Migrating identities: the relational constitution of drug use and addiction
Address for correspondence: Kahryn Hughes, School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT. e-mail: email@example.com
This paper aims to develop a properly social conceptualisation of addiction through drawing on analyses of rich, in-depth data from ex/users of heroin. Practices of addiction are considered as in and of themselves constitutive of particular identities, ways of being, and ways of being with and for others. The discussion seeks to demonstrate how heroin use is predicated upon, and productive of, purposeful drug-using relationships in which users produce and reproduce the conditions for continued use (e.g. scoring, grafting, using). Accordingly, the concept of ‘dependence’ is here reconfigured to encompass both dependence on the provision (and ingestion) of drugs and, simultaneously, dependence upon diverse configurations of users, clinicians, support workers, and so on. The paper makes a critical departure from existing debates in which addiction, even if conceived as a social practice, is nonetheless understood at the level of ‘the individual’. It is argued that this tendency towards ontological individualism leads towards conceiving the problem of addiction as residing predominantly in the individual negotiation and, ultimately, resolution of identity narratives. The analyses presented here explore how the migration from addict to non-addict involves more than identity work. Theorisations of the level of ‘field’ or ‘configuration’ are developed, and considered as both a level of analysis and a conceptual lens for understanding changes in the ongoing, relational, practices involved in such identity migration. Finally, the consequences of intersecting, relational, dimensions of time horizons, place and space in the talk of ex/users are considered for strategies for successful recovery, identified during the research.
These people are playing with their lives every day, I mean physically, do you know? You've got a needle in your arm. I mean I went over three times, once to wake up in an ambulance and it's not a nice feeling. And you don't realise what you’re playing with. In fact, it's not that you don't realise, you’re just not bothered, you don't care.
Steve, (life-history, drugs outreach worker)
This paper seeks to explore heroin addiction and drug use as a set of embodied social practices centrally involving participation and reconfiguration in specific and purposeful inter-relations with other users. My aim, then, is to move away from understanding ‘addiction’ as an individual, solitary, psycho-pathological complex, and towards a potentially more adequate social conceptualisation of addiction (Waldorf 1983, Hammersley and Reid 2002, Gibson et al. 2004, Vitellone 2004).1 In doing so, I am rejecting a positivistic preoccupation with causality (the causes of addiction, see Harding 1986), a clinical search for the ‘mechanism’ of addiction (i.e. at the physiological, cellular, or ‘psychological’ level) (see Bühler 2005), and instead, pointing towards a re-orientation of concepts of ‘addiction’, towards a properly social theoretical object (see also Vitellone 2004).2
Analyses of the talk of drug users/ex-users who are centrally considered in what follows suggest that addiction involves a set of social processes, relationships and practices; in ways of being. In effect, such analyses indicate that practices of addiction are about being one's self. That is to say, practices of addiction are integral to the process by which addicts constitute and maintain their identity; thus, to stop engaging in these practices means, in effect, to stop being themselves. Building on this conceptualisation of addiction-as-(discursive-) practice, I will examine the intimate links between identity practices and living practices integral to drug use. User and ex-user respondents to the study drawn upon in this paper describe themselves as engaged in dynamic inter-relations, where shifts in identity practices (what I do to be myself) entail shifts in living practices (what I do with others in order to be myself). In other words, changes in identity practices can be understood to be fundamentally linked with changes in the means by which people help reproduce the conditions (material, relational, financial, emotional, etc.) for and of a particular existence. In proceeding from this conceptual starting point, the formulation ‘discursive practices’ is adopted throughout (Hughes 1999) to help facilitate the theorisation of addiction-as-practice. Furthermore, by conceiving heroin use and identities of addiction as predicated on participation in purposeful relational configurations, this paper seeks to forward the idea that specific identity practices (taking heroin) cannot be divorced from relational contexts. Accordingly, the paper considers how such practices produce and are products of particular time horizons, characterising these inter-relations through shared practices; it concludes with a discussion of how the theorisations developed here might contribute to existing work on addiction.
It is important to emphasise that addiction and withdrawal have variously been described as a personal hell by the respondent sample drawn upon in this paper. This immediately highlights a core dilemma of academic writing: that in theorising for the purposes of academic exchange we risk losing contact with precisely that which we wish to encapsulate. Vomiting, shaking, lack of sleep, ‘rattling like hell’, the manifold lived experience, the corporeal array of addiction is effectively erased through the use of a technical lexicon. But equally, by focusing precisely on these corporeal aspects because they are so visible and immediate, and those aspects of addiction which we seek to ‘treat’, we risk also obscuring the profoundly social character of addiction and, paradoxically, ultimately failing to develop appropriate ‘treatment’ strategies which must, it is argued here, aim to move beyond the restrictive conceptual level of ‘the individual’.
Background of the sample
The analyses presented here emerged from a study funded under the ESRC Research Methods Programme (RMP). Researchers in the study sought to develop strategies to access and engage with those individuals who had been described as socially excluded by service providers or community leaders in their area. By using an iterative methodological strategy, researchers in tandem with the participants themselves developed methods, strategies and ethical practices which enabled access to further socially-excluded participants.3 During the study we recruited a number of drug users and ex-users as both gate-keepers to other potential participants, and as participants themselves, through a drug mapping project in the locality. Although our interviews initially opened with questions concerning the periods in respondents’ lives when they had felt healthy and unhealthy, the topic of heroin use and addiction quickly became the organising principle for each interview. The analyses presented here are based on interviews with ten people involved in the drug-mapping project. These respondents were interviewed repeatedly, including by telephone, singly in in-depth interview, group in-depth interviews, general group interviews, and individual life-history interviews. The interview format is indicated at the end of each extract of talk.
Extracts from the interviews drawn upon in the discussion that follows have necessarily been selected on the basis that they exemplify the key arguments that are developed in this paper. As such, the extracts do not reflect the full range of topics discussed in the interviews as a whole; indeed, the wealth of insights these have provided have formed the basis for a number of papers currently in development. Care has however, been taken to include extracts containing themes which pervade the talk of all participants; and have been subject to a member-checking exercise in a recent group seminar with five of the participants who considered the substance of this paper as a whole. While the accounts drawn upon here are necessarily reflective of this particular community of drug users, it is hoped that the theoretical insights that they have facilitated will have considerably broader application.
