Social Problem: Addiction

"Out There": The Ecology of Addiction in Drug Abuse Treatment Discourse Author(s): Darin Weinberg Source: Social Problems, Vol. 47, No. 4 (Nov., 2000), pp. 606-621 Published by: Oxford University Press on behalf of the Society for the Study of Social Problems Stable URL: https://www.jstor.org/stable/3097137 Accessed: 24-02-2019 00:25 UTC

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"Out There": The Ecology of Addiction in Drug Abuse Treatment Discourse

DARIN WEINBERG, University of Cambridge, UK

A growing trend in social research concerning illicit drug use has entailed suspending regard for conven-

tional questions such as the etiology of drug problems and the outcomes achieved by assorted interventions in favor of focusing analytic attention on how drug problems are socially constructed in and through human praxis. In this paper, I use a constructionist approach to demonstrate and explain endogenous accounts of what I

am calling the ecology of addiction in drug abuse treatment discourse. These accounts posit a space "out there"

marked by its degradation, dirtiness, solitude, and savagery which commonly tempts those who must live there

to also behave amorally, licentiously, and/or savagely I explain these accounts by showing their fundamental

utility in light of specific conceptual puzzles that participants in drug abuse treatment discourse must inevitably

solve. Namely, speaking in terms of this ecology of addiction provides participants with a compelling narrative

means for reconcilzng the following two claims: 1) they are chronically prone to enslavement by their addictions,

and 2) their addictions can be controlled through ongoing participation in a communal project of mutual help

Over the course of the nineteenth and twentieth centuries, there emerged a fairly coher- ent discourse regarding both the clinical characteristics of drug addiction and the appropriate methods for its treatment (Baumohl and Room 1987; Levine 1978; Schneider 1978). Origi- nally, medical professionals like Benjamin Rush were prominent among those who claimed addiction was not so much a moral failing as a medical condition that demanded medical treat- ment. However, despite their claims-making successes, medical professionals have often abjured the role of actually ministering to addicts themselves. By their incursions into, and flights from, the management of drug related social problems, medical professionals cleared workspaces that lay self-help groups and therapeutic communities eventually came to occupy. These events had the effect of forging a union between two propositions upon which much of the modern drug abuse treatment industry is now predicated. These propositions are: 1) drug addiction is a genuine disease marked by a "loss of control" over one's drug use, and 2) this disease can be effectively treated through ongoing participation in a therapeutic community.

These paired propositions have been widely institutionalized in the sense that contempo- rary participants in drug abuse treatment programs throughout the world are normatively required to honor them if they are to remain in treatment. Program participants inherit these propositions as non-negotiable institutional structures that both facilitate and constrain the kinds of activities they are expected and entitled to undertake as members of a treatment pro- gram. Given these institutionally enforced parameters, participants in drug abuse treatment

My thanks go first to Jay Gubrium for his many insightful comments on earlier drafts of this paper and on the gen- eral project that is its basis. Next, thanks are due to Joel Best, David Smith, and those who anonymously reviewed the paper for Soczal Problems They must be credited for giving the paper a much tighter and clearer thesis. Finally, I benefited greatly from discussions with those to whom I presented earlier versions of this paper at University of California, Berkeley and Yale University. Data collection was funded in part by NIAAA Grant 1 VO1 AA08821, "Evaluation of Treatment Options for the Dually Diagnosed," pnncipal investigators: M. Audrey Burnam and Elizabeth A. McGlynn. Writing was funded in part by a grant from the Lindesmith Center of the Open Society Institute. Direct correspondence to: Darin Welnberg, Faculty of Social and Political Sences, University of Cambridge, Free School Lane, Cambnridge, CB2 3RQ, England. E-mail: [email protected].

SOCIAL PROBLEMS, Vol. 47, No. 4, pages 606-621. ISSN: 0037-7791 @ 2000 by Society for the Study of Social Problems, Inc. All rights reserved. Send requests for permission to reprint to: Rights and Permissions, University of California Press, Journals Division, 2000 Center St., Ste. 303, Berkeley, CA 94704-1223.

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The Ecology of Addiction 607

discourse must inevitably cope with the following conceptual puzzle: Exactly how can people who are, by definition, chronically afflicted by a disease that is beyond their own personal control be empowered to master this disease through participation in a therapeutic commu- nity? And, as a related matter, participants in drug abuse treatment discourse must be able to plausibly distinguish between the actions taken by program participants and the effects of their addictions.

In what follows, I suggest that these conceptual feats are accomplished, at least in part, by discursively sustaining a categorical contrast between two diametrically opposed ecologies- the recovery program itself and what I am calling the ecology of addiction.' Immersion in the social world of the program is held to systematically empower people to take control of their lives (cf., Denzin 1993; Skoll 1992; Sugarman 1974; Weinberg 2000). In contrast, the ecology of addiction, "out there," is painted as a uniformly desolate space that systematically wreaks havoc in the lives of those forced to live there. Through use of this ecological contrast, people cast themselves as accountably invested in, and capable of, recovery through participation in the treatment program but, nonetheless, chronically vulnerable to their addictions, which they claim are enflamed and made stronger by the temptations and frustrations of living "out there."

This analysis builds upon, and contributes to, the social problems work perspective intro- duced by Holstein and Miller (1993). In an effort to promote research on the local construction of social problems, Holstein and Miller (p. 152) call for greater attention to the ways in which "social problems categories, once publicly established, are attached to experience in order to enact identifiable objects of social problems discourse." By giving temporal priority to the "public establish[ment]" of social problems categories, Holstein and Miller clearly indicate that social problems work is, in part, reliant on a stock of already accredited cultural resources. This said, though, social problems work is plainly not coextensive with the campaigns of those concerned to propound or contest the credibility of social problems categories, generally. In this paper, I show how participants in drug abuse treatment discourse effectively reconcile pre-established conceptual claims regarding the nature and treatment of their drug problems through creative use of the narrative construct I am calling the ecology of addiction. I, thereby, demonstrate one way in which specific instances of the social problem category "addiction" are routinely identified and addressed in therapeutic communities designed to tackle this social problem.

