A steady march toward the deconstruction of addiction and recovery

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I want to add one thought to Brian’s recent post about the study of a residential SUD program integrating the use of cannabis as part of their care.

For me, this is representative of a steady march toward the deconstruction of addiction and recovery. If addiction is a social construction and recovery has no conceptual boundaries, this approach makes perfect sense.

Other posts have addressed the impact of the DSM-5’s shift to SUD; the unintended consequences of focusing on substance-specific use disorders; multiple pathways greatly expanding not just the number of pathways, but also greatly expanding the boundaries of the prerequisite problem and recovery; and the public health shift toward looking at drug problems through their population-level lens.

One mechanism of that deconstruction has been stigma reduction as a core value of paramount importance.

The article devoted considerable attention to stigma and frames skepticism of the treatment approach as rooted in stigma emanating from the war on drugs, an irrational emphasis on abstinence from 12-step groups, a lack of understanding about medical cannabis, and a lack of understanding about harm reduction.

The article itself mentioned that staff were not informed of the trial and harbored doubts. The authors seem to assume that this is stigma, and not an artifact of organizational culture issues (like lack of communication), or that adjunctive cannabis is not an evidence-based practice for SUDs, especially SUDs severe enough to justify residential treatment. Why?

Representing staff who harbor concerns about this approach as agents of stigma is a troubling assertion. Stigma is dehumanizing and delegitimizing the person rather than a behavior, belief, or feeling. It’s pervasive and often permanent, and escaping it, where possible, would require not just changing a behavior but disavowing an identity.

Disagreement isn’t stigma.