Contingencies of the will

Uses of harm reduction and the disease model of addiction among health care practitioners

Bibliographic Data

ID4218536
AuthorsKelly Szott (0000-0002-7866-0629, Syracuse University, USA; National Development and Research Institutes, USA, corresponding author)
Year2015
Volume19
Issue5
Pages507-522
Publication date2015-09-01
Open AccessYes
TypeARTICLE
VenueHealth An Interdisciplinary Journal for the Social Study of Health Illness and Medicine (JOURNAL)
Journal identifiersISSN: 1363-4593 • E-ISSN: 1461-7196
PublisherSAGE Publications Inc (PUBLISHER)
DOI10.1177/1363459314556904
PMID25394654
PMCIDPMC4430440
OpenAlexW2080823177
LanguageEN
Citations received10
References cited39

The concept of addiction as a disease is becoming firmly established in medical knowledge and practice at the same time as the logics of the harm reduction approach are gaining broader acceptance. How health care practitioners understand and intervene upon drug use among their patients is complicated by these two models. While harm reduction can be understood as a form of governmentality wherein drug-taking individuals express their regulated autonomy through self-governance, the notion of addiction as a disease removes the option of self-governance through negating the will of the individual. Through analysis of qualitative interviews conducted with 13 health care practitioners who provide care for economically marginalized people who use drugs in New York City, it was found that the absence of will articulated in constructions of addiction as disease offered a gateway through which health care practitioners could bring in ideological commitments associated with harm reduction, such as the de-stigmatization of drug use. Despite differences in the attribution of agency, sewing together these two approaches allowed health care practitioners to work with drug-using patients in practical and compassionate ways. This resembles the strategic deployment of diverse subjectivities found in feminist, post-structural liberatory projects wherein differential subjectification proves tactical and productive. Although drug-using patients may enjoy the benefits of practical and compassionate health care, the conjoint facilitation and denouncement of their will occasioned by the use of both harm reduction and the disease model of addiction imply their management by both pastoral and disciplinary technologies of power

Autonomy · Governmentality · Harm · Harm reduction · Health care · Political science · Public health · Public relations · Sociology · HIV, Drug Use, Sexual Risk · Medicine · Mental Health and Patient Involvement · Nursing · Psychology · Social Psychology · Substance Abuse Treatment and Outcomes

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