Investigation of the data collected began with a simple thematic content analysis using NVivo software and, on the basis of emerging insights, more intensive discourse analysis was used to develop identifications of discursive practices associated with the constitution of the subject, including identity and living practices associated with drug use and non-drug use. Discourse analysis was also used to examine the range of practices in which participants and interviewers engaged during interviews, including negotiations around the discursive constitution and framing of the subject (Bannister et al. 1995, Davis 1986). Framework analyses tracked the social involvement and geographical movements of the participants; and it was at this stage that exploring the dynamic inter-relational character of drug use emerged as a distinct analytical possibility.4 These aspects of the analyses were made possible through the types of data gathered (ongoing, reflective, in-depth, life-history) and the range of contexts in which they were generated (singly, in groups, member-checking). There was a noticeable difference for possibilities of analysis between the life-histories and the drug-mapping access interviews, even when these interviews were undertaken with the same individuals. The difference between interview formats resulted in significant variations in the extent of self-description: what it is that they do; who they are and how they maintain themselves. In this way, the types of analysis that follow can be understood as very much dependent upon the distinctive data collection strategy adopted in this study.
Considering addiction and drug use
Theories of addiction have included conceiving it as a disease (still central to the tenets of organisations such as Alcoholics Anonymous); as a pharmacological consequence (see Davies 1998, see also Bühler 2005); as consequent on an individual's predisposed physical vulnerability (Cloninger 1987); and/or as an expression of biographical events (emotional, psychological, etc.) (see Harding 1986). Briefly, however, it is possible to identify three core thematic strands in the literature on addiction and drug use, namely, the bio-medical search for the pathological individual; an epidemiological investigation of pathological populations; and, to utilise a Foucauldian lens, a sociological consideration of both the ‘archaeology’ of the socio-historical conditions providing for the possibility of addiction, and a ‘genealogy’ of contemporary conditions in which drug taking and addiction occur and can be understood (see Foucault 1981, Vitellone 2004).
An ongoing failure to identify the site of addiction (e.g. body vs. mind), or, indeed, the mechanisms of addiction, has led some to argue that the bio-medical project of adequately identifying the physical pathology of both ‘addiction’ and the ‘addict’ has been only partially successful (May 2001). As May's exemplary review concludes: ‘the shift that medicine has accomplished has been from a condition defined as pathological loss of reason, to one organised around a quasi-pathological loss of motivation’ (2001: 396). In a shift from physical to cognitive pathology, therefore, driven by dualistic discourses of susceptibility and culpability, medical consciousness has shifted toward epidemiological concerns with population variations in drug use and addiction. In other words, it has developed the search for the ‘vulnerable’ and addressed this quest within epidemiological debates (see Helzer and Canino 1992). Epidemiological approaches, although seemingly applying a ‘social’ level of analysis, have in the main nevertheless elided the profoundly social character of drug use and addiction in that social pathologies are presented both as causes and explanations of individual drug use, while drug use and ‘addiction’ remain an individual preoccupation (Susser 1999).
Alongside medical and epidemiological work, a substantial literature has developed seeking to explicate the social relationships in which addicts are located; arguing that addiction is learned as the habit itself is learned, and locating the addict in broader drug using groups (Waldorf 1983). Waldorf's model of recovery is an excellent earlier example of recovery both as a process, and one involving reconstruction of the addicts’ lives (and identities) including the reconstruction of their relationships. This takes a significant analytical step away from bio-pharmacological notions of addiction, and it is, in part, within this strand of the literature that this paper is situated. However, in earlier work there has been little attempt to understand the process of ‘learning’ about the ‘myth of addiction’ (Hammersley and Reid 2002), where the focus remains on the discursive constitution of the ‘myth’ while the embodied participatory character of learning is ignored (Lave and Wenger 1991). Importantly, further theorisation is needed of how practices of habituation operate inter-relationally, and what purposes, or intimate exchanges, may be involved in these forms of ‘learning’. Also, in models such as those developed by Waldorf there is an a-theoretical, voluntaristic understanding of the degree of geographical relocation and distancing of which ex/users or recovering addicts are capable; in particular, the constraints of their social positioning that participants themselves identify, which the analyses here intend to address.
The theoretical move, in debates on addiction from an engagement with causality, has led some to examine the means by which users overcome and transform their understandings of their own addiction, to the extent that ‘addiction’ has been described as, in effect, a discursive device whereby drug users explain and frame their behaviours and motivations (Davies 1997). Here, social context, identity and addiction are linked through analyses of how specific explanations of addiction are learned, and serve the explainer in their drug using behaviour (Davies 1997). These ideas have been used in empirical investigation of ‘narrative construction of self-identity, their relationship to the discourses surrounding drug use and how addiction is established as addiction’ (Gibson et al. 2004). In Gibson and colleagues’ study, as in the interviews for our RMP study, ‘. . . the drug users’ main concerns were with providing accounts of becoming someone they were not and recovering a sense of who they were’ (2004: 604), again suggesting that recovery can be described, as in the Waldorf model, as a process of identity reconstruction (Waldorf 1983). Gibson et al. develop the idea of ‘entangled identities’, where ‘entangled’ refers to the extent to which the person's identity is no longer separable from their drug use. Their participants describe their recovery from addiction rather than their recovery of self, and their understandings of addiction closely reflected the ‘myth of addiction’ (Hammersley and Reid 2002), where drug use is understood as long lasting, if not permanent, even while simultaneously acknowledging that the physical effects of withdrawal were a difficult, significant but temporary part of the recovery process.
