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Drugspeak: The Analysis of Drug Discourse

  John Booth Davies

    1.  Explaining Addiction

The ideas put forward in this book derive from two sources. Firstly, in the book, The Myth of Addiction, certain arguments from the general area of attribution theory were applied to the verbal responses and behaviour of people normally referred to as "drug addicts". It was argued that central to popular and lay beliefs, but also at the heart of some more expert accounts, is the idea that "addiction" changes the basis for human behaviour. The assumption is that "non-addicted" people have control over their behaviour in ways that "addicted" people do not. Whether one conceptualises this distinction as the presence or absence of "free will," or as due to the presence or absence of a pharmacologically-driven compulsion deriving from the drug ingested, makes no difference to the description advocated. The keystone to the addiction debate is the idea that "non-addicted" behaviour is "free" in some way that "addicted" behaviour is not. This alleged but impossible distinction is signalled in the discourse of addiction primarily through the use of terms such as "compulsion" and "loss of control", which by implication contrast with the noncompelled and controlled behaviour of those who are "not addicted".
    The Myth of Addiction argued that, notwithstanding the fact that some people encounter terrible problems as a consequence of their unwise use of drugs, any supposed shift in the principles underlying their behaviour is a myth (or to be more precise, a functional social construction); no such change takes place and indeed such a shift is philosophically untenable and empirically non-demonstrable.
    A major source of information on this supposed shift from mediated to compelled behaviour is the accounts that "addicts" themselves provide about their own behaviour; in other words, the things they say when asked to explain why they perform certain acts. From an attributional standpoint, such explanations are seen as socially functional accounts rather than veridical or "scientific" explanations. Because of the social and legal situations that drug users frequently find themselves in, it makes sense for them to describe their behaviour as non-volitional. Indeed, in a very real sense, being "addicted" means finding oneself in a situation where it is necessary to talk like an "addict" in order to survive. In the Myth of Addiction it was also argued that repeatedly finding oneself in situations where one has to rehearse and repeat such explanations increases the likelihood that one's behaviour will tend to change over time in order to fit with the stereotype of the "helpless addict" that one is repeatedly forced to endorse; and research into the attributional aspects of behaviour suggests a mechanism whereby socially functional explanations can come true at the end of the day. The mechanisms for this lie within the area of "attributional theory", a central notion of which is that the explanations one adopts have implications for future behaviour.
    However, there is a second and much broader set of issues which motivates this present text. In the course of many studies examining the functional nature of verbal reports (that is the way in which people's accounts of themselves vary according to the situation they find themselves in) the author and some close colleagues have become increasingly concerned about a number of the standard methodologies which psychologists use for dealing with verbal behaviour. Consequently, the use of questionnaires as a means of finding out "truth" has become for us an increasingly unsatisfying exercise, and the use of check-lists or forced-choice procedures to "measure" entities inside the head has started to seem an increasingly unlikely enterprise. Perhaps most of all, the very distinction between "true" and "false" as revealed in verbal behaviour of any kind appears to be bedevilled with both philosophical and practical problems; and the use of statistical and psychometric procedures designed to ensure that tests produce "truth" has started to appear like some dangerous self delusion that actually cuts straight across any notion of verbal behaviour as motivated, functional and symbolic (Davies, 1996). To the extent that psychology makes widespread use of such methods in pursuit of "truth", large areas of psychological inquiry come under scrutiny and the results are disquieting. It is reassuring to note, however, that certain other writers feel much the same; Maynard for example has suggested (1990) that questionnaires can "produce a falsely concrete body of data which distorts rather than reflects actor's meanings".
    By contrast, this text suggests that alternative philosophies and methods may offer pointers to the direction in which a new type of psychological inquiry might proceed with respect to verbal behaviour. In the following pages, a theory and an associated method are described for dealing with the natural discourse produced by drug users at various points in their careers. This account, however, represents only an isolated attempt to describe the nature of discourse within a particular area, namely drug use. We believe that a similar approach could be used in any behavioural domain, to provide an analysis of the natural history of functional discourse within a particular legal, social and economic context. By adopting such an approach, by abandoning certain methodological rigours which now appear to us as scientistic rather than scientific, and by replacing them with others which are more appropriate to the symbolic, interactional and functional nature of conversation, we believe that a more useful account can be obtained. We believe that the future of psychology requires the development and testing of new methods with new theoretical underpinnings, rather than the repeated application of accepted wisdoms about what constitutes 11 scientific research" and particularly "psychological measurement" in areas which seem, to us, increasingly inappropriate.
    Contemporary arguments about the nature of scientific enquiry, and the place of social science within that framework, date back at least to the 1940s. However, in more recent times trains of reasoning and thought deriving from logical positivism and materialism, and systems of self-regulating scientific progress as outlined by Popper (1959) have increasingly come under challenge. Nonetheless, this is the broad school of scientific philosophy and method from which mainstream "psychology-as-a-science" still draws its inspiration, and it is a matter for regret that such fixed concepts of science, coupled to a scientistic view of mind, still inform much psychological and other research in the present day. The notion of addiction as the manifestation of an independent or "extra-human" mechanism that submerges and over-rides normal human processes, and controls as if from a different locus the behaviour of the person showing the "condition", is just such an example. Unfortunately, the logic is deeply and obviously flawed, and it is a matter for regret that such an impossible concept is still researched with all seriousness in the name of "science".
    If one is a determinist, all behaviour is determined. If one is a materialist, all behaviour is underlaid by tangible mechanism. "Free will" enters into neither of these pictures and is the territory of the phenomenologist and the existentialist. Yet the "scientific" view of substance abuse as "addiction" invites us to differentiate between people who are able to make decisions about a particular form of behaviour, and those who cannot exercise such powers. It is the opinion of the author that such an idea is basically unscientific, insofar as it violates certain principles of parsimony that scientists insist on as being defining principles of their own modes of procedure. This is a comment on both the concept of addiction, and on a prevailing concept of science in general, and psychology in particular.
    In 1964, Sigmund Koch wrote:

