“What constitutes a ‘problem’?” Producing ‘alcohol problems’ through online counselling encounters

An argument against the implementation of an ‘overarching universal addiction model’ in alcohol and other drug treatment

“…Thirdly, implementing an overarching universal addiction model is likely to be counterproductive, paternalistic and may frame ‘the problem’ in narrow ways that risk oversimplifying and ignoring clients presenting concerns and beliefs. Like others , we have shown how the focus on addiction and the deployment of addiction ideas and knowledge in treatment often relegates other (often interconnected) psychosocial concerns, structural issues and stigma that clients may be experiencing to the background . At the same time, and as Barnett et al .…”

“… point out, models of addiction can pathologise individuals and locate the ‘problem’ within the individual. When faced with so‐called ‘expert’ and ‘professional’ knowledge about addiction, clients' own lived experience, knowledge and beliefs can also be discounted, which further disempowers them . This runs counter to ideas about respect, consumer participation, developing a genuine and egalitarian therapeutic relationship, client‐centred and integrated care — all of which are critical to meeting the needs of clients in a sensitive and empowering way .…”

“…This does not mean that treatment providers do not have a role to play (beyond listening) in facilitating a shared understanding with the client about what the potential contributing factors and solutions to their ‘problems’ might be. On the contrary, treatment providers can play an important role in facilitating discussion and presenting the client with a range of possible models and ways of understanding their experiences and concerns . They can also play a role in gently challenging unhelpful models of addiction that clients may draw upon, such as those that stigmatise, emphasise individual responsibility or weakness of moral character.…”

“…They can also play a role in gently challenging unhelpful models of addiction that clients may draw upon, such as those that stigmatise, emphasise individual responsibility or weakness of moral character. Similarly, treatment providers can (and often do) critically reflect on and challenge their own understandings and beliefs about addiction and people who use drugs to ensure that these are not shaping how presenting concerns and responses emerge in particular ways . Working with complexity and a variety of models is not easy, but alcohol and other drug treatment providers already routinely negotiate complexity and different needs, models, funding, administrative and therapeutic requirements, and in many cases are quite adept at doing so .…”

Enacting ‘more-than-human’ care: Clients’ and counsellors’ views on the multiple affordances of chatbots in alcohol and other drug counselling

“…While not wishing to dismiss participants’ concerns, Bryce's view that AI cannot provide the “right answers” could also be interpreted as resting on the assumption that there are correct or incorrect responses in online care encounters that only a human can provide. However, complicating the anthropocentric notion that providing the “right answers” is the sole prerogative of human subjects, critical drug studies scholarship has foregrounded the many possible (and often contested/political) ways of enacting ‘problems’ and ‘responses’ in relation to alcohol and other drugs – not necessarily right or wrong in perpetuity but socio-historically situated, and as such, relationally constituted across the human-non-human spectrum with different effects (see for example: Barnett, Dilkes-Frayne, Savic, & Carter, 2018 ; Fraser & Moore, 2011 ; Lancaster, Seear, Treloar, & Ritter, 2017 ; Pienaar & Savic, 2016 ; Savic, Ferguson, Manning, Bathish, & Lubman, 2017 ).…”