Shane O’Mahony: The Neoliberalisation of Addiction Understandings in Ireland

16 Feb

ICRN is very pleased to host a guest blog from Shane O’Mahony, a PhD researcher at the University of Manchester. Shane is researching drug addiction in Ireland, approaching the issue from both an historical as well as a contemporary perspective. His research has involved conducting qualitative interviews with people who have drug addiction issues in his native Cork City.

The Neoliberalisation of Addiction Understandings in Ireland:

Continuities and Discontinuities in Irish Addiction History

It seems to me that the real political task in a society such as ours is to criticise the workings of institutions that appear to be both neutral and independent. To attack them in such a way that political violence which has always exerted itself obscurely through them, will be unmasked, so that one can fight against them‘ (Michel Foucault, Chomsky-Foucault debate 1971).

Many social commentators (see here and  here) have noted that a key feature of Neoliberal social policy globally, is a shift away from attempts to uncover the cause(s) of social problems, and toward an attempt to minimise the risks associated with them. In the case of crime and homelessness in Ireland, this has taken the form of a massive increase in the prison population (see IPRT here), as well as the passing of a number of legislative acts criminalising begging (see the Criminal Justice Act 2011 for example) and other behaviours which homeless individuals are likely to engage in (street drinking, and loitering, for example). At the same time we have witnessed, particularly since the 2008 financial crisis, a reduction in spending in social services which have traditionally attempted to alleviate social deprivation (seen as an important contextual factor in crime causation) and to provide social housing, and other measures intended to provide a safety net for the most vulnerable.

However, in the realm of addiction it seems, at least on the face of it, that Irish policy is moving in a more enlightened and humane direction. Indeed,  the Government’s most recent policy document entitled ‘Reducing Harm, Supporting Recovery: A Health-led Response to Drug and Alcohol Use in Ireland 2017-2025′ , argues that addiction is a health problem rather than a criminal one. Is it the case then that addiction policy in Ireland is running counter to domestic and international policy trends in relation to social problems? Or is there more to this development than the Government simply moving in the direction of a policy more sympathetic to those suffering with addiction?

The key to answering this question, I believe, is a reconceptualisation of how power operates, and of how our understandings and conceptualisations of social problems develop across time, along the lines suggested by Michel Foucault. Foucault argued famously that social theorists should ‘cut off the king’s head’. Cutting through Foucault’s grisly poetics, this can be interpreted as a call to shift our gaze from an excessive focus on the state – its policy, concepts, and influence – to a broader appreciation of the many and varied sites from which power can operate; often in subtle and powerful ways. This is potentially beneficial as there seems to be a tendency among those who analyse drug and alcohol policy in Ireland to create a dichotomy between vested interests on the one hand, and progressive campaigners interested only in the public good on the other.

In terms of alcohol policy this has taken the form of the alcohol industry, in particular the Vintner’s Association, being portrayed as nefarious and interested in only their bottom line, rejecting the ‘objective evidence’ demonstrating a link between alcohol advertising and binge-drinking. At the other side of this dichotomy, we find those supporting population-based alcohol consumption models (for example, the medical profession) who argue that certain supply and demand measures (minimum pricing, stricter regulation of advertising, for example) can tilt the balance of incentives and disincentives in favour of a reduction in total population consumption levels, and alcohol problems more generally. In terms of drug policy, the dichotomy is between reactionary drug war supporters arguing for criminalisation and punitive measures intended to punish addicts, and public-health inspired campaigners arguing in favour of viewing addiction as a medical issue. However, a Foucauldian inspired perspective enables us to look beyond such dichotomies.

This shift in focus alerts us to the fact that Irish thinking in relation to alcohol and drug problems has never been, and still isn’t, based on an objective appraisal of the available evidence. Indeed one does not have to think very hard to come to the realisation that such a conceptualisation is not even possible. Facts do not speak for themselves, they must be selected, analysed, and placed within a framework. As psychologists have taught us, such a process is extremely vulnerable to confirmation bias and to our deeply held beliefs and prejudices. Furthermore, as Jean-Francis Lyotard reminds us, the social world is infinitely complex and the narratives and frameworks we deploy in order to render it more understandable are always incomplete, contingent, and intimately influenced by broader political-economic and socio-cultural processes.

So it has been in the history of addiction in Ireland, and two crucial developments will illustrate this point. Shane Butler and Tony Jordan have conducted extensive research on the emergence of the disease concept of alcoholism in an Irish context. In a number of books and articles they demonstrate how the disease concept of alcoholism was accepted initially, not because of the weight of scientific evidence in its favour, but rather, due to broader socio-cultural and political-economic developments. Indeed, the crucial neuroscientific evidence in favour of the disease model only emerged decades later with the advent of modern medical technology (FMRIs etc). Alcoholics Anonymous (AA) and their ambassadors in Ireland had been trying to champion the disease theory since AA’s first European meeting was held in Dublin in 1946. However, initially they were met with an extremely hostile reaction from the Church, and indifference from government and the medical profession. This all changed in the late 1950s, and it is the timing that is crucial here.

