The Stigmatizing Semantics of Methadone Maintenance Treatment

People who use heroin are often described as one of western society’s most stigmatized and marginalized groups. In public discourse, people associated with heroin use are construed as unruly, lacking self-control and generally bad persons. Negative representations of the heroin addict are also reflected in the regulatory framework surrounding Swedish methadone maintenance treatment (MMT) – the most common treatment practice for heroin addicts – which is based on a basic idea that the treatment not only could, but also should lead to a normalization of the clients’ lives.

In this paper, the everyday semantics of Swedish MMT is put under scrutiny. The analysis based on a local, qualitative study exposes that the professional power is not as objective, neutral and fair as portrayed by national guidelines, policy documents and the professionals’ talk. Methods developed in critical discourse analysis and discourse psychology are used in order to analyse a number of key concepts used in everyday clinic practice. For example, at the clinics, “drug-free” and “drug-abuse” are two frequently occurring concepts that are difficult to define because they are not related to the drugs themselves, but to the question of when and how the narcotic substances have been used, as well as who has decided that they should be used. Analysis shows, that according to the professionals’ talk, it is possible to live a “drug-free”, “normal” life with methadone, as long as it is distributed by the clinics and ingested according to the staff’s recommendations, while taking the same amount of drugs obtained from a source other than the clinic is defined as “drug abuse”, legitimizing sanctions of more disciplinary kinds. However, the effects of the disciplinary exercise of power are counteracted by the clients’ modes of resistance, such as subversive interpretations of staffs’ arguments or “narratives of resistance”.