Construing clients with substance abuse problems as alcoholics

Abstract

The article is concerned with the way that a 12-step treatment programme construes a certain kind of image of its clients and their substance abuse problems. The main focus is on how the basic assumptions of the treatment programme are reproduced and maintained at the weekly meetings of the multiprofessional team running the programme. The article offers a behind-the-scenes look at the 12-step treatment programme: in particular, we are interested in the ways that the staff process and use the background information available on the clients admitted. We want to know how the methods and approaches used by the multiprofessional team shape and influence the kind of treatment that the clients will receive. Based originally on the AA recovery programme, the 12-step treatment programme draws on the disease concept of alcoholism. One of our main observations is that this disease concept is conducive to selective and purposive working methods in the programme. Information on the patients' background or their test results are systematically so interpreted that the outcome confirms the view that the clients are indeed alcoholics who can only be treated by methods that are consistent with the programme ideology. Strict normative expectations are placed upon clients in the programme, and any sign of deviation will be interpreted as resistance and reluctance on the part of substance abusers to deal with their own alcohol problems. In this way the programme itself may produce resistance among clients and the staff may easily elicit the resistance and denial that they regard as symptoms of alcoholism. A key focus in the article is on the interactive techniques and tactics applied in the programme to construe clients' alcohol problems in a manner that fits in with the institution's treatment culture. These techniques and tactics are studied using the methods of conversation analysis. The material consists of videorecordings from seven staff meetings in spring 1997, which have been transcribed in line with CA conventions. The focus of our analysis is not on spoken interaction, but we are chiefly interested in demonstrating how the institutional beliefs and values of the treatment programme determine the interactive planning of treatments.