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New research published in Critical social work reveals that dominant understandings of recovery, such as maintaining abstinence, can be perceived by service users as oppressive.
Critical discourse analysis of qualitative interviews with individuals struggling with substance use problems in rural Ontario explores the power dynamics inherent in substance addiction recovery discourse. The author concludes by offering recommendations such as training and education to address stigma and implicit bias among clinicians and to include individuals experiencing substance abuse problems in research, policy development, clinical practice, and education.
Researcher Sandra R. McNeil of the University of Windsor writes:
“By shaping who should recover, how they should recover, and what recovery should look like, recovery discourse constitutes categories of inclusion and exclusion. Examining substance use recovery through a critical lens reveals ideological values that perpetuate the stigma of substance use at micro and macro levels. Equally important are the many intersecting forms of stigma related to race, class, gender, sexuality, ability, appearance, geography, and substance use that are able to (de)construct structural inequalities.”
The definition of what substance addiction recovery means is unclear and ranges from abstinence to substance use harm reduction. However, most definitions promote responsibility and autonomy, reflecting neoliberal values.
McNeil defines neoliberalism as: “. . . the supremacy of the capitalist economy, characterized by increased profits, reduced government spending, and increased individual, family, and community responsibility. Neoliberalism constructs not only disciplined workers and consumers, but also responsible, moral individuals who make “good” choices, and those who fail to conform can be considered a “risk” to society.
Recovery-oriented language in Canada, where the current study was conducted, incorporates neoliberal values as it emphasizes personal responsibility and goals, family and community support, and encourages recovering individuals to fulfill their economic and social roles. As a result, people who do not meet these criteria for “recovery” can be stigmatized and marginalized, especially in rural areas.
Elsewhere, neoliberal ideologies have been linked to poor mental health, loneliness, reduced well-being and suicide stigma, which have been shown to significantly and negatively influence suicidal ideation.
Although risk levels of substance use are similar, if not higher, for rural populations compared to urban populations, and rural populations are at greater risk of being stigmatized for substance addiction, research on substance use tend to focus primarily on urban areas and rural populations do not have the same access to substance abuse treatment and services.
In the current study, McNeil conducted qualitative interviews with 40 individuals living in rural Ontario who self-identified as currently or previously experiencing substance addiction. Participants ranged in age from 19 to 72 and were predominantly white (95%), heterosexual (87.5%), and cisgender women (52.5%), making $30,000 or less per year (85%).
McNeill applied critical discourse analysis (CDA) to her interview research to reveal the power relations embedded in the dominant recovery discourse. Broadly speaking, CDA focuses on: “social inequality, describing and interpreting social interactions and structures, and explaining how discourses can exercise, legitimize and resist power relations”.
Although dominant understandings of recovery argue that recovery is an individualized process, interview participants’ responses revealed common themes, including neoliberal values, loss, and abstinence.
The expression of neoliberal goals grounded in recovery discourse was evident in participants’ discussions of their experiences of loss in active addiction. For example, participants described loss in terms of losing relationships, health, jobs, homes, cars, identity, dignity, respect and self-esteem – highlighting how people struggling with substance addiction are disciplined and stigmatized for not comply with public expectations.
Recovery was framed by many participants as ‘getting things back’, implying that recovery meant having a job, a house, a family, etc., all of which required one to subscribe to and live by neoliberal values.
Similar themes emerged in participants’ descriptions of the ‘substance abuser’ as someone without a job or family and a ‘loser’ compared to what it means to be a ‘functioning citizen’. One participant noted, “People are getting so bad that you would be useless to society. You have to get better so you can be a working citizen… So, I think recovery is about getting back to normal… healthy and clean. Like new, I guess. A good user, I guess.”
Most participants defined abstinence as part of recovery, although some offered opposing views, suggesting that abstinence is not an achievable goal – indicating that traditional understandings of recovery do not fit everyone struggling with substance addiction.
Furthermore, while mainstream recovery discourse recommends that people seek support from loved ones, communities and professionals, participants’ responses indicated that support is not always available to all, especially those living in rural areas who lack access to formal resources .
Additionally, participants’ narratives revealed how intersections such as substance use, appearance, and homelessness led to their dismissal or mistreatment by health professionals.
“I had three kidney stones, but do you think they’re going to give me something for the pain? … I said to the doctor, ‘If I wasn’t on methadone or had all these signs, would you give me this medicine?’ Because I had the same thing [kidney stones] like a person two beds down from me and I know what [medication] he was getting… Because he’s in a tailcoat and tie and I’m in jeans and a t-shirt and I don’t have a permanent address and he does, you’re going to say he can have it and I don’t.”
Moreover, neoliberal values such as personal responsibility, autonomy, choice and contribution to social and professional roles were both supported and challenged by the participants. For example, one participant shared how she sought support for her substance use problems during her pregnancy. However, she was devastated to learn that this “support” included taking custody of her child.
She described her experience: “I was shocked … so I dealt with all this guilt about not being able to be a parent. It was the worst thing that ever happened to me… I felt that there was nothing for someone in my situation: a woman who wants to be a mother, tries to be a mother, doesn’t know how to be, because I don’t I’m allowed to be.
Overall, participants’ responses revealed both support and resistance to the dominant recovery discourse. However, the analysis of their interviews also shows how inequitable power relations underlie mainstream understandings of recovery and how they perpetuate the marginalization of groups of individuals through ableism, classism and the stigmatization of individuals who do not conform to the neoliberal status quo.
McNeil urges the substance use and social work fields to address how the prevailing language of recovery perpetuates the stigmatization of those struggling with addiction, and encourages them to recognize that even the concept of recovery is not something that all people who use substances apply – not everyone sees themselves as damaged or in need of something to recover from and still deserve dignity, respect and access to resources.
Limitations of the study include the small sample size and focus on predominantly white cis-gender populations.
McNeil concludes by recommending further research on substance use among rural populations, particularly that which includes those experiencing substance use problems as collaborators, as well as involving those struggling with addiction in policy development and education. She also recommends that clinicians receive training and education to reduce stigma and implicit bias.
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McNeil, SR (2022). Rhetoric of recovery resistance: A critical discourse analysis and opposing perspectives from people with substance use problems in rural Ontario. Critical Social Work, 23(1), 2-26. https://doi.org/10.22329/csw.v23i1.7589 (Link)
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