Gibson and colleagues’ analyses, however, remain specifically concerned with narrative. Although they include discussion from their sample about heroin use and the physical compulsion of the drug, the embodied experience of drug use is ultimately rendered invisible by their exclusive focus on narrative in a process which de-emphasises practice, where the core activity in recovery is managing the construction of a transformational narrative whereby users can transform their identity from that of user to non-user (Gibson et al. 2004: 608). The principal concern with addiction in this narrative transformation is to reframe addiction as a sedimentation of behaviours which can be disrupted through the process of disentangling one's identity. In the migration from a drug-using, self-preoccupied, ‘momentary identity’, to a non-using identity which becomes capable of conceiving the ‘I being for the other’ (Bauman 1992 in Gibson et al. 2004) drug use (behaviour) must be separated out from identity. Sedimentation, however, seems to be another word for habituation; it seems to be another way of reformulating ‘addiction’, thus retaining the concept yet avoiding the debate around causality. Following on from these ideas, ‘addiction’ becomes a social exchange of narratives; and within these narratives addiction occurs, once again, at the level of ‘the individual’. Addiction becomes something that can be talked away, something about which different stories can be constructed: and these different stories, in turn, are able to change the ontological conditions of daily life, enabling the shift from user to ex-user, addict to ex-addict. In effect, although starting from a similar point to that which opened this paper, namely that what I am is inextricably bound up with what I do, Gibson and colleagues suggest that, instead, identity can be separated out from ontological existence, from the practices of everyday living simultaneously constituting and maintaining identity. Ultimately, expert narrative management can lead to a disruption of habituation; can defeat the myth of addiction; can lead the person in their identity migration from user to a non-user. Consequently, although they acknowledge the social context of drug use, Gibson et al. do not place contingent changes in practice core to the process of changing identity, nor to the process of reconfiguration of purposeful and creative inter-relations in which these identities are maintained, and in and against which changes must occur.
Two key ideas that I seek to develop in this paper could sit alongside Gibson et al.'s, and perhaps contribute to them. My first premise is that it is not possible to separate discourse from practice in the process of identity formation, performance and maintenance; and in this way my intention is to avoid theoretical collapse into a position whereby ‘addiction is discourse’ (e.g. Davies 1997). Second, my position is that identity practices (see below) must always be conceived as part of living practices (I being for the other, Bauman 1992) so that rather than theoretically engaging at the level of the individual, we must always engage at a relational level of individuals in the plurality and, importantly, individuals in terms of the networks they constitute and the relationships they configure. While explicit examples of these ideas are presented in a later section in the empirical context of drug using, I would first like to develop these two conceptual points further.
Identity and (discursive) practice
In his later work (Foucault 1990), Foucault introduces a self which can be practised according to specific aesthetics (see McNay 1992). This enables theorisation of the processes involved in the active construction of the particular materiality of individuals’ existence, within their socio-historic context (Hughes 1999). Through his notion of power-relations as creative rather than monolithic (Foucault 1981), the self, or perhaps better, human selves, can be understood to be engaged in discursive practices. By discursive practices I refer to intentional and voluntary actions, including bodily practices, forming a means by which the subject is shaped, including practices by which individuals may seek to transform themselves according to certain aesthetic values, meeting certain stylistic criteria (Foucault 1990). These practices must be considered social practice, constituting or depending upon certain relationships between individuals, to exchanges and communications, and even to institutions (Foucault 1990). These practices of the self are therefore identity practices, and by considering them as discursive practices, it is possible to situate practice as necessarily predicated within, and productive of, a series of specific relational contexts. Crucially, because this creative self is predicated on practice it is theoretically untenable to suppose that these discourses do not have congruence with corporeal possibility, yet such corporeal possibility must be understood to be always already historically and socially mediated. In other words, practices are embodied; and are within and inseparable from social ‘fields’ of operation (see Bourdieu 1984).5
It is at the level of fields, building on the notion of discursive practices, that it is possible to develop the conceptual formulation of configurations of discursive practices. This allows for analytical engagement with the notion of subject constitution as relational, and thereby not precipitating us into explicating solely individual practices. In other words, such a formulation invokes a level of analysis capable of engaging with both ongoing production and reproduction, change and continuity at the level of configurations of individuals rather than ‘the individual’; in effect, always simultaneously conceiving individuals and the relational networks they constitute.
Analyses of the drug ex/users’ interviews suggest that their drug use is predicated on social processes, relationships and practices: to ways of being. Their talk about themselves, the times in their lives when they were using drugs, is imbued with discourses of addiction (reflective of Hammersley and Reid's (2002) ‘myth of addiction’) and in this way, practices of addiction involve being one's self (and being with others in order to be oneself). Analyses of interviews suggest that addictive practices are integral to addicts’ identities, and to stop engaging in these practices means in effect to stop being themselves.
Theoretical implications of this development include first, that subjects are engaged in the production and maintenance of multiple identities, and that such identities are unfinished and ongoing. Secondly, such identities or subject positions, too, must be seen to be always already engaged in discursive practices which, as operations within local fields of power and resistance, constantly contest, and legitimate such subject positions in a relational context. Further, to conceive of configurations of discursive practices occurring in local fields of operations of power and resistance avoids retreat into a theoretical position which assumes that multiple ‘identities’ are not only available to the subject, regardless of their socio-cultural location, but can be assumed at will and in limitless permutations. Such a conceptualisation is crucial to a more adequate engagement with key ideas of identity migration, and one which presents a particular challenge for strategies based solely on the disruption and manipulation of identity narratives.
Individual, embodied practice can thus be understood to occur at the level of individuals, or configuration (this term also points to beyond a group level). Analyses of discursive practices at a configurational level allows, in turn, for a reflexive explication of the socio-historical location of such configurations, and the conditions allowing for its possibility. In effect, it allows for investigation of the field. These practices, therefore, (such as using, scoring, grafting, in the case of heroin users) involve more than identity constitution, or the production of momentary identities (Bauman 1992), they are predicated upon, and involve participation and reconfiguration within these extended configurations of interrelations. Identity migration, therefore, occurs beyond the level of the individual, and is simultaneously constrained and productive of the relational configuration in which such migration occurs. Additionally, Bauman's (1992) I being for the other is embraced within the concept of living practices which extends this notion of the other to embrace these broader relational configurations. Living practices refer therefore to the reproduction of the conditions necessary for ongoing discursive constitution of human selves.
Turning now to the primary accounts of the ex/users, the paper considers the contributions of this particular theoretical approach to understanding their descriptions and reflections on drug use, and their identities as drug users.
Avoiding the rattle: what needs to be done
Participants’ explanations of relationships and behaviours around what needs to be done and achieved in order to buy and take drugs was driven by the principle of ‘avoiding the rattle’. Rattling refers to the physical effects of withdrawal and operates as a key, often unspoken, organising feature in participants’ presented understandings and explanations of their lives. It is difficult to over-estimate the importance of rattling for these participants, the dreaded conclusion to the six or twelve hour physical cycle from ingestion to withdrawal onset. This cycle was elaborated through the dimensions of time and space: namely, where you can get to and what you can do in the given time in order to avoid the rattle. Time will be taken up in greater detail below as it is diversely conceived in different contexts in participants’ talk about drug use and non-use. Space, in this paper,6 may be characterised as the distance between where the user is currently, where they need to go to score, and from there to where they need to go to use; space is therefore a fundamentally relational concept.