Settings and Methods

This analysis draws upon ethnographic materials gathered during fieldwork in three dif- ferent drug abuse treatment programs. The first program, in which I did fieldwork for a period of four months, was a residential facility housed in one of the many privately funded Chris- tian Missions in the skid row area of downtown Los Angeles. This program served an exclu- sively male clientele drawn, primarily, from the local environs of skid row. The second program was a residential facility remotely located in the foothills above Los Angeles. This program was administered by a private non-profit corporation, but funded, primarily, through a joint grant from county mental health and substance abuse services. It served both women and men from all over Los Angeles County who had been dually diagnosed with co-occurring substance dependencies and serious psychiatric disorders. I spent nine months collecting data there. The third program was non-residential, but otherwise expressly modeled on the second

1 The term "ecology" is used here for two reasons. First, it connotes the materiality of an environment more than does the term "culture," which is often held to refer only to "webs of significance," or symbolic environments (cf., Geertz 1973). Secondly, and more importantly, the term "ecology" indicates a reciprocal relation between agent and environment without presummg the humanity of the agent in question Insofar as members of my research settings construed their addictions as disease agents and not human agents, it is useful to avoid anthropomorphic terms when describing their accounts of the environments within which their addictions were held to thrive.

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program. It was located in Venice Beach, California and was administered by a non-profit research corporation as part of a federally funded study of the comparative costs and benefits of residential and non-residential care for dually-diagnosed homeless adults. I conducted fieldwork in this program for a period of seven months.

My fieldwork in each of these three programs consisted in participant-observation and unstructured interviews with both clients and counselors. I made site visits at least weekly, spending the day with program members and going through their routines with them. I regu- larly attended formal group therapy sessions, participated in informal and recreational activi- ties, and privately conversed with both clients and counselors regarding their activities and experiences in the programs and related topics. All program participants were fully appraised of my status as a researcher. They were assured confidentiality and told of their right not to be included in the study. All clients and counselors in all three programs consented to participate in the research and allowed me to sit in and observe their group sessions.

Following my site visits, I wrote extensive field-notes, fleshing out hastily written notes I had jotted down over the course of the day. I completed these field-notes as soon as possible, normally within a few days of each site visit. In addition to approximately eight hundred pages of single-spaced type-written field-notes, I also collected written materials used in the programs and about forty hours of audio tape recordings depicting group therapy sessions, pri- vate counseling sessions, and staff meetings in the foothill program. By systematically compar- ing therapeutic practice in each of these three programs, I learned to distinguish narrative devices common to all three settings from those that were less common and/or unique to a given treatment program or program participant. My purpose in what follows is to both dem- onstrate and explain the ecology of addiction, "out there," as a narrative construct that was very commonly evident in each of the three programs I observed.

The Ecology of Addiction in Drug Abuse Treatment Discourse

"In" and "Out" in Drug Abuse Treatment Discourse

As I intimated in the introduction, to be described as "in" the program was to be cast as a member of a community of people dedicated to helping each other overcome their addictions (Alcoholics Anonymous 1976). Conversely, when program participants relapsed it was rou- tinely said that they had "gone out." This use of the expression "out" can be seen in the fol- lowing fieldnote excerpts,

Janet2 came back onto the patio and asked how everyone was doing. Layla answered, "Lousy." Janet asked, "What's wrong?" And Ian answered, "She went out this weekend.. ." Janet looked at Layla and said, "Oh no, don't tell me. You used over the weekend?" Layla nodded sheepishly.

After dinner Neil, Sean, and Marta talked about where Tony, Liza, Nat, and Ron were today. Neil was leaning back in his chair smoking a cigarette and in a blase, knowing tone of voice he said, "Yesterday was check day and they're not here today. I don't think that looks too good do you?" Sean laughed and said, "No it doesn't. You think they went out?" Neil said, "I think Liza went out and it wouldn't surprise me a bit if Nat did. In fact, I'm sure that's what he did. Tony's been doin' good lately though, but he has a hard time when he's got money. He's got a real problem with that. Ron, I dunno. I ain't sayin' they went out necessarily, but I think they got their checks and they ain't thinkin' too much about the program."

In the first excerpt, Janet obviously understands "went out" to mean, specifically, that Layla used drugs. By distinguishing "[going] out" from simply "[not] thinkin' too much about the program," Neil also makes it clear, in the second excerpt, that merely being AWOL from

2. All names that appear in data excerpts are pseudonyms.

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The Ecology of Addiction 609

the program did not, of itself, qualify as "[going] out." This expression was reserved to describe only those who had relapsed. By describing Tony as "doin' good lately," but noting that he has a "hard time when he's got money," Neil indicates that the possibility of Tony's relapse did not so much reflect a lack of commitment to recovery as Tony's ongoing struggle with addiction. In drug abuse treatment discourse, "out" or "out there," was generally described as a space one's addiction compelled one to inhabit. It was not a space that most program members freely chose to be.3 One can see this still more clearly in the following com- ments Layla shared in group therapy,

I'm doin' real, real bad right now. I'm feelin' real depressed. I'm havin' trouble right now stayin' clean for more than two days ... I hate myself for goin' out and I don't know if there's anything that can save me anymore. I'm feeling very disillusioned because I feel like I worked this program good. I worked it real hard.... If anybody worked this program, I did, and it still didn't work for me. I'm feelin' real desperate right now.... This last relapse was the worst I ever had and I still feel like I just want more. I think I'm gonna die out there.

Relapse was, then, routinely cast as movement from one ecological space to another. Before explaining why members of these settings were inclined to cast the reoccurrence of their dis- ease in such terms, it will be useful to further explicate the characteristics that program partic- ipants conferred upon this putative space "out there." In the following sections, I address the substance of being and/or living "out" as it was routinely represented in these settings, focus- ing on four major themes by which the ecology of addiction was discursively opposed to the ecology of recovery.4 I have entitled these themes: endogenous accounts of the active addict mentality; legends of the fall; getting "clean" and being "dirty"; and the hazards "out there."