"…the emerging redefinition of knowledge is already at a phase, in its understanding of the particularities of inquiry, which renders markedly obsolete that view of science still regulative of inquiring practice in psychology" (p. 5)

and later

"…the view in question was imported, with undisguised gratitude, from the philosophy of science and related sources some three decades ago but, while remaining more or less congealed in psychology, was subjected to such attrition in the areas of its origin that in those areas it can no longer properly be said to exist. Psychology is thus in the unenviable position of standing on philosophical foundations which began to be vacated* by philosophy almost as soon as the former had borrowed them". (p. 5)

    According to this view, psychology has borrowed and enthusiastically applied the notions and methods of a naive view of physical science (and continues to do so) at precisely the time those views were being superseded at the grassroots of the physical sciences themselves. Alone in the scholarly community, he suggests, psychology remains dedicated to the pursuit of knowledge through a simplistic application of materialist and logical-positivist ideas and assumptions; ground which has since been vacated by the very subjects that psychology originally borrowed the ideas from.
    However, Koch's assertion that only psychology suffers from this malaise may be overly optimistic. The basic problems of the nature of knowledge and the status of truth involve philosophical issues of a fundamental nature, which have been discussed by Locke, Hume, Wittgenstein, Descartes, Nietzsche, Mill, Foucault, Derrida and many others. Unfortunately, their writings frequently fail to impinge on psychology or science degree courses to any marked extent (or indeed, at all in many cases), and thus we find ourselves in a strange position whereby alternative philosophies of knowledge, and more specifically of science, may be largely unfamiliar to many of its practitioners. Unencumbered by this body of literature, it thus apparently remains possible for researchers to plunge ahead with the disinterested and objective search for truth despite serious epistemological problems with the two central definers (i.e. "objective" and "disinterested") and with the nature of the central concept ("truth"). This perhaps has a minimal effect on the ability to carry out "scientific" research, but has more far-reaching and serious consequences for the status and implications that become attached to what is "found out".
    In fairness, it should be pointed out that certain of the writers referred to in the above paragraph appear to be past masters at creating more problems than they solve; and also, at times, of expressing what are important but essentially easily-communicable ideas in the most flowery and opaque language. Furthermore, the philosophy of language which sees it (language) as devoid of absolute meaning, and as possessing significance only in a given context, is at the end of the day a disappointment to anyone who thought there were such things as informed opinions or expert views of the world. In the present text, a way out of this dilemma is tentatively suggested which does no major violence to contemporary philosophies of language (though it admittedly does some minor violence) whilst still admitting the utility of asking sensible questions and the possibility of producing useful answers whose epistemological roots are different, and in some ways arguably less individually subjective, than opinions produced in everyday linguistic contexts. The central theme of this book is that such a process is both conceivable and performable, and that the dilemmas proposed by a theory of discourse-bound-by-context are themselves not absolute. Consequently, it is still possible to distinguish between discourses which are primarily (but not exclusively) performative, and those which are primarily (but not exclusively) informative.
    However, an awareness of the underlying issues is essential to anyone calling themselves a scientist, since the arguments in question have the most profound implications for the way science is carried out, and particularly for any branch of science that makes use of verbal reports. At the end of the day, progress is only made by repeatedly throwing out old ways of conceptualising the world, by creating new frameworks for activity, and by developing new methodological paradigms, so a view of science that permits such re-construction to take place is an essential ingredient of what we like to call scientific progress. By contrast, if at some (any) point in time we presume we have discovered "the truth" about a particular set of phenomena, what need is there for any more research? There is nothing new to find out! (see for example Lawson & Appignanesi, 1989). However, even a cursory glance at the history of science shows that today's "truth", whether it concerns the flatness of the earth, the motions of the planets, phlogiston, or quarks, is invariably replaced by something else. Consequently a struggle to preserve present-day "knowledge" is always misconceived, is essentially anti-progress, and may be more a sign of insecurity and territorial defence than anything else.
