The 1999 Stanton Peele Addiction Lecture (at Deakin University in Melbourne) was delivered by John Fitzgerald, of the University of Melbourne. John examines perspectives on drug use from the standpoint of narratives, or cognitive frameworks in terms of which we — particularly Westerners — interpret our worlds. Without changing these narratives, efforts to change policies for drug regulation face almost impossible odds, and may be doomed. Fitzgerald presents a consumer narrative of heroin use, and the consequences of this narrative for public health, law enforcement, users themselves, et al. Fitzgerald's work represents a brilliant conceptual shift for approaching drug use and addiction.

Further Reading

 

Deakin Addiction Policy Research Annual, 5:3-13, 1999 (Deakin University, Melbourne, Australia)
Reprinted with permission of Deakin University School of Psychology

The 1999 Stanton Peele Addiction Lecture:

Making New Drug Policy Narratives

John L. Fitzgerald

 

Introduction

It is a great honour for me to be able to deliver the 1999 Stanton Peele Addiction Lecture. I hope in a small way, I can contribute to the drug policy debate in a manner respectful of the enormous contribution most of us know Stanton Peele has made (Peele 1985; 1988; 1989 to name just a few). I suggest in this paper that we are at a critical moment in Australian drug policy. We have an opportunity to do more than refute policy argument; we can rewrite drug policy with new stories about drug use. This will involve the careful synthesis of new stories about what it means to use a psychoactive drug. This paper is an attempt to go beyond refutation and to tell a creative and synthetic story about regulating illicit drug use.

Over the past three years Australian drug policy has seen the failure of rational scientific argument (through the failure of the heroin feasibility study), the re-emergence of medical dominance (in the form of expanded pharmacotherapy) and the destabilisation of harm reduction. Single and Rohl (1997) in their review of harm reduction highlighted the multiple definitions of harm and the impact this has had on the capacity for strategic unity in drug policy. Harm reduction is almost dead and we need new drug policy stories.

Policy stories (or policy narratives as I will call them from now on) make decision-making possible. The narratives that underpin drug policy not only frame how we make decisions but make possible the spending of large amounts of money, influence the direction of knowledge and create jobs. Policy narratives can also create human misery through facilitating the spread of disease and through marginalisation of human capital. We are currently at the cross-roads for new drug policy in Australia, and we have the opportunity to choose in which direction we travel.

But why do I keep saying that we need a new policy narrative? Most would feel more comfortable if I said something like 'We need to re-kindle our commitment to harm reduction because the abstinence wolves are baying at our doors, ready to tear down all that harm reduction has struggled hard to establish'. Surely, rekindling the secure warmth of a familiar friend (in the form of harm reduction) is an eminently ethical story to tell. Abstinence advocates have always been opposed to public health and portraying them as wolves at the door ready to destroy our naïve and a-political harm reduction is a necessary story to tell at this time. This backs-against-the-wall story is a familiar one. There is a recognisable foe, there are familiar terms of debate and networks of interest who can be gathered together in the fight for the public good.

But I am not going to tell that story. In this article I will posit a different narrative. I am not going to put an empirical argument for rational drug policy, although it's easy to do so. Nor will I position an ideological story of the need for investment by good government in the social good, no matter the cost (which too is a convincing story). This is also not the time for a drug policy narrative that asks all of the stakeholders (law enforcement, welfare, treatment and public health) to sit around the policy table and come to a common policy position. No, I think it is time to tell a different story.

The core narrative for the current 1998/9-2002/3 National Drug Strategic Framework is 'Building Partnerships'. Why are we now building partnerships, surely we've had partnerships for some time? I would argue that the reason why the new hero of drug policy - partnership - is needed by government, is because the meaning of harm has fragmented as a consequence of its weakness as a policy tool. This weakness, now exposed, has allowed an opportunistic re-positioning of the abstinence narrative in the new National Drug Strategy.

Beneath the word 'partnership' is a story about two competing drug use metanarratives that up until now have coexisted in a precarious balance. On the one side, the liberal drug use narrative and on the other side the addiction/abstinence narrative have, since 1986, coexisted under the umbrella of harm reduction. But when Single and Rohl identified three different definitions of harm reduction in their review of the National Drug Strategy, and as a consequence questioned the very stability of the definition of harm, the capacity of harm reduction to provide a common policy objective began to falter. Sensing this, abstinence advocates have been able to reconfigure the balance of narrative power in the new National Drug Strategy in favour of the abstinence story. The most recent Australian HIV/AIDS strategy has also noted with concern the increased focus on abstinence in the National Drug Strategy.