One strategy for avoiding the rattle was described by the participants as the ability to ‘maintain’; maintain using heroin, or maintain using prescription drugs (‘having a script’) as either a detox process or as a long-term using strategy where one uses heroin at the same time as prescription drugs.
Terry: . . . maintaining is when you get different kinds of drug use. One is where you’re chaotic, it can make you cry, you’re sort of like really going off your head and you get into trouble you know you run into the criminal justice system, you’re very chaotic with your drug use and things, whereas somebody who maintains a habit, basically what they actually do is they've learnt how to budget their money, budget the drugs, and have got a regular supply so, in that case you can function as a normal human being almost, as long as you've got your regular supply and you’re not chaotic with your drug use, so we call it like maintaining your habit basically. [ . . . ] it's more I think with your life about how you maintain your life, because people who are maintained on methadone don't necessarily have a stable lifestyle, they still go out and offend they still take crack they still take smack you know and they’re quite chaotic actually even though they’re being maintained on a prescribed drug basically, so it's the same as when people are using their heroin . . . I did for a long time, two years I worked several jobs and I was still using and I maintained it because I allocated X amount of my wages per week and used.
Terry (2nd in-depth interview, drugs outreach worker).
This extract highlights how maintenance for this user involves sustained effort, planning, foresight, and competence, and immediately the notion of addiction as loss of control is called into question. Maintaining was described as trying to live a ‘normal life’, i.e. maintaining a job, a house, a car, and a family including spouse and children; it is the ability to maintain one's life by controlling one's drug use. This challenges other empirical findings where maintenance is described as a characteristic of middle-class users (Waldorf 1983) whereas our sample was drawn from a low-income estate in a city in the north of England. Importantly, however, being able to maintain is not to suggest that heroin use is not the principal driver in one's life for those in our sample:
Pete: Well the thing is, if you haven't got heroin in your system your mind's on one fucking thing, and overall, over everything you couldn't give a fuck if the world's collapsing around ya, your mind's on one thing and that's fucking getting that heroin. When you've had a heroin problem for so long if you have a hit it doesn't mean to say that you’re going to be fucking intoxicated out of your mind, it means that you can fucking operate a little bit better and function a little bit better.
Pete (2nd in-depth interview, drugs outreach trainee).
This relates to points made by other participants, one of whom suggested that taking heroin wasn't a problem until you couldn't afford it anymore; the task of avoiding the rattle then becomes far more immediate, and it was repeatedly emphasised that lack of money precipitates users into activities that are problematic in themselves, such as ‘grafting’, and potentially into what Terry describes as chaotic use.
‘Chaotic’ use was contrasted with maintenance use. It was described as less a strategy and more a lifestyle in which one is ‘entirely immersed’ in the six or twelve hour cycle (see Klingemann 2000), and is the most frequently described style of heroin use in the literature. To some extent, chaotic lifestyles exemplify ‘the addiction myth’, where users’ behaviour appears to demonstrate loss of self-control (Hammersley and Reid 2002). Chaotic use was described by our sample as episodic and spasmodic; associated with particularly ‘bad’ times in peoples’ lives where their engagement with non-users was described as at a minimum. In effect, they had little or no family involvement, no home, they were not on benefits, had no formal job, did not access any healthcare services and did not mix with friends from non-using days. Instead, during times of chaotic use, users socialised only with other users who often supplied a place to stay (‘somewhere to lay your head’), and were often somebody to ‘graft’ with and use with.
Analyses of the data indicated that both, what users referred to as, ‘maintenance’ and ‘chaotic’ styles of drug-using practices were predicated upon participation with other users, in purposeful relational configurations. This participation was key in terms of chronologies of their drug using (starting, who with, where); and also crucially to ensuring and enabling ongoing drug using practices necessary for avoiding the rattle (e.g. grafting, scoring, using, going to others for help, going to others for somewhere to ‘lay your head’). The relational practice of grafting in particular serves to exemplify such participation.
Pete: Graft is fucking terminology that anybody uses for work they don't really want to do. . . . but graft for a heroin addict is going out and doing crime. Now, every heroin addict or every drug misuser if they do crime, they've got their own grafts, some are great at shoplifting, some are great at fraud, some are great at burglary, some are great at nicking cars, and they usually do stick to them crimes, even though they’ll all be opportunist thieves, em, they do have speciality, em, speciality crimes, graft. Pete (life-history interview, drugs outreach trainee).
Whilst individuals develop their own specialist form of theft, as Pete indicates, they frequently have ‘grafting partners’, where partners may take over if one is feeling incapable of doing the graft, and vice versa. That ‘everybody grafts’ was strongly emphasised, and there were several important points raised by the example of grafting: first, one's moral identity; secondly, the types of relationships mobilised through grafting; and thirdly, how these relationships intersect with broader, community relationships.
First, participants’ talk drew on discourses of addiction-as-compulsion in the process of presenting moral identities. Deviance from these moral identities was used to illustrate how one is driven to alien acts by need for heroin, by the nature of heroin itself (e.g. Pete, above; see also Gibson et al. 2004). Speaking to ideas in Gibson et al.'s work, and that of McIntosh and McKeganey (2000), there is the notion of the pure identity and the identity ‘spoiled’ by becoming a heroin user. Participants’ reflections on the relationship between type of graft and type of (unspoiled) identity sometimes, although not consistently, invoked moral identities (or otherwise) in the people they were describing. Those who picked up a gun to graft when they were using, it was argued, would have picked up a gun before they started using. Those who used their brains before they were heroin users, would still use their brains to graft when using. In other words, participants suggested heroin may mask identities in significant ways, but peoples’ behaviour could be ascribed to their character rather than to their drug use. However, in contradiction to these fundamentally moral identities, participants also suggested people might be driven to more serious crime if things got really rough – it was getting late in the day and their need for heroin was desperate (‘spoiled’ identity):
Pete: But you know, you could be out for fucking 10 hours without getting anything, although you fucking knew as a heroin addict that no matter how hard that graft was, you were going to get summat at the end of the day. There were no fucking doubts about that. Because as end of day went along, the more risk you took, you know, the more risks you take. Pete (life-history interview, drugs outreach trainee).
