Therapy and Punishment: Negotiating Authority in the Management of Drug Addiction

Abstract

Throughout the twentieth century, many behaviors previously considered criminal or immoral were instead defined as medical problems. This process is often referred to as the medicalization of deviance. Like many other behaviors once considered deviant, drug and alcohol abuse has been medicalizing, in a process that accelerated during the latter half of the twentieth century. Despite this movement along the path toward medicalization, drug use, and alcohol use to a lesser extent, are still also sanctioned and managed by the criminal justice system, resulting in a medical-legal-moral hybrid definition of these issues. Today we find instances where these two institutions overlap significantly. At the same time, their mutual involvement in defining and managing drug use is inconsistent. This research uses a qualitative research design to study how this medical-legal-moral hybrid definition of drug use and addiction is discussed and negotiated by various institutions that label and manage individuals who use drugs. I examined this issue by conducting interviews and observations in Philadelphia's Drug Treatment Court as well as in two outpatient drug treatment programs. Results indicate that individuals in both settings frame addiction as a "disease," although the definition is ambiguous and inconsistent. The court and the treatment programs use similar language and methods for assessing substance abuse and how to deal with it. Both also extend the definition of "addiction" to include aspects not directly related to the consumption of drugs or alcohol but to the "drug lifestyle" that includes selling drugs. Still, in neither location is a comprehensive, clear definition of "addiction" promoted and used consistently. This ambiguity results in an overlap of therapeutic and punitive methods to handle the individual's drug usage. In addition, both settings benefit from their interaction and cooperation in managing individuals with substance abuse problems, indicating that rather than moving toward a purely "medical" way of dealing with substance abuse, or placing the issue more firmly in the realm of the criminal justice system, the current mix of moral, criminal and medical methods of labeling and managing substance abuse problems may be more stagnant than the medicalization of deviance thesis suggests.