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Article Excerpt
In this article the results of a qualitative study carried out in Italy regarding the phenomenon of drug addiction remission are presented. The research explores the process of remission experienced by two groups of former drug addicts: (1) One group of subjects who faced their addiction by turning to drug services and a group of subjects who overcame their addiction without treatment. In Italy the phenomenon of untreated remission is all but unknown to most researchers and addiction professionals, despite the fact that in other countries it has been studied for many years. (2)
Considering remission as a process regulated by psychological, sociocultural and environmental mechanisms (Klingemann et al. 2001), a comparative study of the careers of the two groups of former drug addicts allows us to evaluate:
* On what conditions a drug addict is able to quit using drugs definitively without turning to treatment
* If these conditions differentiate him from those who chose to resort to treatment
* If the particular process of remission experienced (assisted or spontaneous) conditions the way in which former drug addicts redefine their identity, adopting a lifestyle no longer conditioned by the experience with drugs
The answer to these questions allows us not only to describe the process of spontaneous remission but also to better understand certain aspects of the process of assisted remission, and thus provides evidence for consideration by both addiction professionals and drug policy-makers.
This study, therefore, deals with spontaneous remission but also with treatment, the mechanisms which regulate its access (promoting it or obstructing it), the meanings that users attach to it and the ways in which it contributes to modelling the identity of "treated" subjects.
The issue and theoretical-methodological frame of the research
The research hypothesis and the theoretical perspective adopted
The starting hypothesis which directed this study is well summarized in the following passage, Granfield & Cloud write (1996: 50): "In addiction, organizations that seek to reform deviant behavior, encourage the adoption of a 'sick role' for the purposes of reintegration.... Such organizations provide a new symbolic framework through which members undergo dramatic personal transformation.... If the addict identity is acquired within such organizational context, it is logical to hypothesize that former addicts with minimal contact with such organizations will possess different self-concepts." In order to evaluate the effects of the (more or less) institutionalized practices of diagnosis, care and treatment of the drug addict, an interactive perspective concerning social reaction and labelling (Becker 1963; Lemert 1951; Rubington & Weinberg 1999) has been adopted for at least two theoretical-methodological reasons:
1. This approach abandons the synchronous perspective, adopting instead a sequential perspective to explain the deviant act (3)
2. In this trajectory, which can be defined as a career, the theory attributes an important role--in the processes of definition of the situation (Thomas 1923) and the subject's identity--to the interaction with significant others and with social control institutions (including those assigned to diagnosis, care and treatment)
The theoretical view of "social reaction and labelling," indeed, explains the consumption of psychoactive substances by adopting a sequential deviance model (Becker 1963; Coombs 1996) which takes into consideration both the changes that take place over time (consumption career) and the mechanisms of social interaction that the subject experiences and that influence such changes: Is the consumer able to hide this particular behavior from nonconsumers so as to avoid being stigmatized? If he was not able to do so, which forms of social reaction has he experienced? Has the image that others have of him changed? Has what others think of him conditioned the way he defines himself?
According to this perspective the acquiring of the identity of "drug addict" is, therefore, the result of a process of social interaction, as the definition that the subject gives of himself and his situation is influenced by the perception that others have of the subject himself (on this matter the transition from primary deviance to secondary deviance is crucial as described by Lemert 1951). Most users of illegal drugs are people who lead a "normal" life and are able to hide their consumption behavior. In many cases the transition from primary deviance to secondary deviance--following an event that has made the consumption behavior public--can jeopardize the subject's image, and the status of drug consumer, which until that moment was secondary, can become a master status (Hughes 1945). Other people, consequently, will begin to observe the person with different eyes and label him as a "drug addict," "sick," "a subject who needs to see a specialist," etc. Because of this labelling process and the effect of "self-fulfilling prophecy" (Merton 1968), the subject may progressively accept the image that others have of him, redefining, consequently, his own identity and situation.
The studies of pathways out of addiction with or without treatment have highlighted how the jeopardizing of what one might call "social functioning" (4)--using the theoretical contribution of Sen (1982; 1992)--may foster the transition from primary deviance to secondary deviance: The drug addict who is no longer able to fulfil certain social roles (worker, student, parent, etc.) in a conventional way will be exposed to a greater extent to social reaction (because the people, with whom he interacts, will be able to define his situation in a certain way and stigmatize some of his behaviors, or because he himself can make his status of drug addict visible to others by deciding to ask for help).
