Abstract
In this article we consider the process of adjustment from active street sex work to life in structured substance abuse treatment among Detroit-area women who participated in a semicoercive program administered through a drug court. We examine this transition in terms of changes in daily routines and social networks, drawing on extensive qualitative data to illuminate the ways in which women defined their own situations. Using concepts from Bourdieu and Latour as analytical aids, we analyze the role of daily routines, environments, and networks in producing the shifts in identity that those who embraced the goals of recovery demonstrated. We conclude with a discussion of how the restrictive environments and redundant situations experienced by women in treatment could be paradoxically embraced as a means to achieve expanded opportunity and enhanced individual responsibility because women effectively reassembled their social networks and identities to align with the goals of recovery.
Keywords
Entering residential substance abuse treatment from active drug use involves a dramatic transition under any circumstances. In this article, we examine accounts of Detroit-area women who abruptly and involuntarily left the world of drug use and street sex work as a result of a court-administered program that aggressively enforced jail terms for minor offenses. They faced the option of serving an entire jail term, which might amount to several months, or entering a residential substance abuse treatment program that provided substantial wraparound support services, including health care. In effect, both positive and negative incentives foisted the role exit process on them. The process compressed Ebaugh’s stages of role exit, such as the weighing of alternatives and the negotiation of turning points, both spatially and temporally.
We refer to the program as semicoercive because it did not strictly enforce participation in substance abuse treatment. The women all had the option of forgoing treatment and choosing jail time instead, and in fact some did take this route. For those who entered the program, however, the abrupt “knifing off” (Maruna & Roy, 2007) of street and drug relations inevitably left a void to be filled, in terms of both daily activities and relationships. Perhaps even more significantly, this abrupt change entailed a process of internal adjustment, of emotion and identity work, which ideally legitimated the separation from drugs and the street and provided a foundation for developing an identity and a set of activities that did not include these previous activities and associations.
We apply the concepts of habitus (Bourdieu, 1977, 1990) and plug-ins (Latour, 2005) in our analysis of women’s accounts of their transition from active substance use to a recovery-oriented existence. We contend that the treatment and recovery process amounts to a deliberate modification or reconstruction of habitus, which itself engenders an incremental resocializing for women both as individuals and as a group. We consider how recovery-based concepts, networks, and routines combine to produce modified identities within this program setting. After discussing the ideas of Bourdieu and Latour, we consider the importance of social networks and daily routines as key components of the recovery process. We then provide a brief description of the program, our methods, and our approach, followed by detailed examples from our qualitative interviews that illustrate the transition to treatment and recovery as a structured sequence of external routines and associations and as an evolution of internalized identity. We conclude with a discussion of our findings and the potential application of these concepts to further research and clinical or community-based practice.
Background
Treatment professionals and scholars have defined recovery from substance abuse as an individualized, unfolding process of growth that consists of many phases and modes of action ranging from incremental steps to transformative epiphanies and from external restrictions to internal decisions (Gagne, White, & Anthony, 2007; Laudet, 2008; White, 2007). Kellogg (1993) used identity theory to examine the process by which people in recovery separate from old identities that are often based on substance use behaviors and networks, and construct new ones based on alternative paradigms, most commonly those supplied by 12-step ideology. Likewise, Eastland (1995) examined recovery as a reflexive, interactive process in which identity is actively reconstructed, and Maruna and Roy (2007) asserted that the process of developing “life scripts” or “scripts for the future” is just as significant as that of desistance from or “knifing off” of old relationships (pp. 120–121). This process amounts to a deliberate alteration of the self.
Bourdieu’s concept of habitus (1977, 1990) is useful here. Bourdieu defined habitus as “the durably installed generative principle of regulated improvisations” that “produces practices which tend to reproduce the regularities immanent in the objective conditions of the production of the generative principle” (1977, p. 78). In other words, individuals tend to act out, as agents, the roles that they have been socialized to perform, and in so doing they recreate the very social order that formed them. If we view addictive behavior through the lens of habitus, such behavior appears as both a reflection of external constraints and a conscious choice, albeit one made within a narrow range of alternatives. According to Bourdieu, the very perception of what is possible is often structured in advance by a system of accepted classifications, or doxa, that functions to legitimate an existing order, making it seem natural or inevitable (1977, pp. 163–166). Other alternative actions or responses might exist, but the individual is conditioned in advance to ignore or dismiss them.