In the 1993-1997, National Drug Strategy, the abstinence story had a limited role behind more pressing objectives:

Harm minimisation is an approach that aims to reduce the adverse health, social and economic consequences of alcohol and other drugs by minimising or limiting the harms and hazards of drug use for both the community and the individual without necessarily eliminating use.

(The National Drug Strategic Plan 1993-1997)

In the new Building Partnerships document abstinence has a far greater priority:

Harm minimisation refers to policies and programs aimed at reducing drug-related harm. Harm minimisation aims to improve health, social and economic outcomes for both the community and the individual and encompasses a wide range of integrated approaches, including

  • supply-reduction strategies designed to disrupt the production and supply of illicit drugs;
  • demand-reduction strategies designed to prevent the uptake of harmful drug use, including abstinence-oriented strategies to reduce drug use;
  • a range of targeted harm-reduction strategies designed to reduce drug-related harm for particular individuals and communities

(National Drug Strategic Framework 1998/9-2002/3),

The relative harmony that in the past harm reduction provided by bringing everyone to the same policy table has now been significantly breached. The new policy story Building Partnerships is an attempt to hide the fact that the previous common objective of reducing harm, can no longer bring people together as it did in the past.

So what is to be done in this political environment? How long can the partnership story balance the two oppositional metanarratives and thus hold the drug strategy together? Is there another way to view the current problem such that it doesn't always come down to a contest between two competing metanarratives about drug use? It is my belief that the two stories actually are not so different. Both stories, liberal drug use and addiction/abstinence have their roots in a common Western narrative about selfhood. Is there a way to write a new policy story that uses these common roots, but then escapes the problems with our current oppositions.

The common ground for both liberal and addiction/abstinence metanarratives is the committing of violence unto drug-using bodies in a continuing quest to be modern. Most of the policy options at present are modifications of this story. As Szasz (1974), Peele (1989), Klein (1993), Derrida (1995), Manderson (1995) and others have noted, the narratives that shape how we understand drug use are linked to core narratives about modernity itself. The rational, autonomous, wilful actor is always threatened by those substances that distract the hero from the lifelong quest for meaning. According to Derrida, the pharmakon or the substance of life, can be both poison and remedy (Derrida 1981; 1995). The pharmakon can both illuminate and delude. It is our ethical life practices that determine whether we can utilise the pharmakon without being waylaid by its traps. The Western stories that inform us of what it is to be ethical, are core narratives that are not easily shifted. These narratives of autonomous will, authentic pleasure and a productive lifelong quest for meaning are central to lawful and ethical selfhood (Derrida 1995). To challenge these narratives goes against the principles of what it is to be a self in modern life. The use of a psychoactive drug has occupied a dialectical position in these narratives (Szasz 1974; Lenson 1995). Drug users supposedly represent all that is against modern selfhood, it makes them less than rational, the pleasure they seek is inauthentic, and finally it distracts them from their quest for meaning by making them less productive.

We will never get outside the Western selfhood narrative, it is a central narrative for the Western industrialised world. To suggest otherwise is utopian and will ensure a failure of argument similar to what Szasz experienced in his overly libertarian writings (Szasz 1974). If you disagree with these stories and see the need for telling a new story about drug use, what do you do when seemingly the western world's core narratives are against you? You can, as the medical and social reformist lobby suggest, posit that drug users are sick and treat them for a disease of the will. You can posit, as naive law reformers do, that all we need to do is change the law and we will in turn, change modernity's selfhood narrative. You can take an economic line and say that drug users cost money, so we should spend less money on them, as the North American new right has suggested. Or you can take the harm reductionist approach and propose to maintain the narratives, but just reduce the coercive character of the punishment dealt to drug users. Alternatively, as I will do in this paper, you can attempt to tell another kind of story that uses the elements of the narratives it is criticising in its own narrative. But it is done in such a way so as to destabilise the story from the inside and to use the language of the narrative against itself. Some would call it a Trojan horse narrative, others call it a contraposition (Roe 1996). This technique is what I would call Deleuzian after the philosopher Gilles Deleuze.

Rather than further deconstruct existing drug policy narratives, I am going to tell about how we put a drug policy narrative together. It has within it the key elements of the story of modern selfhood: autonomous will, quest for meaning and authentic pleasure. However, it differs from the traditional narrative by suggesting that drug users possess the core elements of selfhood. The aim was to not to directly argue against existing Western narratives, but to establish a parallel narrative about drug users and to frame drug policy around the very qualities drug users were meant not to have. The story centres on the term 'regulation'. We created the regulation story carefully so as to be workable as a practical policy narrative, but also to very gently undermine Western discourse on drugged bodies and selfhood.