Secondly, the appeal to fundamentally moral identities was contradicted in several ways within and across interviews. Grafting emerged as frequently dependent on mobilising particular, multiple and extended relationships which brought necessary resources with them (such as the company car needed for getaways; money for bus fare into town to do the shoplifting; other people to distract employees so that shoplifting was not detected). As mentioned earlier, grafting partnerships often develop, and these may be a consequence of both physical inability due to using heroin, and of financial need to buy it in the first place. Discussion of grafting, and supporting the grafting activities of others, drew on moral descriptions of ‘mutual support’ and ‘helping others out’. However, it emerged that grafting partners constantly changed because of lack of trust and frequent betrayal; if one is ready to steal from family, friends, mug people on the street, then one is ready to steal from a grafting partner too. In the member-checking seminar this was raised again, and it was reiterated that, ultimately, the point of grafting was to get money to score drugs to avoid the rattle. The more money one ‘earned’, the more drugs one could buy, the further away one could push the rattle. If this involved lying to one's partner then so be it. Definitions of, and appeals to, morality shifted constantly in participants’ descriptions of themselves at different times in their using lives.
Thirdly, grafting is an example of how these heroin-using practices form the bases of local relationships with non-users. It was clear that in the processes involved in disposing of the products of graft (scaffolding, alcohol, surveying equipment, laptops) these purposeful configurations of grafting inter-relations meshed with broader informal networks on the basis of pecuniary exchange where grafting contributed to local informal economies (Sixsmith 1999). Here place emerged as central to the participants’ involvement in extended inter-relations of people to graft with, to use with, to sell to, to steal with, which seemed to be most dense in their locality; although knowledge of and participation with other users was loosely sustained across the city. Place also emerged as central to participants’ discursive constitution of identity in the context of socio-economic possibility and constraint. Speaking to Waldorf's (1983) idea of recovery from addiction through identity and lifestyle reconstruction through geographic migration, the intersection of identity and place was understood to constrain possibility for individuals’ socio-economic change and, as they described it, opportunity for self-improvement (e.g.‘less likely to get a job interview if people know where you come from’ Pete; ‘the schools around here were crap’ Tina; ‘kids around here are less likely to be able to read’ Steve). Also, as mentioned above, their perceptions of the exclusion of place (Emmel et al. 2007) was seen as a constraint on possibilities for reconstruction of the local relational configurations in which they participate (and are produced) in drug-using configurations and, further, constrain involvement and engagement in local fields from which they were excluded (‘the community’, Pete) because they were ‘stigmatised’. Furthermore, the reason people lived where they did was explained in terms of their proximity to essential support networks (their families) from which they did not want to move away. From these data it was clear, then, that geographic migration was severely constrained in important respects, thus raising significant questions for strategies for recovery based on relocation as part of reconstruction.
Finally, involvement in drug using, family, friendship or even community relationships was fundamentally mediated through drug use, and a degree of involvement emerged as mediated through styles of use (‘maintenance’/‘chaotic’). The example of grafting also serves here to demonstrate the significance of the manner in which different relationships are characterised by users, the implications of which are further explored below.
‘They’re associates, not friends’ (Tina)
In characterising their relationships with other drug users, participants frequently described them as ‘associates’ not friends:
Tina: I don't think you've really got friends that are on drugs, I think they’re more associates, but they are people that are on drugs . . . cos when you've got a group that are heroin addicts I wouldn't say that anybody are friends really, they’re more associates people that you associate with than what you . . . do you know. . . . . like our friends now, Jackie and people like that, we’ll phone em and go – do you want to go to Bingo, or do you want to go to the pub or summat? Well, you wouldn't do that with somebody who was on hard. . . . They are not somebody that you could turn to if you really needed to they look after themselves, so . . .
Tina (life-history interview, user involvement team member).
While the self-interestedness of users meant they couldn't be trusted, nor too could non-users:
Ted: Yes, I think it's a lot about trust, er you lose a lot of trust with people who aren't using, even people who you are using with you don't really trust them, and er you tend to be isolating as well I mean you’re not wanting to like walk around town and stuff you know all you want to do really is just like get what you want and then get into your system as quick as you can and just like do nothing because that's effects of what that actual drug does on you.
Ted7 (drug user).
Non-users (even ex-users) were often considered to be untrustworthy because they could report the user to the police. In this way, illegal practices involved in using serve to shut the user off from non-users while at the same time facilitating familiarisation with other users engaged in the same practices. Additionally, users might deliberately avoid non-users, including their own family. Being known to have a drug user in the family could serve to isolate the user's family on the estate. Ted, however, in the extract above, also wanted to emphasise that the actual practice of using heroin, the nature of the substance itself, served to lock the user off from other people, even other users, as one becomes increasingly self-absorbed. This was repeated throughout and across all the interviews, and reiterated at the member-checking seminar where people stressed the contradictory character of heroin use. Users might become self-absorbed in heroin dependency, locked off from relationships they may describe as emotionally intimate and yet potentially essential in processes of recovery (see below). At the same time, a user is fundamentally dependent on other users in generating the means by which to obtain heroin. Users are therefore involved in relationships in which the illicit, self-absorbed practice, serves to doubly isolate a user from their family and friends. However, detachment from such relationships was constrained by the need to generate funding:
Terry: . . . depends how you’re funding your habit that. If you’re funding it by tapping off your family or somit then you don't need to really get in with anyone else. If you’re working . . . that's when you can just exist by being on your own really. Go score, go home, do your gear. Get up, go to work or get up. Tap your mum, tap your grandma d’know what I mean. . . .
Adam: You don't need to be associated with anyone
Terry: Well you do don't you, but if you’re out grafting you sort of team up with people and you sort live off each other. Giro day, it's his giro day today. . . .
Terry (2nd group interview, drugs outreach worker); Adam (fieldworker).
Ex/users sometimes laughed, and joked that taking heroin wasn't a problem until they couldn't afford it anymore (e.g. loss of job, family no longer willing to fund use), then avoiding the rattle became paramount, being on their own was no longer possible and they were often precipitated into chaotic use: ‘It can happen in a week’ (Steve, member-checking seminar). It was suggested that when crises occur, users rapidly seek to establish relationships with other users (grafting partners, getting a place to lay my head) in order to generate the funding and the conditions in which they can use chaotically (‘And use a lot more heroin’, Tony, member-checking seminar). When describing their relationships with other users, participants reiterated these were characterised by a shared knowledge and understanding of what one could be driven to in order to avoid the rattle; indeed, central to these relationships were shared understandings of shame.