Endogenous Accounts of the Active Addict Mentality

The most critical contrast members of my settings drew between the ecology of recovery and the ecology of addiction concerned their characteristic mentalities while inhabiting these spaces. This contrast was drawn by opposing a conscientiousness demanded by life in the pro- gram to a personal dissolution shared by those still ensconced in "the life." People in treat- ment were, themselves, described as "working a program" which, while involving a fairly vast spectrum of specific projects, basically entailed assiduous efforts to fulfill one's personal responsibilities to oneself and to others. Conversely, the mentality of the active addict was constructed fundamentally in terms of self-abandon. Whereas social scientists have often emphasized the distinctive rationality and sub-cultural aspects of addict behavior (cf., Agar 1973; Finestone 1957; Lindesmith 1947; Preble and Casey 1969; Ray 1961; Stephens 1991; Sutter 1969), treatment program participants generally construed the behavior of active addicts as indicative of disease--that is, as involuntary, self-destructive, and quite beyond the

3 Occasionally people who were not in the program were held to inhabit the ecological space "out there" volun- tarily. These people were usually cast as predators or, at the very least, powerful enough to cope, effectively, with the putatively savage vicissitudes of life on the streets. In this regard, see Sutter (1966) for one of the finest discussions of the "righteous dope fiend" persona However, given the fact that their discussions took place m drug abuse treatment programs, my research subjects were heavily minclined to disapprove of talk which "glorified" the drug life or which indi- cated faith in the possibility of one's coping effectively with hfe "out there " Hence, people rarely spoke of their choosing to "go out." Instead, returns to life "out there" were generally described as involuntary, that is, addiction induced.

4. I do not mean to suggest, here, that these four themes exhaustively descnbe the opposition participants in my research settings discursively constructed between the ecology of recovery and the ecology of addiction. Nor do I claim that all program participants at all times uniformly endorsed this ecological opposition My claim is only that these themes recurrently figured, prominently, in members' discourse across all three settings and that they demonstrate that, and how, this ecological opposition was constructed. Additionally, because the literature is already fairly replete with descnptions of endogenous accounts of the ecology of recovery in drug abuse treatment discourse (cf., Bloor, McKeg- aney, and Fonkert 1988; Denzin 1993; Gubnum 1992, Pollner and Stem 1996; Rubington 1977; Rudy 1986, Skoll 1992; Sugarman 1974; Weinberg 1996, Weppner 1983, Wiseman 1970), my discussion is weighted, decidedly, in favor of describing how the ecology of addiction was, itself, depicted.

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pale of any sustainable cultural order.5 In "going out," the moral and rational dimensions of the addict's temperament were held to have essentially given way to asocial pathological drives.

Simply stated, program participants generally characterized the drug-related behaviors of active addicts as involuntary and "out of control."6 One way this was done was by painting the addicts who remained "out there" as oblivious to their own self-interest. In the following excerpt, Kyle distinguishes himself and his peers in the program from the active addicts who spent time in and around the Mission by invoking the latter's unconsciousness of (and hence, their incapacity to pursue) their own personal welfare,

We're all on the program. At least we've begun to see. Now I've been on the program before and I relapsed before, but at least I know what I need to do. Those brothers out there? They don't even KNOW what they're doin' to themselves.

Of course, program members did not cast themselves as immune to this kind of addictive unconsciousness, but as engaged in a perpetual struggle to overcome and/or prevent it. It was precisely this putative struggle with their addictions that warranted their presence in a treat- ment program in the first place. Sometimes, as above, the active addict mentality was cast as an inability to consider the nature and/or consequences of one's actions. But it was also some- times cast as a jaded indifference to one's own subjective state of being. Program participants often spoke of the active addict's life as corrosive to the capacity to express how one feels or even to know how one really feels,

When things were goin' bad for me, I just said I'll take care of it and I don't need nobody's help. I might be feelin' bad and somebody comes up to me and says, "How you feelin?" And I just say, "Alright." And that's not even an answer; that's not even a feeling! What kind of feeling is "alright," you know? Pretty soon, I don't even KNOW how I feel! I'm always jus' "alright."

From the constructionist perspective I am taking in this paper, the question to ask of such accounts is not: Are they empirically valid or invalid? But, instead: What specific practical work are they doing on the various occasions of their use? (Holstein and Miller 1993). I will return to consider this question at length in the discussion section of the paper. However, at present, I wish to remain focused on how this endogenous image of the active addict mental- ity, a nearly perfect antithesis to the ascendant sociological image of the active addict as ratio- nal actor, was discursively linked to a distinctive type of ecological space. In the following account, Stephen finishes his account of the depravity of his life when he was addicted to speed by describing this period in his life as "out,"

Speed took me to the point where I was sleeping in alleyways and was eating out of garbage cans, going around talking to myself all the time. It was the only thing I ever wanted. I didn't even care if I died. I was filthy dirty. I didn't know anybody and it gave me these sores all over my body. I was a

5. Two pomts merit notice here. First, though, this image of the addict was, of course, constructed m more and less (usually more) extreme guises, addiction was invariably constructed as specifically antithetical to, rather than characteristic of, a given cultural order. Second, though this image is fiercely contested (and empirically tenuous), it is, by no means, exclusive to drug abuse treatment discourse (Lindesmith 1940). It may by found in journalistic accounts, accounts proffered by drug warriors, family members of putative addicts, and others. Indeed, in his acclaimed ethnography, Crackhouse, Terry Wilhams (1992) quotes one of his subjects, "Joan" (herself a heavy crack user), as she described the genuine crack addict,

The crack addict is the person who's lost all sense of what's going on. They are like zombies. They are out there standing in the pouring ram If it's cold and snowing, they'll be walking up and down out there They have no feelings... It comes to the point where they will set up family, fnends, any- body-the point where they don't care anymore (pp 24-25).

6. Recalling the point made in footnote 2, occasionally non-program members were held to persistently use illicit drugs and to inhabit the space "out there" voluntarily. However, program members overwhelmingly abstained from identifying themselves, their peers in treatment, or, for that matter, anyone with whom they empathized as one of these types of people. This was true for the obvious reason that, to do otherwise, would undermine the assumption that people genuinely needed help. If people had been "out there" voluntanly, why would they now be strugglihng to escape "the life" and, therefore, need therapeutic assistance to help them do so?