The following story is about how we put the regulation policy narrative together. This is a creative exercise and the story is not yet complete. However through telling this story I hope to illustrate the opportunities for making new drug policy that can take us out of the tired terrain of drug law reform and into the world of creative storytelling.

Mapping the regulation story

A few years ago a book by the French social theorists Gilles Deleuze and Felix Guattari, (A Thousand Plateaus) convinced me that deconstruction alone does not suffice if we are to be effective in our academic endeavours. Deleuze and Guattari (1987) suggest that rather than simply critique, we should map the world; create the world - through acting in it. Mapping should be done however not in a quest for the true, or to establish a ground for modern progress, but to continually remake the world and value the production of difference in all aspects of our lives. Early on I decided that the outcomes from the research should be put to work through the making of a new story about drug use, and that this new story should not be in essence a critical story, but a creative story - a making of something new; new ideas, new concepts and new challenges. More importantly, it shouldn't just have a practical quality of being a workable story, but this new story should force us to continue to question stories about drug use.

The story we constructed was centred on the word regulation. The regulation framework consisted of several uses of the term. Figure 1 shows a map of the regulation framework. There were two arms to the regulation framework. The practical use of the term regulation was documented in the publication Regulating the Street Heroin Market in Fitzroy/Collingwood (Fitzgerald, Broad & Dare 1999). A theoretical exploration of the term regulation was conducted in the publication Regulating capital (Fitzgerald & Hope 1999). Each arm of the strategy had a different set of policy narratives and a different set of audiences.

Regulating the street heroin market - Drug users as autonomous consumers

In Regulating the Street Heroin Market, we outlined the regulation strategy in the following way:

This report details an overarching framework to regulate the consumer drug market more effectively than is currently happening. This will reduce drug-related health harms, not only for users themselves, but for the wider community. Regulating the marketplace is founded on the principle that the marketplace is not simply about supply and demand. The illegal drug marketplace, like many others, is formed through patterns and styles of consumption. Regulation needs to encompass strategies across a number of domains:
  • Local Government
  • Drug users
  • Business community
  • Public health
  • Law enforcement
  • Outreach Services
Regulation of the marketplace in this sense means the deliberate attempt to control the places where drugs are consumed, how drugs are consumed and the behaviour of the drug consumer. The most dramatic changes to the street-level drug market have been consumer-led changes. Current attempts to regulate the supply side of the drug market will have little effect because the major influence on the drug marketplace resides with consumers rather than the suppliers of heroin. The regulation of the marketplace is an overarching framework for thinking about strategies for the reduction of harm. If the marketplace is consumer-driven then regulation needs to focus on the consumer rather than the supplier.
(Fitzgerald, Broad & Dare 1999, xv)

The emphasis in this policy framework is clear; drug users are consumers. Consumer behaviour is rational and part of mainstream life. Immediately, this brings drug users, like us all, into selfhood. They no longer have a disease of the will, experience inauthentic pleasure or have lost the quest for meaning. We are all consumers to some extent, so drug users couldn't therefore be much different to us. It was practical in the sense that it gave each stakeholder something to do. There was a level of coercion, however the coercion was in the form of regulating consumer culture. This framework applied the language of neo-liberal economics (regulation) to an area previously quarantined within the bounds of state responsibility. Regulation has recently gained ascendancy as an alternative to statutory codes in the regulation of industrial and corporate behaviour and is a central plank in neo-liberal political discourse. By applying the language of neo-liberalism to a domain of social life where the state had previously been dominant, an expected outcome from the introduction of regulation is the questioning of the role of Law/State in drug discourse. Thus the language of neo-liberal politics (regulation) is being used against itself, hopefully with a dual outcome of a change to current drug policy discourse and secondly with a questioning of neo-liberal discourse more generally.

Television news coverage of the report's release showed that there was an emerging 'take away heroin ethic'. This had the potential to be quite disruptive to discourse. The story was not that drug users were suffering terrible addiction at unprecedented levels, it was saying that drug user behaviour was similar to that of mainstream society. In addition to the underlying narrative of consumerism, the report also outlined some very practical strategies to control space, knowledge and behaviour. As a consequence, each of the stakeholders had a job to do, they could disagree with the job given, but at least everyone was allowed a place at the table and given something meaningful to do. The reception to the report was positive. Nobody was quite sure about this thing called 'regulation' but people began to toy with this new way of looking at drug use.