The late 1950s represented a watershed in Irish history. The Government initiated its ‘First Programme for Economic Expansion’ which shifted Irish economic policy from a focus on protectionism and the promotion of native industry, to an aggressive policy of economic liberalism, free trade, and an attempt to attract foreign direct investment. Within this context, Ireland’s outdated and restrictive licensing laws came under attack. Indeed, in 1959 the country liberalised its licensing laws allowing for longer opening hours and easier access to alcohol in general. Despite the Catholic Church opposing this legislation, the Government quoted World Health Organisation research, which argued that alcoholism was a disease of a tiny number of susceptible individuals,  unrelated to population consumption levels. Furthermore, with the advent of foreign holidays and increasing access to the mass media, it is not surprising that the country at large became more receptive to the influence of global policy. Furthermore, the medical profession, eager to fall in line with international best practice, were at the forefront of setting up the Irish National Council on Alcoholism in the coming years. In relation to the Church, Butler and Jordan demonstrate that it was the AA’s ambassador’s theological and organisational sophistication which slowly broke down their resistance to the ‘alcoholism as a disease’ construct. I would add to this the fact that articles began to appear in The Furrow (the Church’s seminary journal), which highlighted alcohol problems among priests, and a drive to modernise the Church in the aftermath of the Second Vatican Council.

Today’s embrace of Neoliberalism – and its attendant focus on the risks related to alcohol and drug use – is no more an embrace of the objective evidence and a move towards a more enlightened policy, than was the acceptance of the ‘alcoholism as a disease’ concept. To better comprehend this shift, one need only examine the policy documents from the late 1990s to the present (see Rabbitte, 1997; Ryan, 2001; Ahern, 2005; Irish Government, 2013; Irish Government, 2017). Throughout each document we see a shift away from discussing causation and towards risk, minimising risk, inter-agency co-operation to contain disorder among those at risk, and, in particular, the need to minimise the risks associated with intravenous drug use. A similar trend is noticeable in the Irish Medical Journal, The Furrow, and indeed the media.

However, such a shift in addiction understandings can be located in a Neoliberal response to the disorder produced by socio-cultural and political-economic restructuring, in particular the 2008 financial crisis. Indeed, none of the policy documents mentioned, nor any articles published in The Furrow, or the Irish Medical Journal, examine the impact of structural readjustment on alcohol and drug related problems. Instead we find a prominent discourse which blames alcohol and drugs for a host of social problems including: crime, suicide, rape, sexual assault, and violence.  At the same time this discourse focuses overtly on minimising risk and eschews discussions of causation. This represents a type of ‘New Managerialism’ whereby market principles and ideologies are used to contain the disorders (or risks) associated with social problems and ‘problem populations’, which is indicative of Neoliberal social policy. Discussions of broader socio-cultural and political-economic processes are afforded little credence and a host of political commentators attempt to depoliticise social policy with calls for ‘evidence-based’ and ‘objective’ policy-making.

However, as has been demonstrated throughout, our thinking, understanding, and responses to alcohol and drug problems are overtly political and always have been. Rather than being based on objective evidence, addiction understandings are produced by power struggles within society and broader socio-cultural and political-economic processes. An approach to addiction policy and understanding, based on a Foucauldian (and indeed a broader post-structuralist) perspective, highlights this and encourages us to challenge those who would impose an ideological (Neoliberal) position under the guise of objective evidence-based policy. What Irish addiction policy and debate needs is more deep discussion of politics, economy, and philosophy, and less rhetoric in relation to ‘objective evidence and policy’. The most immediate political task, however, is to demonstrate the historically contingent and ideologically based nature of addiction understandings and responses. This has the potential to create an opportunity to challenge Neoliberal policy and responses which masquerade as objective science, and opens up the possibility to advocate for radical future alternatives. It is to this end the current piece hopes to contribute.

Citations

  1. Ahern, N. (2005) ‘Mid-term Review of the National Drugs Strategy 2001-2008’. Dublin: The Stationary Office. Available at: http://www.drugsandalcohol.ie/3887/1/2727-2914.pdf (Accessed: 29 June 2017).
  2. Rabbitte, P. (1997) Second Report of the Ministerial Task Force on Measures to Reduce the Demand for Drugs. Dublin: The Stationary Office. Available at: http://www.drugsandalcohol.ie/5114/1/542-0492.pdf (Accessed: 01 July 2017).
  3. Ryan, E. (2001) ‘Building on Experience: The National Drugs Strategy 2001 – 2008’. Dublin: The Stationary Office. Available at: http://www.drugsandalcohol.ie/5187/1/799-750.pdf (Accessed: 03 January 2018).
  4. Irish Government (2013) ‘National Drugs Strategy 2009-2016 Progress Report to End 2013’. Dublin: The Stationary Office. Available at: http://www.drugsandalcohol.ie/21621/1/National_Drugs_Strategy_2009-2016_2013_Review.pdf (Accessed: 05 July 2017).
  5. Irish Government. (2017) ‘Reducing Harm, Supporting Recovery: A Health-led Response to Drug and Alcohol Use in Ireland 2017-2025’. Department of Health: Dublin.
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