“Getting Better”

Abstract

The alcohol and other drug field is characterized by great diversity in kinds of treatment and treatment philosophies. Even the kinds of problems treatment is expected to address vary significantly, although agreement seems to exist that the general purpose is to help people "get better." This article considers this diversity, drawing on a qualitative project conducted in three countries: Australia, Canada, and Sweden. Inspired by the project's multisite approach and the questions it raises about comparative research, the article critically engages with the notion of "comparison" to think through what is at stake in making comparisons. Analyzing 80 interviews conducted with policy makers, service providers, and peer advocates, the article maps key ways treatment is conceptualized, identifying in them a central role for comparison. Participants in all sites invoked the need to consider addiction a multifaceted problem requiring a mix of responses tailored to individual differences. Related notions of "holism" were also commonly invoked, as was the need to concentrate on overall improvements in well-being rather than narrow changes in consumption patterns. In conducting this analysis, this article poses a series of critical questions. What kinds of comparisons about quality of life, the self, and wellbeing do treatments for addiction put into play? What categories and criteria of comparison are naturalized in these processes? What kinds of insights might these categories and criteria authorize, and what might they rule out? In short, what does it mean to understand alcohol and other drug use and our responses to it as intimately intertwined with the need to "get better," and what happens when we scrutinize the politics of comparison at work in getting better through addiction treatment? We conclude by arguing for the need to find new, fairer, ways of constituting the problems we presently ascribe to drugs and addiction.

Fixed and fluid at the same time: how service providers make sense of relapse prevention in Swedish addiction treatment

“…In an early study, Berg (1996) showed that the medical record is not just a container of patient information; it also shapes the very nature of medical practice. Similarly, research has shown that different treatment techniques typically individualise addiction problems and make strong assumptions about what is considered healthy and normal (Dennis, 2017(Dennis, , 2020Fomiatti et al, 2017;Fraser & Ekendahl, 2018;Pienaar et al, 2017). We follow this analytical path and target what objects or entities 'become' through practice, which makes redundant any separation of the entity 'itself' and its discursive representations (e.g.…”

Comparisons in the making: youth accounts of cannabis use in Swedish addiction treatment

“…Comparisons used in accounts can shed light on what key assumptions people have about their lives and living conditions, but they also give us the opportunity to ponder upon what realities they leave out (Fraser & Ekendahl, 2018;Seear et al, 2020). Our analysis reveals that the young people in their comparisons drew on culturally, institutionally and organizationally naturalized narratives about cannabis having objective drug effects, the individual being responsible and autonomous and the persistent risk of use getting out of control.…”

“…Comparison is a fundamental tool used by people to orient themselves in the world -'[w]e are all comparativists' as French philosopher Isabelle Stengers puts it in an article on the topic (Stengers, 2011, p. 48; see also Fraser & Ekendahl, 2018). We make comparisons all the time, and it would be difficult to understand ourselves and our lives without them.…”

“…differences within the group being compared with another group). Studies by Fraser and Ekendahl (2018) and by Seear et al (2020) in the addiction field underscore that other comparisons are always possible. We thus maintain that substances, users and local settings come into being and are made meaningful through processes of comparison.…”

“…Gray & Squeglia, 2018), in-depth research on how people use comparisons provide important insights about how they make sense of substance use. In this study we add to prior qualitative studies on comparison in the addiction field (Fraser & Ekendahl, 2018;Seear et al, 2020). We revisit interview data from a research project on youth cannabis use and treatment and illustrate how young cannabis users compare phenomena related to substances, people and settings to make symbolic boundaries (Copes, 2016;Lamont & Moln ar, 2002) and form narrative identity (Loseke, 2007).…”