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The Ecology of Addiction 611

mess, but I didn't even care. I didn't care if I was addicted and I didn't care if I died.... Not many people have been that far out.

Clint spoke of his own asocial behavior when he was "out there in his addiction,"

When I was out there in my addiction, I fucked over a lot of people. I mean A LOT!! I used to go up to people when I was loaded, people I didn't even know and who hadn't done a fuckin' thing to me,

and just smack 'em as hard as I could. .... I was crazy as hell. .... Those were some real nasty times. It's not just me either... when you're like me, you drag everybody near you down with you and that's exactly what I did, my wife, my parents, my friends. I was not somebody you would ever want as a friend.

In both of these cases, active addict behavior is specifically cast as antithetical, indeed pre- clusive, to cohesive social attachments. Insofar as active addiction was held to consist in disso-

lute behavior by which social bridges were burned, there were obvious incentives to cast the space within which addiction persisted as a socially desolate one. But even further, the putative space "out there" was itself held to promote addictive self-abandon. This can be seen very clearly in the excerpt below. Ian begins by painting the familiar picture of the active addict as con- sumed with little other than survival and the acquisition of drugs. But, whereas scholars since Preble and Casey (1969) have suggested this agenda fills the addict's life with a certain, albeit tragic, meaningfulness, Ian casts it more as the mind-numbing routines of a hapless automaton,

When you're homeless, you're head is just in this place of always havin' to take care of business and watch out you don't get robbed or even hurt or killed sometimes. I'm serious. And it's just, like, livin' that way for awhile get's you so that you're always so tense and so fuckin' frustrated about everything that nothin' matters to you anymore 'cept stayin' safe and keepin' your hustle. It's like you start gettin' into a one-track mind .... People don't even want to think about what's up wit' them. All they want is that rush of good feeling and it don't matter where that rush puts 'em or what it takes to get it 'cause you're already low down as you can get anyway. People just want to deaden themselves and that's what they do.

Here, Ian very clearly links his characterization of the active addict mentality to the relentless pressures of life on the streets, and concisely describes the intimate causal relation- ship that was routinely drawn between what I have been calling the ecology of addiction and the active addict mentality. In sum, within the context of drug abuse treatment discourse, the self- destructive behavior of active addicts was held to be caused not only by an intra-personal "disease," but also by the decidedly despised ecological space that was held to sustain and exacerbate that disease. In the following sections, I briefly demonstrate three further thematic contrasts by which program members conceptually linked an image of addicted behavior as involuntary or "out of control" with the image of addiction's responsiveness to a distinctively insalubrious eco- logical space.

Legends of the Fall

In addition to its being specified as a space "out there," the ecology of addiction was also described as a low or degraded space, a space indicative of social decline. Following AA proto- col, when people entered a treatment program, they generally expressed the view that they had, in some way, "hit bottom," meaning their life had come to seem totally unmanageable (Alcoholics Anonymous 1976).7 This was often cast as a personal fall from grace-a loss of

7. It is routinely held among members of AA (and most others involved in addiction treatment) that addicts are often extremely ambivalent about adrmtting they suffer from a disease that prevents them from controlling their drug use (see Alcoholics Anonymous 1976, pp. 30-31) Hence, a widely acknowledged goal in drug abuse treatment dis- course is to break down the putative "denlal" that keeps the addicted person, him or herself, unconsciously complicit with his or her disease. In the interest of accomplishing this goal, a good deal of drug abuse treatment discourse is taken up with inducing and offering confession of the depths to which one's disease has forced one to sink (see also Denzin 1993; Rudy 1986; Weppner 1983)

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one's former social standing and social connectedness. However, people also routinely attrib- uted their movement into the program to the progressive degradation of their milieu "out there." In the following excerpt, Lonni describes the events that catalyzed her decision to get into a drug abuse treatment program,

Life on the street was just becomin' more and more crazy and dangerous. Most of the homeless people I used to hang around with would get high ... they was a certain amount of people that would hang together and watch out for each other. All those people started to go against each other. ... This one girl got pissed off 'cause she couldn't get high with this guy. And so she started arguin' with me . . and then, when I turned around, she had a knife and was talking a lot of shit. .. . Lonni said this incident "made me wake up and see that living on the streets is not a good idea." I thought, 'I've been homeless for almost seven months ...' I don't even want to deal with that shit. I got tired of that shit. I said it's time to get my shit together, at least attempt to do it.

Lonni speaks of "wak[ing] up" to the need to "get [her] shit together" and, in finishing with the phrase, "at least attempt to do it," indicates this will entail a conscientious struggle, in contrast to the putative somnambulism by which she remained on the streets and unrespon- sive to her deteriorating near group relations. Thus, the imagery of recovery as self-governed/ drug-life as not self-governed is again sustained. Interestingly, these accounts of the degrada- tion of street life, sometimes, went beyond descriptions of descent in one's own biography and/or one's proximal milieu to more fully inclusive accounts of collective descent from an idealized past to a current state of general desolation "out there."s Most generic descent stories referenced a time when street life was dominated by hippies who looked out for one another. Thus, Clarise said,

The attitude out there . .. isn't the same as it used to be. Used to be you could walk down on the beach and you'd see hippies smokin' dope or doin' whatever they was doin', and they'd let you alone. They'd be doin' their thing and you just do your thing. They was homeless, but nobody was scared of 'em. Now you'd have to be crazy to be on those beaches at night.

Clarise was old enough to have known street life in the sixties first hand. But romanti- cized images of the sixties were also invoked by people who acknowledged not knowing if that imagery was really accurate or not. In the following excerpt, Ian uses the utopian image of the sixties as a benchmark from which to trace an ongoing deterioration of street life, the last stages of which he does claim to have witnessed first hand,

People don't know what it's like to be homeless now. A lot of people think it's still like the sixties, you know, where everybody helps each other out. I mean, I wasn't around that far back, so I don't know if it was ever like that, but it sure as hell ain't like that now. I remember when it used to be

you'd get the rockheads all hangin' out in one place and all the drunks here, and all the junkies some place else, and then maybe you had a little bit of people lookin' out for each other. I mean a LITTLE bit. You know, if you got somebody high, then they figure they owe you one and they'd do you a favor or somethin', but even that'd only go so far. I mean you still got ripped off a lot even then. But now there ain't even none of that any more. Everybody just lookin' out for themselves and nobody can't do nothin' for nobody else. Nobody trusts anybody and nobody can be trusted. People rip off anyone; it don't matter who you are. It's pure shit. I used to use behind that shit all the time 'cause I just couldn't take it.