It's all about shame
Tony: I would say that once you've been a drug user especially if it's class A drugs like crack and smack, is the depth and level you will go to, to obtain those drugs yeah, and puts you in a very definite sort of like, it's not even a community. With a drug user who looks at me, they know I've been as shifty and as dodgy and as devious as they have. And there's a lot of shame that comes up with that. Obviously after drugs you don't want to be sat in loads of different like groups going, yeah I fucking waited till he came out of the pub and twatted him from behind and relieved him of all his money. Yeah cos I saw him at the bar with a full wallet, cos it's a pretty shameful thing to admit to. Yeah or that I fucking sold me mum's video. Once again they’re pretty shameful things. Once again that makes you in a very, very strong club there cos you all know to what level and extent you'd gone in the pursuit of drugs.
Adam: right and you've done some pretty shifty things and there's a lot of shame attached . . .
Tony (group interview, drugs outreach worker).
Both grafting (living practices) and, crucially, using (identity practices) were described as core practices constituting and maintaining relationships between ex/users. Relationships within these relational configurations were characterised by a profoundly shared understanding of the shame associated with drug-taking practices. Gibson's paper considers shame as it relates to oral cleanliness, the original focus of their study, where understandings of shame contributed to narratives forming the myth of addiction that was communicated to new users, where new users were inducted into understanding shame as part of addiction, associated primarily with loss of control (Gibson et al. 2004). In contrast, our participants talked about shame as the basis of shared understanding, where not needing to explain underpinned these relationships. Shame, as it emerged from the interviews, is not merely a story shared, it is an experience shared. Other ex/users would understand the need to use ‘shameful’ places on the body to inject, and the shame of being a ‘complete bastard’, robbing one's family, using physical violence. Everyone knows how low they can go, and know other ex/users feel the same shame. They know all interest in others can be lost, driven by the desire to get that junk in their veins, reckless and regardless of anybody else. Shame operates more than as a shared understanding of addiction, it is part of the relational pull between addicts, ex-addicts, users and non-users, characterising these relationships, and the basis on which certain exchanges and intimacies occur. Crucially, what emerges from these data is an account of drug use and addiction predicated on participation in these drug-using configurations demonstrating how practice involves simultaneous social production and reproduction, such that paradoxically users recreate the conditions of their own dependency.
Addiction in these analyses, therefore, involves participation in relational configurations predicated on mutually assured distrust and shame; where uncertainty stands in contrast to their mutual dependency. Further, the practices illustrated above abundantly illustrate the poverty of viewing heroin addiction as involving loss of control, and show quite the converse: that continued use is considered to necessitate foresight and planning often on a daily basis, the communication of and learning of skills and the development of shared time horizons relating to the shared embodied experiences of heroin use: a point particularly reiterated in the member-checking seminar. The next section considers in more detail how these shared time horizons further characterise purposeful drug using relationships, and have significant implications for developing services and strategies for recovery that involve more than the manipulation of identity narratives.
Time, space and recovery: ‘Building bridges out of addiction’ (Steve)
The addict runs on junk time. His body is a clock and the junk runs through it like an hour-glass. Time has meaning for him only with reference to his need. Then he makes his abrupt intrusion into the time of others and [ . . . ] he must wait, unless he happens to mesh with non-junk time (Burroughs 1982: 48).
Burroughs's notion of junk-time relates closely to our participants’ accounts of the six to twelve hour cycle and, as he says, is measured through the user's body. Body time is the crucial measure of the proximity of ‘the rattle’. However, junk time as presented by Burroughs is individually experienced, but this was not the only conception of time used by those on maintenance, whether that be heroin or prescription drugs. In the talk of ex/users about maintenance, a conception of extended time horizons emerged. These time horizons are based on first, the metabolisation of the drug (in turn, different according to a user's degree of tolerance and tachyphylaxis); secondly, based on radically different understandings of what span of time constitutes a period of abstinence proper, one defined in the context of using addicts, and the other based in clinical and support settings; and thirdly, based on ‘script’ and ‘scoring’ time circuits which here are spatialised, i.e. predicated on physical proximity to use. The latter two aspects of time horizons are of particular significance for the arguments presented here.
Burroughs's notion of junk-time was directly supported in our interviews in talk about getting a script, and in particular how the six to twelve hour cycle of addicts utterly fails to mesh with the time frameworks underpinning formal services. Services often require addicts to demonstrate that they have been off heroin for, say, at least three weeks, which is like doing detox ‘bareback’ (Tina, Pete, Steve, Colin); when users are chaotic, in desperate need of a script, they said there was no point waiting for one because it took too long:
Steve: It's either six week or three month. Then you go down, even if you’re with your parents or partner, you think something's gonna happen that day. No . . . got another six weeks to wait. It's that process. . . . why should I fucking bother . . . You know what's the point . . . These people are supposed to be helping and they’re making things worse.
Tina: Yeah because when you decide you want to come off it you want to come off it. . . .
Steve: (overlapping) You want it within. . . . you know, within at least a decent time limit Steve (in-depth group interview, drugs outreach worker) and Tina (mother; user involvement team worker).
One participant, Colin, described scoring prescription drugs on the street in an attempt to detox in terms of his own time horizon, while other participants said people would deliberately get arrested because it was possible to get a script within 24 hours from a police cell. There has been some work on time and addiction, notably by Klingemann (2000), who suggests that there needs to be a consideration of the time frameworks underpinning treatment settings (opening times) and addicts’ time and, importantly, detoxification times.
Steve: I mean obviously, you try your hardest [ . . . ] If you were injecting, you need drugs every six hours to feel all right, and maybe if you had a big one you could get like eight hours kip but you'd wake up feeling shit. [ . . . ] But that's a nasty little circle you've got there going and it's a necessity circle. . . . so if I had two days off on medication, that to me is a fantastic achievement, and that's what's the comparison between that world and that world, because the doctor thinks, right I’ll give him a three-month detox, three months in't a long time. And you know, he should be able to breeze this. If I give him what he wants, he’ll be able to do it. So in three months, from the doctor's perspective, it's not a lot of time. But from a drug taker's perspective you might as well be talking 30 year. So like, if he slips up once in three months and gets knocked off his script, he's thinking, fucking hell I had two and half week off there, didn't I do well? And the cunt's gone and cancelled my scripts. But the doctor's thinking, fucking hell he's only gone two and half weeks, what's he playing at.
