Research focus

In the United Kingdom, Australia and elsewhere, ‘new recovery’ has become an increasingly prominent feature of alcohol and other drug policy and treatment responses (Duke et al., 2013; Lancaster et al., 2015; Monaghan, 2012). Characterised by ‘voluntarily sustained control over substance use which maximises health and well-being and participation in the rights, roles and responsibilities of society’ (UK Drug Policy Commission Recovery Consensus Group, 2008, p. 6), it is presented as offering transformative change in addiction treatment and in the lives of recovering persons. New recovery’s advocates – dissatisfied with the outcomes of existing ‘acute-care’ treatment approaches – argue that it promises a more hopeful and optimistic future for people who use drugs by promoting freedom, choice, transformation and new aspirations (Best & Laudet, 2010; Her Majesty’s Government, 2010; Betty Ford Institute Consensus Panel, 2007; Scottish Government, 2008).

Why did we undertake this research?

‘New recovery’ can be distinguished from longstanding recovery notions found in addiction self-help discourses (Keane, 2002) and 12-step fellowships (Frank, 2011; Kitchin, 2002; Miller & Kurtz, 1994; Valverde & White-Mair, 1999). However, its meanings are still very much ‘under construction’ culturally and politically (Fraser & Seear, 2011, p. 2), and the continuities and differences that endure from older forms of recovery have yet to be explored.

The research we undertook examined both new recovery’s claims to newness and its ability to fulfil the liberatory and transformative functions claimed by its advocates. We wondered what kind of liberation is posited when the sole focus of new recovery is the improvable self. Three main research questions thus guided our research:

• How is new recovery produced in drug policy, research and treatment in Australia, and what assumptions and claims does it make about drug use and about people who use drugs?
• How do people who use drugs adopt, accommodate, resist or otherwise engage with new recovery in treatment and in their everyday lives?
• What are the political implications of new recovery?

What did we do?

Answering these questions required an approach sensitive to continuity and difference, and the politics of emergence. To this end, we drew on three concepts from recent work in science and technology studies:

• ‘enactment’ (Law, 2004): all phenomena, such as new recovery, are forged and sustained through unstable networks of practices;
• ‘multiplicity’: because phenomena such as new recovery exist only in their enactments (and re-enactments) through networks of practices, they cannot be thought of as coherent, independent entities (e.g. residing in individual identities and behaviour). Instead they should be understood as intrinsically multiple (Mol, 2002);
• ‘ontological politics’: because phenomena are enacted, realities too are enacted: made in ongoing practices. As such, they can always be made in alternative ways (Law, 2004; Mol, 1999).

We used these tools to analyse several spheres of practice, all of which are implicated in the production and mobilisation of new recovery in Australia: national and state-based drug policy, key research on ‘recovery capital’ and ‘social identity’ change, and treatment settings (most datasets were taken from Victoria, but findings are relevant to other states as well). We collected in-depth qualitative interviews with 25 people with current or past experience of drug injecting, and 11 relevant health professionals. In our analysis we traced the ways in which new recovery was mobilised by people who use drugs, professionals and treatment practices.

What did we find out?

The analysis showed that new recovery practices in policy, research and treatment contexts can be termed ‘new’ only insofar as they expand on and intensify many of the existing assumptions about drug use, people who use drugs and their social relationships already operating in previous policy, research and treatment in Australia and elsewhere (Duke, 2012; Fraser, 2004, 2017; Keane, 2000; Lancaster et al., 2015; Moore, 2004; Moore & Fraser, 2006). In particular, we found continuity in individualising and stigmatising framings of drug use and drug issues. For example, we identified and examined the neoliberal political universe that people who use drugs are asked to embrace in their adoption of new recovery. Similarly, built into different enactments of new recovery are different forms of stigma that cast drug-using subjects as failed citizens, as pathological and disordered, and as socially deviant (Frank, 2018). These processes of individualisation, stigmatisation and exclusion simultaneously buttress a regulatory myth of ideal neoliberal citizenship to which all must aspire. Achieving citizenship, health and community membership is almost solely defined here in terms of individual effort, improvement and enterprise, rather than as intimately bound up with political, legal, social and economic forces and arrangements. This both limits the kind of political claims available to people who use drugs, and the development of more socially and politically equitable responses to drug use, poverty and marginalisation.

What does it mean and where to next?

Researchers have repeatedly observed that recovery is a notoriously elusive concept that defies definition and the achievement of consensus among policymakers, researchers and practitioners (e.g. Best, Groshkova, Sadler, Day, & White, 2011; Kelly & White, 2011; Laudet, 2007; Neale et al., 2014; White, 2007). Extremely broad, shifting and at times vague, new recovery’s ambiguity and opacity have no doubt contributed to its prominence and conceptual utility. However, this same breadth and vagueness also mean it is amenable to interpretation along traditional lines too. In this respect its novelty and innovativeness are not always clear, and this perhaps explains why it has not succeeded in dislodging older forms of recovery, such as those found in self-help discourses and 12-step fellowships. Where the lines of a new approach are very broadly drawn, contradictions with, or benefits over, other approaches may be obscured. In our analysis we showed how professional practices in different sites produce different recoveries. In turn, practitioners must draw together these different recoveries into a common therapeutic entity and attempt to manage the contradictions that arise. These professional forms of coordination produce local, hybrid enactments of recovery that combine new associations between recovery and notions of progress and citizenship, as well as older elements that reproduce normative goals around abstinence and the recovery ‘journey’ towards sobriety. Similarly, recovery-focused treatment tends to be organised around particular addicted drug-using identities. The notion of recovery is enacted and elicited here in ways consistent with older and pathologising notions of addiction, while reproducing the contemporary focus on the ‘flawed’ social relationships of people who use drugs, and again on individual responsibility.