Here Ian uses an account of collective descent into a quasi-Hobbesian order to indicate that his drug use was a product of defeat ("I just couldn't take it") and not deliberate or ratio-

8. It is worth mentioning that these accounts of collective descent are, at least partially, confirmed by empirical research (Bourgois 1997; Currie 1993; Jencks 1994, Wacquant 1994, 1998; Wilson 1987) Though they may differ in their emphases of particular causal factors (a precipitous declihne in manufacturing jobs, state abandonment, capital flight, etc ), studies of urban poverty agree that the circumstances of the urban poor in the United States have been get- ting more miserable and, in some instances, more Hobbesian (see Wacquant 1998, pp 12-13), since the early 1970s. No doubt, program participants found each other's accounts of a collective fall a bit more plausible for their relative parity with the descending material conditions of contemporary urban poverty

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The Ecology of Addiction 613

nal adjustment. The phrase, "I couldn't take it," reflects a very different vocabulary of motives (Mills 1940) than, "using drugs seemed sensible given my dire circumstances." Hence, drug use is held to reflect an environmentally induced relinquishing of self-control, rather than a deliberate exercise of self-control. The excerpts in this section variously demonstrate how pro- gram members described the ecology of addiction in terms of decline from a higher, more humane, social order. Sometimes this decline was cast in solely personal terms. But it was often also cast as a collective fall suffered by the bulk of those with whom one shared "the life." In contrast to the involuntary fall that delivered one over to addiction, recovery was cast as a laborious ascent from the depths (see also Marvasti 1998). While immersion in the ecol- ogy of the program could empower one to accomplish this ascent, it could not completely relieve one of the inevitable personal struggles that "getting clean" entailed.

Getting "Clean" and Being "Dirty"

Another salient feature of the ecology of addiction in drug abuse treatment discourse was its association with dirt in opposition to the cleanness characteristic of recovery.9 When one was known to be "in" the program, s/he was commonly described as "getting clean." Con- versely, when blood or urine tests indicated recent drug use, those tests were described as "dirty." The affinity of cleanliness with recovery and dirtiness with the drug addict's life was commonly manifest in a variety of other ways too. In the following excerpt, Clarise, a counse- lor, tells of her efforts to work with Del on his grooming. She said,

I'm trying to get him to cut his hair, shave regularly, clean his clothes-I think those things are a real important part of getting into a recovering lifestyle. Once they start caring a little more about how they look, that's a real good sign that they're taking the program to heart. People may be com- ing regularly, but if they continue to look like they're homeless and don't really take care of their appearance, I can't help thinking they aren't bringing a lot of what they get in the program out with them when they leave.

Findings of an affinity between dirtiness and drug addiction were by no means limited to counselors on staff. In the following excerpt, Charlie struck a chord with many of his peers when he opened a group therapy session with a lament regarding a recent encounter with a "pan-hassler" [an aggressive panhandler]. After recounting the incident to the group he con- tinued as follows,

"These people don't care about keepin' clean or keepin' any kind of self-respect about themselves. I'll tell ya, stayin' clean and healthy and keepin' my clothes lookin' all right is important to me. If you don't try and distinguish yourself from the scum, then you'll turn into the scum. If you don't try and get yourself outta the gutter, you'll become part of that gutter. And that's what a lot of these people out there are. They don't got no principles. They don't demand anything from themselves." Mack laughed and added, "They'd literally kill their own grandmother to get a hit." Charlie said, "Yep, it's all about the drugs. That's all it's about. People don't care about anyone or anything. They have no respect for themselves, no respect for other people, and no respect for their environment." Mack, Del, and Clarise were nodding fiercely in agreement. Others were also doing so occasionally.

In this passage, Charlie opposes his own conscientious efforts to "[stay] clean and healthy" to the profligate dirtiness, degradation, and amorality of "these people out there." Charlie seems to suggest that cleanliness flows from deliberate effort, dirtiness mere dissolution. Moreover, by equating them with "scum" and the "gutter," Charlie clearly invokes a close relation between a degraded space "out there" and its degraded inhabitants. The narrative linkage of this general degradation and addiction, in particular, can be clearly seen in Mack's taking up Charlie's lament with an unprecedented invocation of drug use ("they'd literally kill

9. See Douglas (1966) for the classic statement concernmg the cross-culturally pervasive totemic imagery of cleanliness and dirtiness.

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their own grandmother to get a hit"). Evidently Mack understood Charlie's complaint as one specifically about addicts and, indeed, Charlie confirms Mack was correct in his next remark

("Yep, it's all about the drugs ... ."). Once again, in its ascribed affinity to dirtiness, drug use is, here, held to simultaneously reflect the feral influence of a space "out there," as well as per- sonal lapse and dissipation, rather than self-governed activity.

The Hazards "Out There"

Beyond descriptions of oblivion, descent, and dirtiness, accounts of the ecological space "out there" tended to depict a doleful world fraught with myriad emotional and physical haz- ards. In vivid contrast to the trust, compassion, and communal solidarity ascribed to the world of the recovery community, program participants claimed, overwhelmingly, to have feared and/or distrusted those with whom they had shared the street. Even when they did socialize with others, members claimed they were careful not to become close. The distinction between "friends" and "acquaintances" was very commonly invoked in each of the three programs (see also, Rosenbaum 1981, p. 57). In the following passage from a group therapy session, Claire, a counselor, chided Neil about his supposed popularity. She said,

"You got a million friends right Neil?" Neil said, "I do?" Claire said, "Yeah. Don't you? I thought you

did. You talk about a lot of the people you know ... ." Neil interrupted, "Well I might KNOW a lot of people, but they ain't my friends. Those are acquaintances. There's a difference! (Laugh.)" The other clients laughed in recognition of the importance of this distinction. Neil continued, "I have a lot of acquaintances, but I wouldn't call any of 'em my friends."