Steve (life-history interview, drugs outreach worker).
Additionally, time horizons are described as fundamentally spatialised; space intersects with body time significantly in the context of chaotic use, to the extent that users’ body times and perceptions of place are diametrically opposed to those underpinning service location and provision. Treatment/service locations often take longer to reach than places to score which regularly affects decisions by people using chaotically about going to try for a script. Where users sought to move from chaotic to maintenance use, negotiating within the body-time dimension was described as incredibly difficult; negotiation with doctors and other service providers took place over years, sometimes involving several visits within a month, and at others no visits for up to a year (see also Palm 2004). In this way, the embodied experience of drug use was described as serving to lock users off from formal service networks.
Tales of successful recovery, however, described extended time-horizons able, to some extent, to mesh more closely with those of non-users and, importantly, those underpinning drugs services. Several ex/users described successful engagement with services when they were able to control (through exercising choice): the length of time it took to access services; the prescription of the drugs they needed and felt were personally suitable for their detox; and the length of time they felt it would take for them to successfully detox. Prolonged experience of drug use, drug services, and multiple attempts at detox over a number of years meant that they knew who to see, what to say to them so that they got rapid treatment, and which detox drug they had confidence in and that suited them best. In using detox, a further conception of time-as-space emerged: a form of conceptual distancing from the urgent (body time):
Steve: Yes, patience that it is going to work, that when you wake up in the morning instead of thinking you’re going to feel like shit, you aren't going to feel like shit because you've got your medication. And it's that moving on, put a bit of space between you and it, do you know, and [ . . . ] instant gratification. Steve (life-history interview, drugs outreach worker).
In effect, therefore, participants presented accounts of successful detox which described how they re-engaged and participated within non-using relationships, engendered through changes in conceptions of the embodied time horizons of withdrawal, their ability to cope with it, and participation in practices constituting and maintaining non-using lifestyles and relationships.
These time horizons, then, can be seen first, to characterise local fields through conflicting experiences and understandings of time; secondly, to close users off from non-users at the level of social, family and formal service relationships and networks; and thirdly, in accounts of successful recovery, to necessitate new kinds of participation in changing networks of social relationships and, in particular, to involve recalibration of existing relationships. One implication for recovery might be that those who are using in ways which here have been described as chaotic may have difficulties in recovering because this recalibration of conceptions of time, and re-engagement in non-using relationships, requires the ability to think beyond the rattle.
Migrating identities: a life after heroin
From analyses of the talk about the process of transition or migration from user to non-user identities, two main topics emerged. First, it was important to have belief in one's ability to stop; in effect, to believe in a (future) non-using self. Secondly, and in extension of this, that in order to effect changes in identity it was important to acknowledge the extent to which changes were needed in (particularly body) practices, living practices and social involvement and engagement in different webs of inter-relations (e.g. users, family, formal services):
Pete: Do you know what, I think it was treating you with a lot of compassion and a lot of understanding and treating you like a fucking human being not like a criminal or a fucking drug addict, to give you hope that there's a fucking life after heroin. I think it were my key worker and staff, constantly telling me that there's hope, you’re too good for that fucking shit, you know, there's a fucking life out there for you if you want it, which in 10 years of heroin no-one's ever told me.
Pete (life-history interview, drugs outreach trainee).
Much of the talk about belief in ability to change concerned how participants had been treated and the narratives of successful recovery provided by ex-users, reflecting findings by Gibson et al. (2004), and McIntosh and McKeganey (2000). In addition to this, however, ex-users also described creating different lifestyles for themselves, involving getting a job, getting fit, engaging in any activity which could ‘build a bridge’ out of addiction (Steve). Several participants described these attempts as trying to find out who they really were, trying to become somebody who didn't take drugs, and as getting back to the ‘old’ me. While these narratives reflect those mentioned by Gibson et al. (2004) and McIntosh and McKeganey (2000), a key feature of all narratives of successful recovery and attempted recovery, was the extent to which they attempted to re-orientate their living and identity practices as part of a transformative project towards becoming a non-user. In other words, what they did was core to their understandings of who they were; these practices (identity and living) were never conceived as relationally isolate. Participants described the need to understand how these practices simultaneously engaged them in trajectories of use which would lead them to non-use; from conceiving time within the ‘body clock’ of heroin addiction, to the time of other ‘human beings’. In effect, trajectories of use to non-use were described as involving participation in different styles of use; the introduction into the body of different substances with different pharmacological effects (e.g. methadone) and therefore different embodied experiences of the prolonged process of detoxification. In turn this was seen to enable new forms of engagement and participation in existing, or new, relational configurations predicated on a socially inscribed perceptual reordering of time; specifically, in non-using relationships.
Thus, the process of identity (trans)formation, not only concerns creating and maintaining effective transformative narratives, but through purposeful changes in living and identity practices, also involves forging and re-forging the relationships that can take individuals from a discursive position of addiction and into a position of non-addiction; from user to non-user, from the ‘me as I am now’, to the ‘me as I am now (at a future point) and whom I do not, as yet know’. Whilst, therefore, there is quite clearly a crucial role for narrative analysis of how users become a ‘not-me as I currently understand myself’, this does not capture the wider dynamics of the intricate web of social (including familial) relationships into which the user must purposefully mesh in order to access the types of emotional support (e.g. through positive identity formation practices) understood to be required in this process of identity transformation. Thus, identity migration or transformation is not only dependent on what users will and can do, but what they will and can do in the context of the willingness of others to engage in, and support, such change.