    The basic illogicality of the notion of addiction, which brings the exclusive worlds of mechanism and free will into straightforward collision, and then claims that this has actual explanatory value in scientific terms, is a concrete example of a construct which is preserved for its social functionality, despite its lack of scientific coherence and the philosophical incompatibility that lies at its core. It also illustrates the basic and still-resounding dilemma in psychology; how to come to terms with mind within a philosophy that asserts that there is only matter. Or, if you prefer a behaviourist interpretation, how to describe volition within a system that only admits environmental vectors. At some point we have to come to terms with these fundamentally different but equally significant ways of thinking about human action, and of clarifying for ourselves that level at which we wish to speak, and for what purpose. The concept of addiction is a barrier to progress, since it confuses these issues at the very outset. Perhaps it is time it went the way of all scientific ideas, whether about the flatness of the earth, the earth as the centre of the universe, phlogiston as the essence of matter, or in time (as sure as eggs appear to be eggs) quarks. Such concepts are always throughstations on the lines along which we travel in the practice of science (as we conceive of it), but none of them can be said to be the terminus.
    If the above polemic has any merit at all, it can come as little surprise that the scientific study of addiction has made only modest progress when it comes to applying scientific theory to the actual day to day problems faced by those whose drug use is, for whatever, reason, problematic. On the one had, we have research at the micro level (physiology, pharmacology, biochemistry, neurology) which elucidates specific drug related effects on the brain, which have at best only the most oblique and tenuous explanatory power with respect to activities such as going down to the local pub for a pint of beer, or stealing a television to get money to pay for a fix of heroin. On the other hand, we have social research, which commits itself largely to prevalence (or head-counting exercises), supplemented by the atheoretical search for plausible, convenient and probably serendipitous relationships between who takes what drug, and a variety of social and demographic variables. This is usually followed by a brief statement indicating that such relationships do not necessarily indicate causality, followed by a lengthy discussion of their possible causal status!
    The gulf between going down to the pub explained as an act of choice (however conceptualised) within a social and historical context, or in terms of (say) the adaptation of neurones in the reticular formation to repeated doses of a general anaesthetic, remains as vast as ever. According to choice, we either count the one, or measure the other, and shout abuse across the void about whose view is correct, or most correct; or most "true" or "scientific". For the time being, it is sufficient simply to point out that the sentence "The reason the man went to the pub was that he wanted a pint of beer" is philosophically distinct, and its implications quite different, from the sentence "The cause of the man's behaviour in going to the pub was alcohol", this despite the fact that either sentence could be said to describe the act in question honestly. But the first description implies choice whereas the second implies compulsion.
    The way we conceptualise such phenomena is thus reflected in a very real way by the words we choose (decide to use) to describe it in the first place; and that choice is functional insofar as it sets the scene for whatever particular approach we already intend to bring to the problem. The choice of a particular research approach to the phenomenon of a man going to a pub depends not on any "scientific" principle, but reveals itself as an a priori judgement via the initial preference for one sentence rather than the other as the preferred (i.e. "better", "more scientific", "truer") description of the act from the outset. And this in turn derives from our own learning histories which encapsulate the kind of expertise we wish to bring to bear. What is clear, though, is that the answers one obtains from the chosen method will address only certain types of question, and do little justice to other ways of conceptualising the problem.
    The limited utility of addressing a physiological or pharmacological issue in social terms is usually apparent (for example, explaining the function of the reticular formation in terms of social class) but what is more difficult to understand is why answering a socially constituted question in pharmacological terms should be any more sensible. The latter can only be seen as "more sensible" from a standpoint that views (in this case) the pharmacological explanation as superordinate to another (or any other) type of explanation. That is, as in principle "better", "truer" or "more real". In fact, however, such a standpoint is implicit in "reductionism", which in a sense seeks to represent "the ultimate truth" underlying all matter and all existence. We should remember though that reductionism is in itself philosophically derived; not scientifically. It is not provable by science, but only defensible in terms of deductive (non-empirical) reasoning. As such, people can disagree with the premises underlying it, as with any other idea based on certain a priori assumptions. Any scientist claiming a superior status for his/her particular brand of reductionist epistemology is thus unfamiliar with the basic building blocks of the trade; that is, with the philosophy of science.