Regulation of the drug market is of course not a new idea. Many in the past have suggested that the drug market is poorly regulated and we should try to regulate it better (Erickson 1995). But regulation in the current sense is extended to encompass not just an illegal marketplace, but the regulation of behaviour, drug use practices and drug-using spaces.

Regulating capital

Regulation could be more than just the regulation of behaviour, space and drug use practices. The language of regulation could be applied to what is currently at the core of our national drug strategy: harm. Single & Rohl (1997) noted in their review of harm reduction that in addition to the old and new definitions of harm reduction, there was also an empirical definition for harm reduction. They noted that:

It is a flexible conceptualisation which, by calculating the net gain or loss for a program, encompasses any program which can be shown to actually reduce net harm. Conceptually it makes a clear distinction between programs which are harm minimisation and those which are not.

Disadvantages

The empirical evidence of drug-related harm is usually lacking so it is impossible to quantify a net gain or loss (Single & Rohl 1997).

Regulating capital (Fitzgerald & Hope 1999) outlined the regulating capital framework in detail. It was when we attempted to define and measure social harm that I confirmed, as Single and Rohl observed earlier, that harm is not a readily measurable quantity. We went further and suggested that rather than harm being hard to measure, harm was more accurately a political effect. As a consequence, harm remains undertheorised and in many respects analytically quite useless. Harm is not a 'given' as was previously thought. As was discussed in 1995 by a number of commentators, there was a risk that harm could mean anything you want it to mean (Erickson 1995; Single 1995; Wodak & Saunders 1995). Since that time, it was hoped that the definition of harm reduction would gain stability. Unfortunately, this hasn't been the case. There has been both a splitting of meaning and a more sophisticated attack on harm reduction from abstinence advocates.

At the core of harm reduction's problems was the ambivalence of the meaning of 'harm'. Policy consensus has become less and less likely as it has become clear that harm can mean many different things. The problem here is with the analytical power of harm. Therefore the new policy story must promise a more robust analytical and theoretical basis upon which to formulate a new policy framework.

When we tried to estimate the social impact of injecting drug use in Melbourne using a harm reduction framework, it became very clear that many of the 'harms' we were noting were more symbolic than material in their nature. For example, the appearance of syringes did not cause significant material/physical harm in (and of itself). It is the symbolic impact of the sight of syringes on the ground that can impact heavily on a community (Manderson 1995). Syringes symbolise danger and their symbolic weight cause material/economic harm through the costs of syringe disposal and law enforcement strategies to displace drug users from high profile city locations (Fitzgerald & Hope 1999). For the research, we needed to understand social impact through the symbolic presence of the signs of drug use in the community. The usual grid of harms approach (Figure 2) where harm of different types are cross-tabulated against its different levels (individual, community and society vs health social and economic) was however, not particularly helpful with understanding harm that was in the symbolic domain.

As a consequence of the critiques of harm reduction and our own empirical work, there were two areas of theoretical import that needed some attention. Firstly, it was our conclusion that the substance of harm is not a measurable quantity, and therefore an alternative language was needed to articulate what was at the basis of the perception of 'harm'. Secondly, we observed that the impact of drug use in one domain (symbolic) could be easily translated into other domains (economic), therefore the framework would need to be able to translate this movement. The Regulating Capital framework we proposed was based on the work of Pierre Bourdieu (1984). In this framework it was possible to be empirical about the substance of harm (capital) and to be able to map the shifts in capital from one form to another and thus show how things in the symbolic domain could be translated into material and economic effects. It was also possible to rank the symbolic capital associated with different anti-drug strategies, ranging from abstinence strategies through to more liberal strategies. In short it was now possible to look at the economic impact of symbolic harms and to assess public support for drug strategy in more concrete terms.

Most importantly the framework is not explicitly partisan for either of the two metanarratives (liberal and or abstinence) underpinning the current National Drug Strategy. Using an empirical basis for its analytical efficacy, regulating capital, as a policy framework is essentially empiricist and rationalist in its narrative. By shaping drug policy in terms of symbolic, political, cultural economic and social capital, rather than in terms of levels of drug use or levels of harm, any policies based on regulating capital by default will need to be more empirical in their design than policies based on harm. The empiricism is both in terms of measuring outcomes and in terms of monitoring public support for different strategies.