Through habitus, social structures, “both externally imposed and internalized” (Byrne & Callaghan, 2014, p. 11), are embodied within individuals. To undo or revise such a deeply embedded adaptation requires extensive, simultaneous modification of both the exterior environment (constraints) and internal thought processes (choices). Within recovery and recovery settings, this requirement is explicit. The treatment process represents a deliberate attempt to “reassemble the social” (Latour, 2005) for substance-using individuals, substituting new associations for old ones and thereby producing not only a “new” person but a new social reality surrounding that person. These associations function as “plug-ins” (Latour, 2005, p. 207) and are adopted with the same sense of mechanical functionality, in that one needs to unplug from the old associations and plug into new ones to become a person in recovery.
What recovery consists of in practice therefore diverges somewhat from its rhetoric. A vocabulary and ideology of spiritual transformation and transcendence underlies the process of recovery (Eastland, 1995; Kellogg, 1993); however, many daily routines and rituals of recovery are repetitive and mundane. Even though this divergence might seem like a contradiction on the surface, it makes sense when the concepts of habitus and plug-ins are applied. Although some scholars view Bourdieu’s (1977, 1990) brand of critical social theory and Latour’s (2005) Actor Network Theory (ANT) as being at odds, we contend that these concepts reinforce each other in the case of recovery. As we engaged with this population and their situations, we observed that integrating the seemingly oppositional aspects of recovery was one of the central tasks of the residential treatment program.
Scholars who are critical of the recovery approach, such as Lerum (1999), have highlighted the ways in which leaders of recovery programs frame phenomena such as sex work and substance use as individual problems or pathologies, and how this framework fits conveniently with the imperatives of a bureaucratic state system (itself a form of doxa). Likewise, McIntosh and McKeganey (2000) and Moore and Fraser (2013) have examined the processes by which narratives of recovery and definitions of addiction are socially constructed in ways that match institutional goals. Fischer (2003) has critically evaluated the political and ideological implications of the drug court model. The criticism is that people in recovery are expected to take responsibility for their own actions even though those actions are often a direct result of social and institutional constructs.
In this article, we do not take a position on the political framing of sex work or drug court programs. Instead, we try to understand the transition that women in treatment experience, and how they make sense of their daily realities and associations. Taking a cue from Duff (2011b), we aspire to engage in “the patient labour of documenting the myriad associations by which ‘societies’ are created in everyday life” (p. 406). In this case, we examine the constellation of people, places, and institutions engaged in the process of treatment and recovery. This examination requires us to pay attention to the framings that individuals themselves employ, while also noting the potential sources of those framings as revealed in documented associations. To do so, we focus on two main areas: social networks and daily routines.
Networks and Routines
Social networks consist of structured sets of relation-ships between social entities, including not only indivi-duals but also organizations and institutions (Luke & Harris, 2007; Pescosolido & Levy, 2002). Networks are a primary mechanism that links individual behaviors and health outcomes to larger social structures and forces (Berkman, Glass, Brissette, & Seeman, 2000; Pescosolido, 2006). Considerable evidence connects social networks and relationships with the likelihood of initiating and continuing patterns of problem drug use (Schroeder et al., 2001), the likelihood of seeking treatment, and the effectiveness of treatment. Relapse into substance abuse correlates with social factors such as poor housing status, limited social support, and lack of drug treatment (Mayer et al., 1993).
Conversely, researchers have found associations of successful recovery with living in residential treatment programs (Rollins, O’Neill, Davis, & Devitt, 2005) and with other measures of positive social support within local or family networks (Barber & Crisp, 1995; Flynn, Joe, Broome, Simpson, & Brown, 2003; McMahon, 2001; Trulsson & Hedin, 2004). The classic work of Waldorf and Biernacki (Biernacki, 1986; Waldorf, 1983; Waldorf & Biernacki, 1979, 1981) also highlights the interconnection between the assumption of new social roles and the adoption or activation of alternative social networks. Woodhouse (1992) and Kearney (1998) used life histories and meta-analysis of qualitative research to examine how women in recovery settings construct identities and alternative narratives. More recently, Leverentz (2010) and Opsal (2011) conducted interview-based studies with woman ex-offenders in Chicago and Denver in which the researchers examined the reframing of contexts and interior identity work that enabled women to harmonize their stigmatized pasts with conventional or hegemonic goals.
The latter two researchers place more emphasis on the top–down influence of dominant societal values, whereas Woodhouse (1992) and Kearney (1998) focused on the bottom–up potential of women’s transformative processes. However, they all stressed the agency of individual women in crafting both narratives and identity to respond and adapt to changing life circumstances. In this respect their work reflects a humanist paradigm. A posthumanist (Weinberg, 2013) approach such as ANT offers the possibility of considering not only conscious, reflective individuals as agents but also places, systems, substances, and objects as actants. In this article, we consider how the assemblage of recovery “plugs in” as a substitute for the assemblage of “people, places, and things” (Leverentz, 2010) that defined the lives of sex workers in the street.
Research Setting
The Sex Worker Program (SWP) was a Detroit-based substance-abuse intervention program for female street sex workers who had come into repeated contact with law enforcement. The SWP involved a partnership between city and county law enforcement agencies, the health department, service providers, and the drug treatment court. The program addressed the specific needs and challenges of female street sex workers by providing services such as transitional housing, medical treatment, and job training. The stated goals of the SWP were to remove women from active street prostitution, provide treatment for substance dependency, and foster engagement in the Detroit-area recovery community.
The SWP had a three-phase structure. In the first phase, city police arrested women in planned sweeps. Police identified a target neighborhood at least one week in advance of the evening sweep. They typically arrested the women on a Friday evening and took them to the centrally located city jail. The judge of the drug treatment court preferred that the women have the weekend to detoxify before their court appearance on Monday morning. Women who qualified for the SWP, typically those with eight or more outstanding misdemeanor charges for pandering, were diverted from the regular criminal court to the drug treatment court. They then appeared before the judge, who offered the program to them during arraignment. According to the wishes of the judge, the SWP began with a 30-day stay in jail, during which the program administrators explained the expectations to the women and the women began counseling for their substance abuse.
Women who chose to accept the judge’s offer to enroll in the SWP returned to the drug treatment court. The judge assigned them to a residential treatment facility where they began full-time treatment for substance abuse as soon as they completed their 30-day jail term. During the initial phase of residential treatment, the women appeared before the judge at least monthly. The judge and the case managers, who had weekly contact with the women, reassessed the period required for residential treatment (30 to 90 days). After successful completion of residential treatment, the women were assigned 1 to 2 years in transitional housing. The women later transitioned to independent housing, with the timing of the transition depending on factors such as employment status, preference, and availability.
In the sections that follow, we examine the situations of women who moved from the first phase, in the jail, to the second phase, residential treatment. We explore, in particular, how these women described their transition from one role to another, with all the accompanying changes in routines, associations, and identities. The treatment phase involved adaptation to a new setting and adjustment to a new role. At the same time, it required making sense of preceding phases, potentially including each woman’s entire life course up to that point.
Methods and Sample
We developed our study after months of close interaction with SWP participants at a variety of levels: program and agency officials; employees such as substance abuse counselors, police, and drug court representatives; and current and former clients (Roddy, Draus, Asabigi, & White, 2013). The research proposal, funded by the National Institute on Drug Abuse in 2009, involved a proposed sample of 100 women at various stages of the treatment and recovery process. The final number of study participants was 94, 44% of whom were African American and 54% of whom were White or Other (Native American, Latina, or Asian American). The participants’ mean age was 39 years.
Our approach combined specific analytical tools drawn from economics and sociology and reflected the influence of the story that program officials and representatives told us concerning the effectiveness of the program and its mechanisms of action. In particular, we repeatedly heard that people in the treatment program turned from social liabilities into taxpaying citizens and that individuals converted their capacities from destructive to productive uses as their mindsets transformed. In other words, participants in the program demonstrated significant internal or identity change as well as corresponding changes in external behaviors and resources. We therefore designed our research to capture these changes in both subjective and objective terms.
Because participants conceptualized the recovery program as a phased process, we chose to focus our study on phases of change. We predicted that social networks would reflect both economic and social constraints and that the expansion of networks would correlate with expanded opportunity and resources, especially in the third phase. However, we also planned to examine the “internal conversations” (Archer, 2003, 2007) that women engaged in throughout this process. An open-ended qualitative interview structure provided a flexible framework for capturing how participants defined their situation in comparison to past experiences as well as future plans. The interview style was semireflective, and although we informed the participants that the interviews had no therapeutic purpose, some stated that they found the interviews helpful because of this interactive reflection.
With every participant, we also employed a “daily routines” exercise designed to elicit social network data while simultaneously generating descriptions of quotidian experiences. We asked participants to describe a typical day, using a timetable format to go through the day from beginning to end. We asked them to note people and places encountered in the course of the day, as well as regular activities. Finally, we utilized an economic interview, in which we gathered self-reported data on monthly resources and expenditures, to produce data that we could compare across participants and phases and correlate with treatment outcomes.
The Institutional Review Board at the University of Michigan, Ann Arbor, approved the final study proposal. In addition, we obtained a certificate of confidentiality from the U.S. Department of Health and Human Services to protect sensitive information. We conducted all interviews in private settings, with only the participant and the two university investigators present (Draus and Roddy). In the interviews that we completed within correctional settings, we secured private rooms with no officers present.
Our goal was to understand the full context of recovery. We expected that external changes in social networks, geographic settings, and economic resources and opportunities would accompany the desired behavioral and identity changes. Although we interviewed individual women, we did not attempt to measure the correlates of change in individual women across the different phases. Instead we sought to characterize changes as the women within each phase described them. In combination, our methods produced nuanced and granular accounts of the treatment and recovery process as the women themselves experienced it. This approach fit well with the paradigm of ANT, with its insistence on the importance of assemblages of individuals, associations, and nonhuman actants. As Latour (2005) stated, “Actors do the sociology for the sociologists and sociologists learn from the actors what makes up their set of associations” (p. 32).
We audio recorded all of the interviews and transcribed them verbatim with names removed; we later coded the transcripts using QSR International’s (2010) NVivo 9 qualitative data analysis software and analyzed them using the constant comparative cycle described by Boeije (2002) to identify emergent themes and persistent patterns. This article represents the outcome several cycles of analysis. The theme of redundant situations emerged in the interviews while we were still collecting data, and we presented some preliminary findings at a small research conference. Although we based our initial qualitative approach on the traditional humanist or interpretive model of ethnography, designed to elicit participants’ perspectives on their own situation, we became interested in posthumanist approaches precisely because of the themes that emerged in the research process.
After we collected the final data, we engaged in more systematic coding of the interviews, this time informed by posthumanist perspectives. In the sections that follow, we draw on the interview data in an analysis grounded in the lifeworlds of study participants and informed by theory. We examine the meaning of recovery in terms of both individual meaning making and concrete associations as captured in the record of daily routines and economic resources. We include interview segments that are minimally edited to preserve the flow of the interaction between interviewer and participant while also capturing significant empirical details, especially those related to ANT-like associations.
Findings
Chaos and Routine: From the Streets to Treatment
As noted, the women, who had actively engaged in routines centered on the street economy, experienced a sudden transition to the treatment setting. The following account from a participant shows how this abrupt shift actually spurred the same process of considering alternatives that Ebaugh (1988) described: I was walking down the street, often alone, just all of us over there and he stopped me, put me against the car. I had five unpaid tickets: flagging, paraphernalia, flagging, paraphernalia, and disorderly conduct. I was scared to serve the time so I thought maybe I could just go to rehab [rehabilitation] and complete and be done. Then I found out that when I signed this contract, it’s fifteen months long and I wanted out so bad though because I wanted to run or get high—to where I signed the contract for an opportunity to take off and I just never did. I ended up getting the desire back to stay clean and not wanting to go back to that. Things were starting to get better. I got my ID [state identification card]. I have to start paying the responsibility fees to get my license back. I’m going to go back to school.
We note here the correlation between the particular manifestations and requirements of various systems that this woman entering the SWP experienced and her own thinking or intentionality, expressed here as her “desire to stay clean.”
In this short passage, we see a number of examples. On the street side are the unpaid tickets, the drug paraphernalia, and the police who are empowered to enforce laws prohibiting prostitution-related behaviors, here referenced as “flagging.” When she entered the jail, the judge offered her the opportunity to sign up for the SWP, and she did so because it offered the possibility of getting out of jail and going back to the street, “to run or get high.” Then the mechanics of the program kicked in: getting a state identification card, paying “responsibility fees” to get her driver’s license reinstated, and finally, “going back to school.” Each of these listed items represents a concrete action, item, or contact point and a particular relationship to an organizational or institutional entity. In the woman’s account, these somewhat mechanical steps took on a deeper significance as a turning point: “Things were starting to get better.”
Another woman, who had recently completed the SWP, characterized her staged transition in terms of corresponding shifts in mobility:
I went from walking to riding a bus to driving my own car.…I was walking the streets as of two thousand six. I got in SWP and I was able to get bus passes from two thousand seven to two thousand eight.
So you say walking in the streets. This is before you were in the program?
[Sniffs] Right.
How would you characterize your life at that time in terms of—what you were doing?
In my addiction time? Characterize it with?
Compared to what you just talked about here—like your daily routine.
Well, it, that too was a routine—it was just a real narrow-minded routine.
Well, tell me more about that.
It was always on the go. You were either using [drugs], making money, or trying to take money. Sleep wasn’t—[laughs], you know, it came when you passed out. That’s about it—that—that just narrowed it right down.…Everything that I did, I did within a five-block radius. I could—I could grab a trick, a hotel, a liquor store, a dope house, and a Coney Island [a generic name for a particular type of diner or fast-food restaurant that is common in Detroit] all within a five-block radius.…I never had to leave the neighborhood—everything was within a five-block radius, all day long.
So that was—what were the things again you said—a trick, a dope house?
A dope house, a Coney Island, a liquor store, and a hotel.
Where you were staying at the time? Did you have a place to stay?
You mean when I was in my addiction?
Yeah.
No, I—all within, between, okay we could range it more in a mile—a one-mile radius and that’s pushing it. There were probably four hotels to rotate around. You could get them by the week, by the night; somebody always had one and ten people would sleep in them. Or somebody had a smoke-in house, where you could purchase smoke and stay as long as you were buying and you took up your time that way, because you’d be up for two, three days at a time sometimes.
We then asked the woman to describe the transition from this chaotic but routine street environment to the routines of the SWP: First you had to schedule your sleep; you had to like, get that down. It took a long time for a lot of women—and I could witness that—to even not sleep on the floors because that was a secure foundation.…But we started with morning routines and you had to learn—there was a time to sleep and there was a time not to. They had a daily schedule for you as far as you could—shower and get yourself together between six a.m. and eight-thirty a.m.—you had two and half hours to get yourself together. By eight-thirty you either had chores or you had something to do out the door. You had to keep a daily log of everything—all the activities you did within and turned them in weekly. Now to this day, I do the same thing. I have a certain amount of time I know it takes me to get up, wake up, and be out that door. I could be ready within an hour; I have my day planned ahead of time. I have a schedule and once that schedule—once my—I’ve completed my list for the day, sometimes it will be three [o’clock] in the afternoon. I’m in for the night…then some days I don’t even have to leave the house, but don’t think I sit around and watch TV. I’ll make a list this long when I wake up in the morning—all the things I want to get done in the house.
In this account, we see both the before-treatment and the after-treatment routines discussed in some detail. Thinking in ANT terms, we especially note the associations between external places, people, and activities, and internal processes, decisions, and adjustments. The shift from worse to better circumstances represented a common theme in the qualitative interviews we conducted, although the women did not always welcome the steps in the process and often questioned and sometimes resisted them.
In the qualitative interviews we asked women to comment on their current life position and how it compared to their previous life—however they chose to interpret the question. Many participants described the material environment of the street phase in very concrete terms: “A dope house, a Coney Island, a liquor store, and a hotel.” In the treatment phase, they focused not on places but on time: on making and following schedules. They internalized these schedules, as a structuring component of the external environment, through a deliberate device: “You had to keep a daily log of everything—all the activities you did within and turned them in weekly.”
We sum up the contrast between the two phases by noting that the imposition of the schedule exerted a form of control over both the environment and the individual. The participants also stated the contrast in terms of a transition from constrained to expanded mobility: “I went from walking to riding a bus to driving my own car.” Although one might question whether driving a car actually makes one more independent or self-sufficient than walking or riding a bus, in the participant’s context this change represented a clear improvement. Other things that regularly structured the days of women in treatment include meals, chores, groups, and appointments with various categories of helping professionals or regulatory officials: doctors, counselors, court representatives, and laboratory technicians who collected urine for drug testing. All of these elements added up to crowded daily schedules that oddly paralleled the day-in, day-out grind of the street hustle.
The participants nevertheless distinguished the movement from one “narrow-minded routine” to another by what those routines represented. In the following interview sequence, a woman drew a distinction between chaos and productivity, between existing “on an animal level” and being considered “responsible”:
Why don’t you just tell me a little bit about your life as it is today?
Well, it is less chaotic. It is more productive. Right now today, I am a more responsible parent. And of course, I am clean. Not being involved with a lot of street nonsense due to my addiction.