    Whilst the absence of an integrated theory of addiction remains as stark a reality as ever, this book represents a second attempt to reconceptualise the notion of addiction as a motivated species of discourse. Briefly, it is argued that drug use becomes addiction when a person who uses drugs finds him/herself in situations where it is necessary to talk like an "addict" in order to survive. Such situations are defined in terms of factors which are pharmacological, social, economic and legal in origin, although the state of "addiction" per se inheres in none of these areas. Within such a system, issues of freewill or compulsion, or pharmacological versus social determinism, are sterile; whilst the search for the "causes" of addiction as a state are doomed to failure, since the search is in fact for a mechanism underlying nothing more substantial than a learned and widely known set of functional figures of speech. However, it is the message of this book that the key to understanding drug problems requires an examination of how and when that figure of speech becomes necessary, and why it is so highly valued by drug users, their families, clinicians, and researchers alike. From such a viewpoint, "addiction" is not simply a state of a person; nor an inherent pharmacological property of drugs, nor an inevitable response to demographics although all these things play a part. It is a way of thinking (a "construct"), and it is the psychological consequence ("output") of a many faceted system. Furthermore, it is a property of that system as a whole, and is not defined wholly or partly by any individual element in that system. However, the final essential piece of the addiction jigsaw puzzle slots into place when the user starts talking about him/herself in a particular way, in order to reduce the sanctions attendant on a disapproved-of form of behaviour. As we shall see in later chapters, once this decision has been made there is no way back and paradise, or at least a type of innocence with respect to drug use, is indeed lost forever.
    "Addiction" then, it is argued, is a way of talking and behaving which is adaptive for drug users who encounter problems within a system which places sanctions on this type of activity. In a different setting "it" might not exist, or might exist in some other form. To search for "it" as an entity that resides inside people, or inside substances, is to basically misunderstand the problem. As long the notion of "addiction" has at its core the basic requirement to flit between two (volitional versus nonvolitional) types of explanation which are non-complementary, or worse, to imagine that volitional and non-volitional are opposite poles of a continuum (so that free will becomes a matter of degree) we can expect to continue chasing our tails for the foreseeable future.
    The present text seeks to suggest possible ways out of this hall of mirrors. A method is suggested for dealing with the things that drug users tell drug workers, which makes no assumptions about the truth or falsity of the accounts offered, but seeks to examine their functionality within a drug use career. The result is a kind of natural history of drug discourse, in which the kinds of explanations, stories and narratives offered by drug users are seen to change and evolve in predictable ways over the course of a drug using career, as they adapt to changing circumstances. The driving force for these explanations, stories and narratives is assumed to be their adaptive utility in a sequence of evolving and changing contexts surrounding drug use, and therefore, the ability to recognise particular features of the narratives would, in principle, give a guide to the kinds of situations currently being encountered by the rapporteur. The "truthfulness" of the accounts is unknowable, as with all verbal reports but furthermore, in the context of the present method, it is unimportant.
    Finally, it is the intention and hope that the analysis of the discourse of drug users offered in this text will be simply one example of an approach which can be applied in other areas. By virtue of the changing dynamics of the situations in which they find themselves, drug users comprise a crucial study group, insofar as the functionality of their conversations changes (we believe) in a known sequence, sometimes in a fairly short space of time. We do not believe, however that the dynamics of their conversations are fundamentally different from those of anyone else. In order to illustrate this point, the present text also offers a loose discursive analysis of some of the standard and more-or-less hallowed definitions offered by experts whose chosen vocation includes the treatment of those who are believed to be addicted. The aim is to show that the functional discursive phenomenon we have described as "drugspeak" (after Dally, 1990) characterises the utterances not only of users, but also of those who propose therapeutic means of influencing that use. We believe that whilst the functionality of both discourses is in principle identifiable, objectivity or "truth" cannot be assumed to reside in either. However, this does not mean that progress cannot be made.

Chapter 2

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