Recovery Language in Substance Use Treatment Experienced as Oppressive Without Input of Service Users

New research published in Critical Social Work reveals that dominant understandings of recovery, such as maintaining abstinence, can be experienced by service users as oppressive.

The critical discourse analysis of qualitative interviews with individuals struggling with substance use issues in rural Ontario examined power dynamics inherent to discourse on substance addiction recovery. The author concludes by offering recommendations such as training and education to address stigma and implicit biases among clinicians and the inclusion of individuals experiencing substance abuse issues in research, policy development, clinical practice, and education.

Researcher Sandra R. McNeil of the University of Windsor writes:

The definition of what it means to recover from substance addiction is unclear and ranges from abstinence to reducing harms associated with substance use. However, most definitions promote responsibility and autonomy, reflecting neoliberal values.

McNeil defines neoliberalism as: “. . . the primacy of the capitalist economy characterized by enhanced profits, reduced government spending, and increased individual, family, and community responsibility. Neoliberalism constructs not only disciplined workers and consumers but responsible, moral individuals who make ‘good’ choices, and those who fail to conform may be considered a ‘risk’ to society.”

Recovery-oriented language in Canada, where the current study was conducted, incorporates neoliberalist values in that it emphasizes personal responsibility and goals, family and societal support, and encourages recovering individuals to perform their economic and social roles. As a result, individuals who do not meet these criteria for “recovery” may be stigmatized and marginalized, especially in rural areas.

Elsewhere, neoliberal ideologies have been tied to poor mental health, loneliness, reduced well-being, and suicide stigma, which has been shown to significantly and negatively affect suicidal thoughts.

Although the risk of substance use rates are similar, if not higher, for rural populations compared to urban populations, and rural populations are at greater risk for being stigmatized for substance addiction, substance use research tends to focus predominantly on urban areas, and rural populations lack the same access to substance addiction treatment and services.

In the current study, McNeil conducted qualitative interviews with 40 individuals living in rural areas in Ontario who self-identified as currently or previously experiencing substance addiction. The participants’ ages ranged from 19 to 72 and consisted primarily of White (95%), straight (87.5%), and cisgender women (52.5%), making $30,000 or less per year (85%).

McNeil applied critical discourse analysis (CDA) to her examination of the interviews to uncover the power relations embedded within the dominant recovery discourse. Broadly speaking, CDA focuses on: “social inequality, describing and interpreting social interactions and structures, and explaining how discourses may exercise, legitimize, and resist power relations.”

Although dominant understandings of recovery assert that recovery is an individualized process, participants’ responses in the interviews revealed common themes, including neoliberalist values, loss, and abstinence.

The expression of neoliberalist goals as grounded within recovery discourse was evident in participants’ discussions of their experiences of loss in active addiction. For example, participants described loss in terms of loss of relationships, health, employment, homes, car, identity, dignity, respect, and self-pride – which highlights how individuals struggling with substance addiction are disciplined and stigmatized for not conforming to societal expectations.

Recovery was framed by many participants as “getting things back,” insinuating that to recover means to have a job, house, family, etc., all of which require subscribing to and living out neoliberalist values.

Similar themes arose in participants’ descriptions of “substance abuser” as being someone who lacks a job or family and is a “loser” versus what it means to be a “functioning citizen.” One participant remarked: “People get so bad, you’d be useless to society. You need to get better so you could be a functioning citizen…So, I think recovery is to become normal…healthy, and clean-cut. Like new, I guess. A good consumer, I guess.”

Most participants identified abstinence as part of recovery, although some offered opposing opinions, suggesting that abstinence is not an attainable goal – indicating that traditional understandings of recovery do not fit everyone struggling with substance addiction.

Further, while mainstream recovery discourse recommends that individuals ask for support from loved ones, communities, and professionals, participants’ responses suggest that support is not always accessible to everyone, particularly for those living in rural areas who lack access to formal resources.

Additionally, participants’ narratives bring to light how intersections such as substance use, appearance, and homelessness resulted in them being dismissed or mistreated by healthcare professionals.

Moreover, neoliberalist values such as personal responsibility, autonomy, choice, and contributing to social and occupational roles were both supported and challenged by participants. For example, one participant shared how she sought support for her substance use issues during her pregnancy. However, she was devastated to learn that this “support” involved the removal of her child from her custody.

She described her experience: “I was shocked…so I dealt with all that guilt of not being able to be a parent. That was the worst thing that ever happened to me…I felt like there was nothing there for someone in my position: a woman who wants to be a mother, is trying to be a mother, doesn’t know how to be, because I’m not allowed to be.”

Overall, participants’ responses revealed both support of and resistance to dominant recovery discourse. However, analysis of their interviews also demonstrates how inequitable power relations underlie mainstream understandings of recovery and how they perpetuate the marginalization of groups of individuals via ableism, classism, and the stigmatization of individuals who do not meet the neoliberal status quo.

McNeil urges the substance use and social work fields to attend to how predominant language on recovery perpetuates the stigmatization of those struggling with addiction and encourages them to acknowledge that even the concept of recovery itself is not something all individuals who use substances relate to – not all view themselves as damaged or in need of something to recover from, and are still deserving of dignity, respect, and access to resources.

Limitations of the study include its small sample size and focus on predominantly white, cis-gendered populations.

McNeil concludes by recommending further substance use research with rural populations, particularly that which includes those experiencing substance use issues as collaborators, as well as including those struggling with addiction in policy development and education. She also recommends that clinicians undergo training and education to reduce stigma and implicit biases.

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McNeil, S. R. (2022). Resisting recovery rhetoric: A critical discourse analysis and counter perspectives from people with substance use issues in rural Ontario. Critical Social Work, 23(1), 2-26. https://doi.org/10.22329/csw.v23i1.7589 (Link)