for instilling within me the idea that I could produce a dissertation. The work I do is never just “mine.” I hope I can pay it forward in my future career. To friends, family, and loved ones. Thank you for putting up with me as I researched and wrote this project, in between teaching and the rest of life. Thank you especially to my partner Jeffrey— for your love and support in these difficult final stages. To all the individuals who shared their experiences with me in these pages-- Thank you for lending your courageous voices to this project. Your stories are inspirational in countless ways. i Dedication For Katie and other brave hearts ii Table of Contents List of Tables …………………………………………………………………………… v Chapter 1: American Addict............................................................................................ 1 Proliferating Addictions .................................................................................................. 1 The Crisis of Legitimacy in Addiction Science .............................................................. 3 The “Two-Track Treatment System” .............................................................................. 8 Study Design, Case Selection & Methodology............................................................. 14 Governing the Addict: Theoretical Anchors ................................................................. 18 Bridging Divides: Back to the Body ............................................................................. 26 Chapter 2: Setting the Scene: Addiction Recovery in the “Treatment State” .......... 40 The Land of 10,000 Treatment Centers ........................................................................ 42 From Criminalization to Coerced Treatment: KJ’s Story ............................................. 52 Coercing Criminal-Addicts: The Evolution of “Strong-Arm” Logic and Practice ....... 57 Inside Arcadia House .................................................................................................... 70 Middle-Class Pathways to the Minnesota Model: Kevin’s Story ................................. 76 From Bad to Sick: The Birth of the Minnesota Model ................................................. 81 Inside Healing Bridges .................................................................................................. 87 Chapter 3: “Habilitating” the Hustler: Rehab in the Shadow of the Carceral State ...... 94 Part I: Coercing the Criminal-Addict: The Punitive Face of Strong-Arm Rehab......... 99 Part II: Habilitating the Hustler ................................................................................... 121 Chapter Four: Recovering the Self-Manager in the Minnesota Model .................. 141 Part I: Addiction, a Disease of Your Own That is Not Your Fault ............................ 148 Part II: Eliciting the Recovered Self-Manager............................................................ 159 Part III: “Addiction Doesn’t Discriminate” ................................................................ 173 iii Chapter 5: Recovery Narratives across the Social Structure .................................. 202 Cross-Class Comparisons: Reconciling Treatment Logics & Lived Experience ....... 202 Life History Interviews ............................................................................................... 206 Middle-Class Addicts: Managed Binger to “Better Self-Manager” ........................... 208 Working-Class Addicts & “Recovering Co-Dependents” .......................................... 221 Treatment, Prison or Death: Recovering the Marginalized Poor ................................ 236 Symbolic Violence: Treatment Logics, Lived Experience, and Misrecognition ........ 254 Conclusion: Shifting Governmentalities .................................................................... 257 Notes on Methodology .................................................................................................. 266 Bibliography .................................................................................................................. 275 Appendix A: Interview Guide ...................................................................................... 292 iv List of Tables Table 1: Program Snapshot, pg. 92 Table 2: Program Demographics, pg. 93 v Chapter 1: American Addict Proliferating Addictions We live in the era of the addict. Eve Sedgewick noted decades ago that addictions were “everywhere proliferating” (Sedgwick 1994). It turned out to be a sage insight. Over the last century, rates of addiction have continued to increase in nations across the globe (Alexander 2008). The latest chapter in the American drug saga centers on heroin use, which has increased over 63% in the past decade-- much of it linked to the abuse of prescription pain medication (Jones et al. 2015). Policymakers and treatment providers note with alarm that the United States is 5% of the world’s population but consumes 80% of its opioids, and that more people now die from prescription drug overdose than car accidents (Lavitt 2014). The latest figures claim that addiction is now a leading cause of rising death rates among middle-aged, white Americans—a first-time reversal in decades of health longevity for a group that is otherwise privileged on most social and economic indicators of wellbeing (Case and Deaton 2015). The “cost” of addiction is estimated to exceed $468 billion annually—not including the untold costs to individuals, families, and communities who bear the weight of addictive suffering (CASA 2012).1 The white, suburban, middle-class contours of the nation’s latest drug scare have generated new concerns and cultural anxieties, and a reinvigorated political commitment to go to war with the nation’s centuries-old scourge. In many ways, none of this is a new story. Historical evidence of Americans’ long love-hate relationship with intoxicants abound. Even a cursory glance at American social history reveals that drugs, alcohol, and the many varieties of “getting high” were inscribed into the very foundations of the country’s social, economic and political order (Acker and Tracy 2004, Burns 2009, Courtwright 2001, Grim 2010, Musto 1973). From the consumption of morphine-laced “patent medicines” by 19 th century housewives 1 This is a conservative estimate that doesn’t include family, out of pocket or private insurance costs (CASA 2012). 1 (Acker 2002), to the drinking of “demon rum” in Prohibition-era speakeasies (Inciardi 2008), to the relentless mass marketing of pharmaceutical opiates and sedatives in the 1980s and beyond (Quinones 2015), the national consciousness has always been, in some senses, an intoxicated one. But the fact that so many more Americans seem to be turning to drugs and developing addictions in modernity requires new understandings and better theories. Sociologists have been offering some compelling ones. Their explanations highlight the cultural tensions between repressive Protestantism and indulgent consumerism (Reinarman 2008b); the mass dislocation caused by the spread of free- market capitalism (Alexander 2008); and the enduring social injuries of race, class, and gender (Friedman 2002). I will revisit these theories in the pages that follow, but I first want to return to Sedgwick’s assertion that addictions are “everywhere proliferating” because it offers us another way to think about the addiction explosion—that is, as an expanding trope for reinterpreting social problems. As addiction has become a more common