Still a drug addict? methadone clients' identity work

Methadone maintenance treatment (MMT) for opioid addicts has been the subject of much debate and conflict in Sweden during the past 30 years, and it remains highly contested and controversial. Thresholds for gaining access are high and control policies strict within the programmes. Even though they attend a legitimate treatment, methadone clients are subject to a range of control measures and exclusionary practices due to their status as ex-heroin users. Urine tests delivered under surveillance are mandatory as security measures ‘in the clients’ best interest’, and supplementary drug use results in three months’ suspension from the program.

The dominant picture of heroin users in western society is negative, producing stigmatized identities. Categorization is not a neutral act, it changes the way people act and think about a phenomenon, a situation or an individual. Individuals defined as belonging to a problem category, such as ”drug addict” and ”homeless”, have to manage these attributed identities, either by acceptance or resistance.

The questions addressed in this paper are:  how do methadone clients construct their social identities and how do these self-identities relate to 1) their prior stigma as drug addicts, and 2) the institutional identities ascribed to them by and through MMT? This identity construction is studied through narrative ethnography. In particular, the narrative resources and larger discourses that the clients use to construct their identity are explored. The data of the study are qualitative; transcribed interviews as well as field notes from observations in waiting rooms, receptions and staff meetings in three MMT-clinics.

Drawing on prior work on the management of stigmatized identities this paper illustrates and analyses which categories and institutional identities MMT-clients construct for themselves, and how they respond to membership categorizations attributed to them by others.