A fairly obvious result of this pervasive distrust was that the awful loneliness of living "out there" became a recurring theme in drug abuse treatment discourse. In the following field note excerpt, Lee gives a moving account of his loneliness, indicating its relation to both his drug use and his assessment of those with whom he shared the streets,

"I've had periods in my life when I was really lonely, REALLY lonely, like, when I decided to bum it last time and those were bad times ... 'cause I didn't know anybody and I couldn't meet anybody. That was the worst part about bein' homeless. (Laugh.) It's funny, too, 'cause I used to always go and sit on a bench out there in Palisades Park and there was this other homeless guy who used to sit across from the bench I sat on, and one time, he came over to talk to me, but I said, 'Hey, I don't wanna talk to you, get outta here.'" Claire asked, "Why'd you do that?" Lee replied, "I don't know why. Maybe I thought I was better than him unconsciously or somethin'. Maybe I was scared he was gonna con me or rip me off. I dunno." Tanya nodded and laughed in agreement. Neil also nod- ded in recognition of the sentiment Lee was expressing. Lee spoke again, "I get lonely though. It's bad. That's the worst feeling I know--loneliness. That's always when my worst depressions would set in and when I got depressed, that was when I'd relapse. You know you just start thinkin', like, nobody cares, so you say, 'Why should I care? I don't care either.'"

Similar to Ian's report on page 612, in this account, Lee attributes his relapses to the demoralization, fear, and loneliness he suffered while living out. Relapse is, thus, cast, not as a deliberate act of self-control, but as a relinquishing of self-control in the face of overwhelm- ingly adverse circumstances (". . . you just start thinkin', like, nobody cares, so you say, 'Why should I care? I don't care either.'"). In addition to being characterized by loneliness, life "out there" was also commonly described as disorderly and dangerous. Danny put it this way after Eve asked him about his motivation to get clean,

Eve asked, "Do you want to get clean now?" Danny answered, "Well, sort of. I don't know really. I'm sick of all the bullshit." Claire asked, "What bullshit?" And Danny said, "You know, the street stuff: getting robbed, getting beat up, loosin' your stuff all the time, bein' dirty all the time."

People represented the ecology of addiction as fraught with predators and the threat of harm. But, as I have said, it was not simply that living "out there" forced one to contend with

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The Ecology of Addiction 615

the prospect of being robbed, hurt, or killed. Of course, those prospects were described as ever present, but, even further, the predatory and licentious nature of the street addict scene was cast as infectious. According to program participants, drugs were only one element of a much wider set of circumstances that forced people into "the life." Poverty, homelessness, and unemployment were all given their due as well (see also, Rosenbaum 1981; Wacquant 1998). And the condition of living amongst others "out there" and having to compete with them for the scarce resources necessary to sustain one's own survival was often given particular emphasis. Thus, Del said,

"Those people out there are dangerous, they're rude, they're selfish, they're diseased--a lot of 'em- and they don't care about anything. They've seen it all and nothing affects them anymore. They're numb. They ain't got no sympathy for anyone 'cause they don't feel like anyone's got any sympathy for them. You see it all the time. People in the food line lyin' about how they got a family they gotta bring stuff back to so they can get more than their share. They ain't got no family; they're just selfish dirty dogs who wanna get as much as they can get and they don't care about nobody else. That's the streets. That's just what ya gotta contend with everyday. Ain't nothin' new about it. I been dealin' with that for years. You just gotta learn how ta deal with it." Charlie said, "Sometimes it really gets under my skin."

As Charlie's remark indicates, program members, by no means, cast themselves as immune to the pressures of life "out there." This is also evident in the following field note excerpt, wherein Rickie comments on his having been accused by some of his peers in the program of "acting like a dope fiend" and "having an attitude,"

I don't know why they think that. I know I had an attitude out on the streets, but ya had to have an attitude if you wanted to survive, you know? Up here ain't no reason to do that stuff. . . . Out there's a different story, though. You know, you get burned and you burn somebody back, you know? That's just the way it is on the streets. After awhile, you lose your twenty [dollar bill] so many times you say, "I ain't gonna be the only one who's losin'!". . . It's crazy out there. Nobody trusts nobody. I didn't know nobody and I didn't trust nobody enough to be runnin' with him as a partner. He'd be the dude that get's me you know?

Here Ricky acknowledges an "attitude," but insists that it is drawn out of him by condi- tions "out there," and is decidedly not an enduring feature of his personal temperament. As he says, in the program, there "ain't no reason to do that stuff." The ecology of recovery culti- vated in the treatment program is, thusly, held to free one from the practical compulsion that s/he might otherwise feel to "act like a dope fiend." But, given the ever looming prospect of a return to life "out there," people described themselves as "trying to change," but, nonetheless, eminently susceptible to the challenges that this distinctively dysfunctional ecological space posed to their recovery. When confronted by the world "out there," people claimed to feel powerfully drawn toward comporting themselves in ways that were responsive to that world, even if these responses were recognized as ultimately self-destructive. Living "out" or "out there" by these lights, was to live under crazy, violent, and capricious circumstances. In other words, the ecological space indicated by reference to "out" or "out there" was held to power- fully entice, if not relentlessly compel, its inhabitants to live savagely and licentiously for the moment and anticipate betrayal by anyone. I will now discuss the specific utility of this narra- tive construct in drug abuse treatment discourse, and hence, its persistence in this particular type of social problems work.'"