Shifts in living practices not only concern developing and maintaining these closer emotional relationships, they are also predicated on and (potentially) enabled by managing and negotiating in powerful and meaningful ways in formal services and service networks. Engagement in these formal services was repeatedly emphasised as necessary for meeting the perceived and experienced physical needs of the user in this embodied transition from user of heroin, to user of maintenance drugs, to non-user. In effect, these services are seen to be crucial for managing a detox successfully that does not precipitate the user into further chaotic use (the detox manages to avoid the rattle), and therefore allows the user to develop, over time, a different, non-using lifestyle with people outside the purposeful drug using networks. In this case, then, theories solely preoccupied with narrative transition fail to encapsulate this embodied and profoundly social/relational process: a process, furthermore, where opportunity and possibility are seen to be critically circumscribed by the users’ position in the socio-economic context wherein users can be seen to be producing the conditions for their own (inter)dependency.
The additions to the literature of these analyses is that much of the drug taking process cannot be done alone. Users in this sample are bound up in dynamic and purposeful configurations in order to produce and reproduce the conditions for using. These analyses suggest that, while these relational configurations are constantly changing (‘they can change in two weeks’, Terry) there is nevertheless a ‘tragic longevity’ to them (Steve): as long as you are known by somebody who knew you when you were taking, you can gain access to them if you wish to begin using again, thus pointing to engagement at local field level. Significantly, these practices constitute and maintain the conditions for drug use, so users can be seen to be actively engaged in reproducing the conditions for their own dependency. Also, participation in these relational configurations inscribes the extent to which narrative transformation is possible; where a ‘tangled’ identity is not solely entangled with individual drug-using practice, but entangled with processes of identity constitution ongoing in the users’ wider inter-relational context; in other words, for me to change, you must change also. And further, that this relational context is fundamentally inscribed socio-economically; in which possibilities for transforming identities are always socio-historically bound.
Dependence can therefore be seen to be at once dependence on the provision (and ingestion) of drugs and, simultaneously, dependence on diverse configurations of users, clinicians, support workers, and so forth. This presents a challenging picture of ‘dependence’. To play the word somewhat, this dependence requires in turn dependence on social networks for resources, and involves active production of the conditions for an everyday life which can incorporate drug use on the part of users.
Addiction, then, using the theoretical developments outlined earlier, can be usefully conceived as a discursive practice. Rather than ‘addiction’ remaining at an abstract level, serving the needs of drug users in their attempts to explain their behaviours (Davies 1997), discourses and practices of addiction can be understood as both productive of and constrained by corporeal experience. We do not therefore need to thrust responsibility for addiction onto a ‘body that thinks’, nor retreat to a position whereby compulsion is a story we tell ourselves and others. Addiction is therefore no less compulsive because it is imbued with discourses of addiction; these are embodied and articulated through the body. The practices are in and of themselves constitutive of particular identities, and ways of being with and for others. Importantly, the level of analysis presented here provides a conceptual lens for understanding changes in ongoing practices of subject constitution involved in identity migration as occurring at a configurative level.
Unlike Strauss's notion of sedimentation, a process of repetition to which we become habituated, the conceptual formulation developed in this paper allows for understanding how being ourselves is productive of certain aesthetics or styles of living, rather than merely a product of specific discourses or habituations. Addiction therefore cannot be reduced to the rattle which would be replacing bio-medical addiction with withdrawal. While avoiding the rattle is a key driver in accounts of drug use, it is also merely part of what forms to create a relational understanding of heroin addiction; one which cannot be understood solely at the level of the individual but must also be extended to recognising participation in relational configurations, characterised by different trajectories of use, invoking different time horizons, that are produced in, and are the product of, shared practice. Transforming identity is not just about changing our minds, or simply ‘selecting’ somehow voluntarily a new identity; it involves pursuing a new trajectory, new kinds of participation in changing configurations; learning and experiencing new time horizons, ones which have greater congruence with, say, those of clinicians, support workers, families. The inevitable pull of the previous network, the deep entanglement of use, the ongoing identity and living practices in which one must inevitably engage as part of the ‘new’ identity (being a parent, going to work), and the configurations of discursive practices within which these are produced and reproduced, operate as part of the compulsive and addictive character of use.
Finally, the intention here is definitely not to replace a one-sided bio-pharmacological conceptualisation of addiction with an equally one-sided sociological one, but rather, to demonstrate the crucial importance of a properly social level of analysis to understanding addiction; a level of analysis which both draws upon and, via synthesis and reconceptualisation in relation to empirical investigation, develops this. Thus, this paper does not seek to compete for the conceptual terrain around addiction, but to contribute to it in the hope that these insights can be reconciled with the wealth of existing research and theorisation on addiction from the cellular level upwards. In conclusion, therefore, the contributions of the theorisation presented here are that it brings together work from those such as Gibson et al. exploring how migration from addict to non-addict must be conceived as an embodied, practising, process of becoming ‘not-me, as I am now’ to ‘me as I will be then’; and work by writers such as that by Nicole Vitellone (2004) who explore how drug use as an embodied practice can explicate broader social theories of the relationship between social suffering, cultures of drug use and addiction. This paper thus foregrounds work which would aim adequately to theorise the ‘field’ or ‘configuration’ of practices of addiction that, here, has been brought forward as a level of analysis.
I would first like to thank the participants who were so generous with their time and experience, agreeing to be repeatedly interviewed in different formats and settings and so producing exceptionally rich data for the ESRC RMP study and this paper. I would also like to thank the fieldworker for his continued effort in undertaking this fieldwork. In respect to the writing of the paper, I would like to thank the other members of the ESRC RMP team for their many contributions: Nick Emmel, Joanne Greenhalgh, and Adam Sales. In addition, thanks to Justin Keen and Nick Jewson for reviewing early versions of this paper; and also thanks to the reviewers and editors for their direction and support. Finally, I would like to express my deep gratitude to my brother, Jason Hughes, for his unstinting and unfailing help in the production of this paper; it was invaluable.
This paper does not intend to present a general ‘model’ of heroin addiction, and the arguments here may be restricted to the respondent sample of this study. Instead, this is a vehicle for critical analysis around prevailing understandings of addiction.
This paper only considers heroin addiction.
Emmel, N., Hughes, K. and Greenhalgh J. (2003).
It is important to note the analyses here are a serendipitous outcome of a study where theoretical developments on the substantial data gathered are still ongoing and will not form the core of this paper.
I am drawing on Bourdieu for his level of analysis rather than seeking to extend his notion of ‘field’.
Both ‘place’ and ‘space’ are currently part of ongoing theoretical consideration by the RMP team.
In emphasis of one of the preliminary comments made in this paper, this participant died within a short time of this interview through an accidental overdose.