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The aim of this article is to address how conceptualizations of addiction shape the lived experiences of people who use drugs (PWUDs) during the current opioid epidemic. Using a discourse analytic approach, we examine interview transcripts from 27 PWUDs in rural Appalachian Ohio. We investigate the ways in which participants talk about their substance use, what these linguistic choices reveal about their conceptions of self and other PWUDs, and how participants’ discursive caches might be constrained by or defined within broader social discourses. We highlight three subject positions enacted by participants during the interviews: addict as victim of circumstance, addict as good Samaritan, and addict as motivated for change. We argue participants leverage these positions to contrast themselves with a reified addict-other whose identity carries socially ascribed characteristics of being blameworthy, immoral, callous, and complicit. We implicate these processes in the perpetuation of intragroup stigma and discuss implications for intervention.

Background Social media platforms are popular tools for people with IBD to seek support. In the current study, we sought to examine and characterize IBD and distress discourse on public social media platforms. Our goal was to identify topics associated with these online discussions. Methods We collected public social media posts about IBD and distress from Reddit (N=40,625) and Twitter (N=40,306) published between September 2017 and August 2019. We created a term-based dictionary to characterize posts based on eight different, non-mutually exclusive topics: 1) symptoms, 2) medication, 3) nutrition, 4) procedures, 5) marijuana, 6) stigma, 7) ostomy, and 8) intimacy. We used descriptive statistics to characterize the frequency and order the prevalence of the topics on the two platforms, and to assess topic co-occurrences among posts. Results Most Reddit (79%) and Twitter (56%) posts mentioned at least one IBD topic. The order of topic prevalence was the same for the two platforms. Symptoms was the most mentioned topic (Reddit: 57%, Twitter 36%), followed by medication (Reddit: 30%, Twitter 11%), and nutrition (Reddit: 27%, Twitter 9%). Intimacy was the least mentioned topic (Reddit: 2%, Twitter: <1%). Topic co-occurrences varied by platform. Most Reddit posts (57%) mentioned at least two IBD topics, whereas only 27% of tweets mentioned multiple IBD topics. Conclusion This study contributes to a growing literature examining how IBD is discussed on social media—specifically, in distress-related contexts on Reddit and Twitter. These cross-platform findings highlight important areas potentially associated with IBD-related distress, which could help facilitate future support.

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