10. One reviewer interpreted my analysis as a case study of Lakoff and Johnson's (1980) general arguments on the place of metaphor in human discourse and cognition I am not opposed to being linked with this tradition, but I would insist on two points. Lakoff and Johnson (1980) write, "the essence of metaphor is understanding and experienc- ing one kind of thing in terms of another" (p. 5). This formulation seems to imply some a prlon resolutions as to the nature of the "kind of thing" that is being described such that literal terms of descnption might be somehow distin- guished from metaphorical ones. I would prefer to avoid that implication here. Secondly, whereas Lakoff and Johnson (1980) demonstrate the importance of inherited narrative imagery as sense making devices, they are not as concerned

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Discussion

Students of the history of social problems theory will, no doubt, have observed, in many of the foregoing accounts, a certain affinity with what I call, sociogenic personal deficit theories- theories like social pathology, social disorganization (see Faris and Dunham 1939), disaffilia- tion, under-socialization (Pittman and Gordon 1958; Straus 1946), and Cloward and Ohlin's (1960) famous double failure theory of addiction. Much like these sociological theorists, par- ticipants in my programs seemed to condemn certain types of drug related practices as patho- logical and to explain these practices as, in part, responsive to the dysfunctional ecological environments within which they are held to develop. Though their substantive affinity is real, it is critically important that we carefully distinguish the foregoing accounts from those given by sociologists. Why? Because in their accounts of addictive drug use, participants in drug abuse treatment discourse, and sociologists are engaged in entirely different sorts of work. Whereas participants in drug abuse treatment discourse are using these accounts in a pri- marily therapeutic context to do primarily therapeutic work, sociologists use such accounts in an academic context to do scientific work.

While it is fair enough to criticize scientific theories because they are logically muddled or inadequate in light of extant data, such complaints are somewhat off point if they are made of accounts being used to do something other than scientific description (Bogen and Lynch 1993, p. 214; Bourdieu 1990). We mustn't forget that the program participants were not, them- selves, doing social science, nor were they particularly concerned to reconcile their accounts with social scientific theory. They were concerned to solve what they viewed as their own problems in living. This said, however, it may still be useful for present purposes to briefly compare their accounts with those given by social scientists. The ethnographic literature on homeless street life, "street addict culture," and "bottle gangs," is fairly abundant with con- vincing critiques of the starkly pathological images one finds in the writings of sociogenic per - sonal deficit theorists. Largely due to ethnographic critiques, most social scientists have long since abandoned sociogenic personal deficit theories as better documents of researcher pre- conceptions than careful empirical analyses (cf., Mills 1943; Wiseman 1970). Likewise, then, this literature strongly suggests that, as a strictly scientific matter, the desolate images of life "out there" painted by clients in my settings were, at least, selective descriptions of street life and, quite probably, also somewhat exaggerated. Simply stated, then, the ethnographic lit- erature provides very good scientific reasons for us to wonder why people in treatment pro- grams so consistently describe, not only their own personal drug habits, but the whole drug scene in such profoundly disparaging terms.

Let me now return to my suggestion that we focus our attentions on the two propositions I described in the introduction as foundational to contemporary drug abuse treatment dis- course. These were: 1) Drug addiction is a genuine disease marked by "loss of control" over one's drug use, and 2) This disease can be effectively controlled through ongoing participation in a therapeutic community. As was mentioned earlier, participants in my research settings inherited these paired tenets as non-negotiable institutional structures. To the extent they sought to remain as participants in good standing in these settings, their actions were inevita- bly both facilitated and constrained by the organizationally enforced requirement that both of these tenets be honored. This meant that participants in these programs, inevitably, had to work out exactly how, despite always being prone to enslavement by their addictions, they were also capable of being empowered to master their "disease" through ongoing participation

as I am to link the invocation of narrative imagery to specific types of shared work. I would argue that making-sense-of- our-expenences is only rarely, if ever, undertaken as an end m itself and is generally undertaken as a means of facilitating myriad other empirically identifiable kinds of work. Hence, for example, in the following section, I explicitly distinguish

making-sense-of-our-experiences in the academic context of social scientific work and makming-sense-of-our-experiences in the therapeutic context of a drug abuse treatment program.

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The Ecology of Addiction 617

in a therapeutic community. It is in light of this institutionally enforced conceptual puzzle that the distinctive utility of the narrative construct I have been calling the ecology of addiction can be most clearly understood.

Let us begin with the first tenet. The idea that drug addiction is a bona fide "disease," his- torically arose and has been sustained, precisely because it gives conceptual semblance to the notion that certain types of drug related troubles reflect sufferers' "loss of control" over their personal behavior (Levine 1978). This has, in turn, provided, by far, the most politically effec- tive means for legitimating specifically therapeutic approaches over punitive approaches to solving drug related social problems (Baumohl and Room 1987; Musto 1987; Wiener 1981). Quite clearly, generic claims on behalf of "the disease theory of addiction" have been crucial in campaigns to promote therapeutic interventions at the level of public policy. But generic claims regarding the nature of drug problems do not determine how concrete instances of these problems are actually identified in practice (see Holstein and Miller 1993; Loseke 1999). To use the disease theory of addiction to foster solutions to the problems of particular people, one must be able to plausibly identify the symptoms of addiction-that is, the specific personal events held to have been caused by this disease. Of course, this is not only true of addiction. This problem is but one instance of the type/token problem that is encountered by both med- ical and non-medical diagnosticians of all diseases.

However, addiction is a very odd case of this problem in the following respect. Partici- pants in drug abuse treatment discourse must plausibly attribute to a disease agent, segments of personal behavior that, at first blush, often appear quite subtly adjusted to the social worlds in which alleged addicts live. In other words, the types of events that are held to qualify as symptoms of the disease, addiction, often look a good deal more like rational human conduct than do the types of events held to qualify as symptoms of other diseases. This can be seen in the following field note excerpt. Here, Lee explains why he had come to California and, then, immediately diagnoses that explanation as symptomatic of addiction. This remark was made without the slightest hint of irony or sarcasm,

It's warmer out here. That's the main thing. I was sick of being homeless in New York. New York is a shitty place to be homelessness. It's too damn cold there. But I guess that's thinking like an addict.

