Concepts of addiction in Australia, Canada and Sweden: Research findings

In 2013 SSAC program leader Professor Suzanne Fraser began a program of research funded by an Australian Research Council (ARC) Future Fellowship. Initially focused on concepts of addiction in Australian and Canadian policy making and service provision, the program quickly grew to include a Swedish arm, and expanded, with the aid of additional funding support from Curtin University, into several other areas.

_MG_7045Working with research fellows Dr Kate Seear and Dr Robyn Dwyer, the program explored addiction and the law, addiction screening and diagnostic tools, and addiction in social media. Postgraduate students also joined the program, exploring drug education, drug courts, marginalised young people’s engagement with services and compulsory drug treatment in China. Next, the program expanded with a collaboration with Healthtalk Australia and further ARC funding to research experiences of addiction and build a website to offer richer and more balanced accounts of the lives of people affected by addiction. Run by Dr Kiran Pienaar and Dr Ella Dilkes-Frayne, the project produced

As Suzanne explains:

The fellowship acted as the catalyst for a much larger program of research, and produced new ideas and critical insights well beyond anything I anticipated when I first applied for it. I’m lucky to be working with incredible collaborators both inside and outside the National Drug Research Institute where I’m based, and to have received the ARC funding and further funding support from Curtin’s Office of Research and Development. I’m also incredibly grateful to the participants, who were so generous with their time and gave me so very much to think about. While this project is now reaching completion, it’s prompted so many questions and new directions that it’s going to influence my work for many years into the future.

Most recently, the program has begun new projects on take-home naloxone and performance and image-enhancing drug use, run by Dr Adrian Farrugia, Dr Aaron Hart, and Ms Renae Fomiatti, both also funded by the ARC. Overall, the program continues to expand and diversify, even as its original focus on concepts of addiction continues to inform SSAC’s analyses of the issues and problems facing the alcohol and other drug sector, and individuals affected by public drug-use debates.

While these new projects progress, Suzanne is bringing to a close the original international policy project that instigated all this work. The project and some of its key outcomes are summarised below.

Australian Research Council Future Fellowship (FT120100215): Analysing and comparing concepts of addiction for improved social and health outcomes in Australia

Australian federal and state governments spend billions of dollars per year responding to alcohol and other drug consumption. In doing so, they operationalise a wide range of prevention, education and treatment measures, all of which are the subject of intense public scrutiny and controversy. Prevention education initiatives, for example, attract criticism for reproducing social stigma. Government rhetoric on alcohol and other drug use is criticised for being at odds with program funding. Drug consumers are urged to seek treatment yet some experts have pointed out that its effectiveness is modest. As these debates suggest, alcohol and other drug policy and practice is a complex arena shaped in no small part by social and political forces, as well as longstanding unexamined assumptions about the origins, nature and meaning of drug use and addiction. Using qualitative interviewing, policy analysis and other methods across three sites, Australia, Canada and Sweden, this research project analysed a key concept underlying much of the political struggle over alcohol and other drug policy and service provision: addiction. Based primarily on 80 in-depth interviews with policymakers, service providers and advocates in three countries, the project produced a range of refereed journal articles and presentations, as well as a book. Each made different original arguments but the unifying concerns and findings were that:

  1. policymakers and service providers in all sites express a pronounced need for ways of framing and responding to regular drug use and ‘addiction’ that do not homogenise it or treat it as a simple medical or psychological problem or ‘brain disease’;
  2. public opinion and public engagement on the issue of addiction were significant concerns for policymakers and service providers, yet the composition and action of the public was poorly understood. Many participants expressed a sense of being heavily constrained by lack of public understanding in creating and implementing effective responses;
  3. addiction diagnoses can provide strategic benefits in creating simple labels to communicate with and attach resources to, but have very limited utility in characterising conduct, predicting outcomes or preventing problems. Alternative ways of framing the issues currently attributed to drug use and addiction need to be found;
  4. addiction screening and diagnostic tools contain many weaknesses and inconsistencies, and need to be reconsidered and revised; and
  5. social media and other public discussion of addiction demonstrates very limited public understanding and knowledge. Stigma is a key problem and improving public understanding of drug use issues is needed.

The project has involved a range of scholarly and public presentations, contributions to public enquiries, and publications. Key scholarly publications are:

Fraser, S., Moore, D. and Keane, H. (2014). Habits: Remaking addiction. Palgrave Macmillan, Basingstoke, UK.

Moore, D., Fraser, S., Törrönen, J. and Eriksson Tinghög, M. (2015). Sameness and difference: Metaphor and politics in the constitution of addiction, social exclusion and gender in Australian and Swedish drug policy. International Journal of Drug Policy, 26, (4), pp. 420-428.

Dwyer, R. and Fraser, S. (2015). Addiction screening and diagnostic tools: ‘Refuting’ and ‘unmasking’ claims to legitimacy. International Journal of Drug Policy, 26, (12), pp. 1189-1197.

Fraser, S. (2015). A thousand contradictory ways: Addiction, neuroscience and expert autobiography. Contemporary Drug Problems, 42, (1), pp. 38-59.

Fraser, S., Valentine, K. and Seear, K. (2016). Emergent publics of alcohol and other drug policymaking. Critical Policy Studies. Published online: 14 Oct 2016, Paper.

Dwyer, R. and Fraser, S. (2016). Addicting via hashtags: How is Twitter making addiction? Contemporary Drug Problems, 43, (1), pp. 79-97.

Fraser, S. (2016). Articulating addiction in alcohol and other drug policy: A multiverse of habits. International Journal of Drug Policy, 31, pp. 6-14.

Dwyer, R. and Fraser, S. (2016). Making addictions in standardised screening and diagnostic tools. Health Sociology Review, 25, (3), pp. 223–239.

Fraser, S. (2017). The future of ‘addiction’: Critique and composition. International Journal of Drug Policy, 44, pp. 130-134.

Farrugia, A.C. and Fraser, S. (2017). Prehending addiction: Alcohol and other drug professionals’ encounters with ‘new’ addictions. Qualitative Health Research, 27, (13), pp. 2042-2056.

Dwyer, R. and Fraser, S. (2017). Engendering drug problems: Materialising gender in the DUDIT and other screening and diagnostic ‘apparatuses’. International Journal of Drug Policy, 44, pp. 135-144.

Fraser, S. and Ekendahl, M. ‘Getting better’: The politics of comparison in addiction treatment and research. Contemporary Drug Problems. [In Press].

For further information on the broader program of research described above, explore the Social Studies of Addiction Concepts web site projects pages.

Please contact Suzanne Fraser if you have any questions about the research findings or would like access to publications: