Ordering clinical realities: Controversy and multiplicity in alcohol and other drug treatment for young adults

Abstract

BackgroundAlthough young adults receiving treatment for alcohol and other drug (AOD) use often experience disadvantaged life circumstances, there has been little qualitative research into how treatment agencies understand and respond to intersections between these life circumstances and the AOD use of their clients. MethodsThis article draws on analytic techniques from science and technology studies to detail how treatment clinicians become sensitive to client life circumstances; how therapeutic plans of action are formed; and how clients respond to these processes. Ethnographic data were gathered through interviews with clinicians and agency staff, documentary analysis and field observations in a public AOD clinic treating young adults in Melbourne, Australia. ResultsFindings detail emerging controversies concerning dependence, dosage, mental health and AOD comorbidities, forensic treatment, and resumption of use after treatment. ConclusionI argue that each controversy can be understood as a contest between aggregated, humanist and situated modes of ordering clinical phenomena. Aggregated modes of ordering are crafted for coherence at a population level and position AOD use as the primary problem in clients’ lives. Humanist modes of ordering foreground clients’ poor life circumstances and lack of resources, and frame treatment to address AOD use as benevolent. In situated modes of ordering, the effects of AOD use are transformed by emotional, social and material entanglements and AOD use is no longer necessarily the problem in clients’ lives. I conclude that, since clinicians seem to readily abandon aggregated approaches in favour of humanist ones, and humanist modes of ordering are often ineffective insofar as they are politically disempowering and engender client resistance, the scientific task of constructing practice tools for more situated approaches in clinical AOD treatment settings seems to be a priority.