It is in light of talk like this that we may begin to understand the allure that images of a distinctive ecology of addiction have for participants in drug abuse treatment discourse. Though driven by fundamentally asocial appetites rather than rational self-interest, or any other specifically cultural endowments, the behavior of the active addict is, nonetheless, regarded as often subtly adjusted to an ecological niche that is more or less peculiar to addic- tion. By making recourse to such imagery, participants in drug abuse treatment discourse are able to fuse a sense of the addict's behavior as essentially antisocial and uncontrolled with the sense that it might, nonetheless, be exceptionally sly and/or well-honed to the demands of "the life." This fusion of guile and disease is well illustrated in the following discussion between Clarise and Bob. Clarise said,

"Mack relapsed." I asked what happened and she said, "Well, Mack finally got his retroactive SSI check. I guess they owed him several thousand dollars or something ... ." Bob laughed sarcastically and said, "Figures, don't it? He left me holdin' the bill to the cable too. He's got all this money all the sudden and he goes off leavin' me with the bill for the cable." Clarise asked, "It was his turn?" Bob said, "Think he'd leave when it was my turn? No way. That mother-fucker was goin' for all he could get. Dope fiend mother-fucker is all he is." Clarise said, "We've all done things like this, but that doesn't mean it ain't a shame. I thought Mack was doin' real good. I guess it just goes to show you, doesn't it, how destructive this disease can be?" Bob said, "Yep."

Given the institutionalized requirement that clients periodically construe sophisticated sequences of behavior as involuntary-caused by a disease-the image of the conniving, but impetuous "dope fiend" is of considerable conceptual utility. But what of the second basic

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tenet of drug abuse treatment discourse? How might a disease that is, by definition, beyond the personal control of the individual sufferer, be construed as somehow amenable to the con- trol of a group of sufferers linked as a therapeutic community? Social scientists have made a variety of important contributions to explaining the therapeutic process in group settings, but in doing so, we have generally forsaken the view that addictions are diseases in favor of a basically rational choice model. Stephens (1991) is only one of the more explicit expo- nents of this position,

The theme of this book has been that street addicts are generally, what I would refer to as "rational actors." To a large extent, they "choose" to become street addicts. However, remember that this "choice" is conditioned by the socioeconomic circumstances in which the vast majority of addicts find themselves. The street addict role is one of only a few relatively rewarding roles open to most persons who become street addicts. Therefore, we need not "blame the victims" for choosing one of the very limited numbers of available roles .... If the street addict role becomes too onerous. . ., or if other roles can be made more attractive, most persons will abandon the street addict role (p. 180).

No doubt, rational choice theory does, in fact, go a considerable distance in sociologically accounting for entrees into, and exits out of, episodes of heavy drug use (see Elster and Skog 1999). However, as a conceptual resource for participants in drug abuse treatment discourse, it is profoundly problematic. It is problematic because it compels program participants to think about their relapses, and, indeed, all of their behavior while addicted, as having been ratio- nally calculated. Adopting this conceptual framework summarily precludes attributing any behavior to the disease that program members use to conceptually justify their need for, and entitlement to, therapeutic assistance in the first place. Given their current mandate, partici- pants in drug abuse treatment discourse must somehow reconcile the view that they can be socially empowered to overcome their drug problems with the view that those problems are, indeed, caused by a disease over which they have little or no personal control.

This kind of social problems work does not require concepts that plausibly explain or jus- tify drug related activities; it specifically requires concepts that allow these activities to be plausibly disowned. It is only by plausibly distinguishing the actions of clients from the effects of their addictions, that clients might be simultaneously understood as amenable to the restor- ative influence of a therapeutic community and afflicted by the disease that, alone, justifies and demands that therapeutic engagement. Furthermore, participants in drug abuse treat- ment discourse require concepts that go beyond merely providing credible justification for absolution or disowning of past misdeeds. "Working a program" is an essentially ongoing exer- cise of anticipating and preventing the rekindling of people's putative problems with drugs, and it requires concepts that, not only facilitate, but actually warrant, such a project in the first place.

Insofar as it is precisely the therapeutic community-the ecology of the program-that is held to possess medicinal force, simple logic dictates that whatever forces are held to possess the potential for rekindling addiction (and that, alone, warrant ongoing participation in the program) must be located, as it were, ecologically elsewhere. There are, then, strong organiza- tional incentives for linking people's addictions with an unhealthful ecological space "out there," or beyond the confines of the program. These incentives stem from the distinctive practical logic of drug abuse treatment discourse-specifically, its demand that participants reconcile the view that they can be socially empowered to overcome their drug problems with the view that those problems are caused by a disease. The reality of this organizationally enforced conceptual puzzle, combined with abundant ethnographic testimony to the richly nuanced social organization of homeless street life and street drug and alcohol use, strongly suggests the following analytic conclusion: The recurrent accounts in my settings of a savage and unhealthful space "out there" flow less from participants' native familiarity with such a uniformly desolate space than from their subjective investment in the distinctive conceptual logic of contemporary drug abuse treatment discourse, itself.

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The Ecology of Addiction 619

There is a more general, though perhaps less original, conclusion that follows from this analysis as well. The ethnographic habit of distinguishing etic and emic orientations to social phenomena, or outsider and insider perspectives, can, all too easily, slip into a rather more methodologically dangerous distinction between those who possess first-hand knowledge of social phenomena and those who do not. Reliance on this later distinction will then, some- times, encourage us to think of the "local knowledge" of those who presently inhabit a social world as valid knowledge and all other perspectives as variously biased and/or distorted. Hence, in the present case, one may feel compelled to argue that the descriptions I have ana- lyzed here are somehow less valid than are those provided by people who remain active on the street drug scene. I think this would be a grave analytic mistake for two reasons.

First, although I have argued that there is good reason to believe my research subjects' reports were selective and perhaps, exaggerated, accounts of the negative dimensions of the street drug world, they were still as much "first-hand" reports as are those offered by people who remain in that world. Second, we must be cautious about attributing too much descrip- tive innocence to the accounts offered by people who remain on the street. While we are now decades past the prima facie prejudice that street drug users cannot be reliable interviewees, this does not mean their accounts are ever comprehensive, nor does it mean they are pristine (see Holstein and Gubrium 1995). Description is always partial, selective, and responsive to the practical activities within which it participates. Hence, rather than seeking only to distin- guish genuine truth tellers from the weavers of fictional yarns, a more methodologically sen- sible, and theoretically fruitful, course would be to locate, describe, and explain the shared activities within which, and specifically for which, description is undertaken. That is precisely what I have sought to do here.

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