In particular, the studies carried out on spontaneous remission (Biernacki 1986; Klingemann 1992; Granfield & Cloud 1999; Waldorf et al. 1991) have shown that the jeopardizing of a subject's "social functionality" (often found in the careers of former drug addicts who turned to drug services for help) is not the inevitable (natural) outcome of a drug addict's career but a social construction in the sense that how individuals cope with problematic biographical events is strongly influenced by both the resources that they can use (those directly at their disposal and those that they can acquire through their social relationships, that is, their social capital), (5) and the capabilities that they are able to activate in order to convert the commodities into functioning, that is, to acquire different modes of functioning, to exercise them and to make alternative and freely chosen combinations of them (Sen 1982; 1993; 1992).
The resources to cope with problematic events (in our case, problems connected with addiction to illegal drugs) are not distributed equally in our society but "are rooted in the social relationships and so should be examined by studying the interaction structures in which the subjects are located" (Meo 2000:32). Since one of the ways with which this unequal distribution of resources can be operationalized is to turn to the concept of social capital (Granfield & Cloud 1999: 137). The drug addiction careers were reconstructed (and their impact on the other life course trajectories of the interviewees) the remission was analyzed within the more general theoretical framework of the interactionist perspective of deviance by focusing attention on social capital. To do this refer to Sen's theoretical contribution on the subject of inequality, considering inadequate the idea of a subject's overcoming a problematic event being determined solely by the commodities he has at his disposal or which he can activate by turning to his social network. Instead, Sen shifts our attention from the commodities such as they are to the capabilities necessary to use the commodities in order to acquire modes of functioning: the notion of functioning, according to Sen, is closely linked to the ability to function that represents the potentiality of a person that allows him to acquire modes of functioning, exercise them and make alternative and freely chosen combinations of them. It is these abilities that allow subjects to convert commodities into modes of functionings.
Aims of the research
Considering remission as a process regulated by specific social mechanisms, and treatment as one of the most important signification modes that can characterize this process. The careers of the two groups of former drug addicts have been studied in order to evaluate:
1. If there exist significant differences between the two groups as regards self-definition, lifestyle, taking on of a role, etc.
2. If (and to what extent) such differences may be attributed to the interaction with one specific type of social reaction (6)
The study adopts a phenomenological perspective, starting from the idea that the effects of the social reaction on the identity of the subjects interviewed, on their self-definition and on the development of their careers can only be understood by referring to the definition of the situation by the actors themselves, that is, to their perception and interpretation of reality, and to the relationships of both with their behavior. In this perspective the layman is the expert of his world (Schwartz & Jacobs 1979).
Method
In this study 41 subjects were interviewed, 21 of whom overcame their addiction without treatment. For the aims of this research the following had been defined. First of all, the criteria by which a person may be considered to be a drug addict. Secondly, the criteria according to which a person may be considered as a former addict. Lastly, the criteria necessary to define the spontaneous remission.
As regards the definition of the criteria for whether the subject has been a drug addict (and not, for example, an occasional or regular user), in line with the international literature on the phenomenon of natural recovery. In this study a subject was considered a drug addict if he/she spent at least a year taking heroin every day and if he/she needed to take this substance in order to alleviate the psychophysical unease of the withdrawal syndrome and/or to continue to experience the pleasant effects of use, and if he/she, at the time he/she stopped taking the drug, experienced certain typical withdrawal symptoms.
In line with the Italian literature on the evaluation of treatment results, subjects who claimed at the time of the interview not to have used heroin for at least three years were considered to be in remission. Finally, those subjects who did not make use of any form of treatment, or who attended a service for no longer than two weeks, were considered as "untreated" (16 out of 20 subjects defined as untreated have never turned to any form of treatment).
Many aspects of the lives of persons, like those being investigated in this study, cannot be observed directly or reproduced experimentally. The best (and perhaps only) way to understand these phenomena is to collect and analyze personal accounts. (7) The "biographical interview" tool was used to reconstruct the drug addict career of those interviewed (and how this career conditioned other life course trajectories), and in particular the ways in which they overcame their addiction, redefining their identity and their lifestyle. The aim was to assess whether there were significant differences between the accounts of the two groups of former drug addicts, and if these differences could be traced back to the various signification processes experienced by the subjects. (8)
The interviews were all audio recorded (except one in which authorization to do so by the interviewee was not granted). As regards the sample criteria...
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