We also explored how the accounts of people who use drugs emphasise 12-step models and associated practices of recovery, and how these play out through intense practices of self-work and self-management. At the same time, some of these accounts also critique the ways in which people come to be defined by notions of addiction, recovery and health, and often feature dynamic practices of resistance, accommodation and incorporation. People who use drugs provide accounts of health, citizenship, life and their social relationships in terms that disrupt the normative images and binaries of citizenship and health, and the neoliberal political universe, constituted in new recovery.

In summary, this research analysed how drug use, people who use drugs and their social relationships are constituted in and through the new recovery. In doing so it drew attention to the stigmatising and marginalising ontological politics of new recovery, arguing that, despite efforts to enact new, more respectful subject positions, the new recovery encompasses a traditional politics of exclusion. These effects are significant because they help determine the available narratives through which people who use drugs may account for their lives and conceive and enact their futures. Without careful scrutiny, they can buttress and perpetuate limiting ways of thinking about responsibility, citizenship and normality, as well as pejorative assumptions about drug use as a form of deviance from which one must necessarily ‘recover’.

For further findings from this project, please see:

Fomiatti, R. (2017). Hope, choice and the improvable self: A critical analysis of ‘new recovery’ in Australia. PhD Thesis, Curtin University (please contact the first author to discuss access: renae.fomiatti@curtin.edu.au).

Fomiatti, R., Moore, D. & Fraser, S. (2017). Interpellating recovery: The politics of ‘identity’ in recovery-focused treatment. International Journal of Drug Policy, 44, 174-182. DOI: 10.1016/j.drugpo.2017.04.001.

Acknowledgements

The research on which the article is based was funded by a PhD scholarship from the Centre for Research Excellence into Injecting Drug Use (National Health and Medical Research Council Grant Number 1001144). NDRI is supported by core funding from the Australian Government under the Drug and Alcohol Program and also receives significant funding from Curtin University. The authors are particularly grateful to the research participants for taking part in the study and for sharing their time and insights so generously.

Selected References

Best, D., & Laudet, A. (2010). The potential of recovery capital. Retrieved from http://www.thersa.org/__data/assets/pdf_file/0006/328623/A4-recovery-capital-230710-v5.pdf.

Betty Ford Institute Consensus Panel. (2007). What is recovery? A working definition from the Betty Ford Institute. Journal of Substance Abuse Treatment, 33, 221-228.

Duke, K. (2012). From crime to recovery: The reframing of British drugs policy. Journal of Drug Issues, 43, 39-55.

Duke, K., Herring, R., Thickett, A., & Thom, B. (2013). Substitution treatment in the era of ‘recovery’: An analysis of stakeholder roles and policy windows in Britain. Substance Use and Misuse, 48, 966-976.

Frank, D. (2011). The trouble with morality: The effects of 12-step discourse on addicts’ decision-making. Journal of Psychoactive Drugs, 43, 245-256.

Frank, D. (2018). ‘I was not sick and I didn’t need to recover’: Methadone maintenance treatment (MMT) as a refuge from criminalization. Substance Use and Misuse, 53, 311-322.

Fraser, S. (2004). ‘It’s your life!’: Injecting drug users, individual responsibility and hepatitis C prevention. Health, 8, 199-221.

Fraser, S. (2017). The future of ‘addiction’: Critique and composition. International Journal of Drug Policy, 44, 130-134.

Fraser, S., & Seear, K. (2011). Making disease, making citizens: The politics of hepatitis C. Farnham: Ashgate.

Her Majesty’s Government. (2010). Drug strategy 2010: Reducing demand, restricting supply, building recovery: Supporting people to live a drug free life. London: HMG.

Keane, H. (2002). What’s wrong with addiction? Melbourne: Melbourne University Press.

Kitchin, H.A. (2002). Alcoholics Anonymous discourse and members’ resistance in a virtual community: Exploring tensions between theory and practice. Contemporary Drug Problems, 29, 749-778.

Lancaster, K. (2017). Rethinking recovery. Addiction, 112, 758-759.

Lancaster, K., Duke, K., & Ritter, A. (2015). Producing the ‘problem of drugs’: A cross national-comparison of ‘recovery’ discourse in two Australian and British reports. International Journal of Drug Policy, 26, 617-625.

Law, J. (2004). After method: Mess in social science research. London: Routledge.

Miller, W.R. & Kurtz, E. (1994). Models of alcoholism used in treatment: Contrasting AA and other perspectives with which it is often confused. Journal of Studies on Alcohol, 55, 159-166.

Mol, A. (1999). Ontological politics: A word and some questions. In Law, J. & Hassard, J., (eds), Actor network theory and after. Oxford: Blackwell (pp. 74-89).

Mol, A. (2002). The body multiple: Ontology in medical practice. Durham: Duke University Press.

Monaghan, M. (2012). The recent evolution of UK drug strategies: From maintenance to behaviour change? People, Place and Policy, 6, 29-40.

Moore, D. & Fraser, S. (2006). Putting at risk what we know: Reflecting on the drug-using subject in harm reduction and its political implications. Social Science and Medicine, 62, 3035-3047.

Scottish Government. (2008). The road to recovery: A new approach to tackling Scotland’s drug problem. Edinburgh: SG.

UK Drug Policy Commission Recovery Consensus Group. (2008). A vision of recovery. Available at: http://www.ukdpc.org.uk/wp-content/uploads/Policy%20report%20-%20A%20vision%20of%20recovery_%20UKDPC%20recovery%20consensus%20group.pdf, retrieved 31 July 2018.

Valverde, M. & White-Mair, K. (1999). ‘One day at a time’ and other slogans for everyday life: The ethical practices of Alcoholics Anonymous. Sociology, 33, 393-410.