The underlying policy narrative implicit in regulating capital is about radical empiricism. This is in stark contrast to the building partnerships narrative of the current National Drug Strategy. The partnerships narrative, as previously noted, attempted to remedy the splitting of harm reduction. There is no attempt in regulating capital to attempt to salvage harm reduction. Nor is there a call to arms against the addiction/abstinence narrative. There is instead an explicit call for policy based on empirical valuation of the capital at stake for the community when it comes to managing drug use. By evaluating policy in terms of capital and by formulating policy on the symbolic capital associated with different forms of drug strategy (through community survey and monitoring) a new kind of narrative is being proposed that does not pit drug use metanarratives against each other.

There is an explicit attempt in the regulation narrative to bring drug policy discourse away from tabloid discourse and closer to mainstream public policy discourse. For many years drug policy has been different to other public policy issues. The strength of rhetoric over the loss of self in addiction is hard to argue against, and yet the pragmatics of supporting abstinence policies are hardly based on rational economic principles. In short, there seems to be few brownie-points for more liberal policy shifts, even when they would save money. The new language of regulation can open up new possibilities. For example microcredit small business schemes for young Southeast Asian drug users, instead of being called a government handout for drug addicts, could now be better described as an investment in social and cultural capital for better public health outcomes (Fitzgerald & O'Brien 1999).

Building new drug policy narratives

The move to basing drug policy on an empiricist framework such as regulating capital is as much calculated on evidence-based practice as a political tactic. Deleuze and Guattari are emphatic in their advocacy for political tactics that compel experts to continually rethink their practices. Libertarian drug policy critics have been critical of experts for the structures (maps) they create through which to control knowledge and ultimately individual subjectivity. Deleuze and Guattari are likewise critical of established discourses and institutions (such as psychoanalysis and criminology) that prevent the production of new ideas, however they offer a more positive strategy than stifling the activity of established institutions. Deleuze and Guattari believe that when one maps the world you construct the world and stratify the world into boundary lines. If this was all that occurred when constructing the world, then continuing to construct the world would be an overly oppressive practice that would reduce the possibility for new ideas. However Deleuze and Guattari believe that at the same time you stratify you also implicitly destratify and create the possibility for a different world. Thus inherent in every oppressive discourse/policy narrative there is always the possibility of new narratives; new uncontrollable discourses that can undermine the dominant stories. However, we must be vigilant in allowing these new stories to emerge by continuing to be committed to re-mapping the world in new and different ways, to enable the production of new and different ideas. It is when we refuse to appreciate the new that we will fail. Therefore we should map the drug policy arena with more vigor rather than to be continually delimited by the metanarratives that we have.

The moment is right for new stories. The regulation map was designed to assist a range of stakeholders in their work to continually re-map the world. In this case the imperative was to attempt to see drug policy in terms other than the two dominant metanarratives (liberal and addiction/abstinence). The regulation strategy has at its core a logic of radical empiricism that says you must re-map the world as often as you can in as many different ways that you can, so as to produce new ways to regulate. That is why we said that capital should be seen in five forms rather than in simply economic terms. Regulation was used in two senses (practical and theoretical), not to confuse people (although this is a distinct possibility), but to firstly, be practical and secondly to get people thinking about the term in different ways.

In regulation, there is no attempt to get outside the western narrative of a controlled and controlling self. Rather, the regulation narrative accepts that we have to regulate the use of drugs and the best thing we can do is to regulate drug use in the most ethical manner possible. This of course negates both the liberal narrative of the right of an individual to use drugs and at the same time, undermines the abstinence narrative.

This was a story about the making of a new drug policy narrative. Regulation may or may not be a successful policy narrative, however I hope the story has sparked some questions about the role of story in our drug policy debates. Please examine the work I have described briefly in this paper and discuss it. The stories themselves may not be the final answer, however, hopefully through the debate, we may find some new stories for our drug policy.

To conclude, I would like to thank the advisory panel of the Stanton Peele Addiction Lecture for their support and encouragement throughout this year. It has been a stimulating year and one that has seen the production of some interesting developments in drug policy. I wish next years recipient well and encourage them to be creative in the dual task of finding ways for people to achieve, as Stanton has said, joy and competence in the world.

 

Figure 1. Outline of the Regulation Strategy
Outline of the Regulation Strategy

 

Figure 2. Newcombe (1992) Framework for Drug-Related Harm
Type of harm Level of harm
 

Individual

Community

Society

Health

     

Social

     

Economic

     

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