Multiple Logics: How Staff in Relapse Prevention Interpellate People With Substance Use Problems

Abstract

This study analyzes how staff in Swedish alcohol and other drug (AoD) treatment interpellate service users as people who can benefit from relapse prevention. Relapse prevention is a widely used intervention. Research is scarce, however, on how relapse prevention is practiced locally and how treatment staff perceive the relationship between AoD use as a problem and relapse prevention as a solution. Drawing on Actor-Network Theory and critical studies of AoD issues within this tradition, we elucidate how staff through specific interpellative logics enact service users, their individual characteristics, and living conditions. The data derive from interviews with 18 professionals working with assessment, counseling, case-management, therapy, and healthcare at AoD treatment agencies in the Stockholm region. The results show that the participants drew on four interpellative logics, and thereby enacted service users as four different object types. Region and network logics pinpointed that individuals have stable observable characteristics that determine their problems and eligibility for treatment (e.g., living conditions, diagnoses). Fluid and fire logics emphasized that their characteristics also vary depending on context and can be present and absent at the same time (e.g., harms, agency). This flexible interpellation of service users echoes the tendency among treatment staff to embrace sometimes irreconcilable understandings of AoD problems and to enact multiple realities of addiction. This suits a professional field where many factors are thought to cause and help resolve problems, but where the treatment supply is often limited to specific interventions. We conclude that it is easier to create a reasonable match between the service delivered and the potential service user if the characteristics of the latter are considered diverse and flickering. This exemplifies Carol Bacchi’s tenet that problem representations are adjusted to fit the solution at hand.

Fixed and fluid at the same time: how service providers make sense of relapse prevention in Swedish addiction treatment

“…This study analysed how professionals in Swedish addiction treatment make up RP as a relevant intervention. Our prior work shows that addiction treatment staff refer quite creatively to the characteristics of substance users when establishing a reasonable match between the solutions they propose and the problems they identify (Ekendahl & Karlsson, 2021). Service users are many 'things', and are thus easy targets of an intervention such as RP.…”

“…We can expect a similar reasoning among professionals working with RP in Sweden. The emphasis on self-efficacy in RP may align poorly with both the notion that addicted persons suffer from loss of control (Ekendahl & Karlsson, 2021), and with the Swedish tradition of a social-democratic welfare model that favours collective solutions to individual problems (Moore et al, 2015).…”

“…RP is today considered evidence-based. It is popular globally (Donovan & Witkiewitz, 2012) and is delivered by most addiction treatment agencies in Sweden (Ekendahl & Karlsson, 2021;Socialstyrelsen, 2019). However, distinguishing RP from other psychosocial interventions is challenging.…”

“…Critical scholars have showed how 'addicts' are made up as people with specific and often stigmatized problems in, for example, drug policy (Lancaster et al, 2015;Moore et al, 2015), bureaucratic systems , the law (Seear, 2020) and in treatment (Ekendahl & Karlsson, 2021), but also through measuring scales (Dwyer & Fraser, 2016), diagnoses (Keane, 2012), and even personal accounts of substance use (Demant, 2009;Dilkes-Frayne & Duff, 2017). How ideas such as addiction (Fraser, 2016), volition (Karasaki et al, 2013), recovery (Fomiatti et al, 2017) and 'triggers' (Dennis, 2016) are understood and put to use have also been explored.…”

Self‐interpellation in narratives about craving: Multiple and unitary selves

“…Both these talk therapies assume that addiction can be conquered by restoring a ‘true’ self or abandoning an earlier one. This view is pertinent in RP, where people learn how to change cognition and behaviour (Brandon et al., 2007 ; Ekendahl & Karlsson, 2021a , b ; Marlatt & George, 1984 ). The typical AA‐recovery story is also structured around personal development; in this case through hitting rock bottom and then initiating change, but the idea of a stable ‘addict identity’ is fundamental too (Cain, 1991 ; Reith, 2004 ; Sawer et al., 2020 ).…”