Okay. It is less chaotic?
Yes.
More productive. Can you elaborate on what you mean by each of those things?
Well, the chaos actually came from being in the streets around people that just don’t give a damn. You put yourself at risk, so I would just say I put myself in less risk now. I am not being bothered with the trade-off on the streets. Being more productive—I would say, as far as getting up and taking care of my business, being responsible for it. That is an important thing. Getting ID’d and just knowing where the day sits—you know?
Yeah.
And seeing my daughter—I see my daughter now more than when I was using. I spend more time with her, take part in her schooling.
When you say productive, it is like getting things—
Done. Getting things done. I haven’t quite got a job yet so—
Right, so—sometimes productive can mean, some people think about things you are producing or money you are producing.
Okay. I ain’t producing none but positive images right now.
Okay, well, that is good. How would you compare your life today to how it has been in the past? You talked about the chaos on the streets and stuff like that.
Yeah. Well, you know, our book said something about animal level. I have been on the streets on my own and with my addiction, you become on the animal level. Abandoned houses—you know, not having the key to your own house, having to leave when somebody else tells you to, not being trusted.
Note here that the participant mentioned abandoned houses as a reference point for living “on an animal level.” This comment alludes to the fairly common practice within Detroit neighborhoods of making use of unoccupied properties for habitation, for commercial purposes, or both. The high level of abandonment in many of these neighborhoods has little to do with these individuals and their choices. Long-term trends such as deindustrialization, suburban sprawl, and racial redlining, among others, have structured the situation.
Nonetheless, the speaker implicated the abandoned houses as coconspirators in the life of chaos or “street nonsense,” an index of living without responsibility. The simple fact that people occupying abandoned houses could face eviction at any time relates, in turn, to individual-level qualities or characteristics: “not having the key to your own house, having to leave when somebody else tells you to, not being trusted.” Within the context of the treatment program, the transition from being a person in active addiction to being a person in recovery connected to the more mundane reality of daily life and habituation to regular routines. This change, in turn, connected to the idea of “productivity,” though the participant did not define it in the standard economic sense; rather, she stated, “I ain’t producing none but positive images right now.” Here, the participant stressed the internal life that corresponded to the new, intentional routine.
Wet Places and Wet Faces: The Importance of Social Networks
Women moving from the street to treatment also made critical changes in their social networks: reestablishing preexisting but latent ties, severing some active ties, and establishing new ties. The treatment and recovery process emphasized normalizing relations with alienated and estranged family members, often including parents and children, so the fact that many women reported changes in their social network as a central achievement is not surprising. The interviews consistently reflected the importance of building new relations with other people in recovery and in the “straight” world—working, taxpaying, responsible, and non-substance-abusing people—as a second component of assembling the social (Latour 2005). Finally, participants discussed cutting off old ties related to substance use, often referred to as “wet places and wet faces,” as a primary goal.
One woman described the process of entering the SWP for the second time, after she had relapsed and returned to the street. We recount her narrative in detail below, noting the references to social networks, as well as the assemblages of ideas and nonhuman actants that accompanied them, and the decisions or behaviors that resulted from these configurations: I didn’t know how, about, I really didn’t know how to identify wet places and wet faces, as they call it. That’s like people who still in active…are using, or, you know, being at the wrong place at the wrong time. Not in a structured environment. So I was hanging around my family because, you know, I felt as though they was starting to welcome me back in because I was trying to get my life together. They, uh, but at the same time, me doing my own thing, not knowing that I wasn’t strong enough…[to] deal with my troubles. And all that I knew, when something would bother you all that I knew what to do was to go back to where I started out. What made me feel better was me drinking and drugging. So I tried my hardest, and then me and my sister were going through some things, arguing back and forth, this, that, me and my mother, and this, and that, and that. And I ran across an old trick [former customer]. That started it. He solicited me. I solicited, you know, agreed. We did what we did. I got the money, and it was right with me. One went hand to hand. Partying went with the drugs, the drugs went with the sexual acts, so like, “Okay, I’ve got all this money. Now what do I do?”
Here we see a string of interconnected people, environments, and objects, with a kind of polarity established between the family network and the street network: the family “pressuring” her to stay clean, but the street network welcoming her back when the pressures of the family overwhelmed her. Once on the street, a series of other associations popped up: the old trick, the can of beer, the corner where she worked. At the time, she stated, she did not know “how to identify wet places and wet faces.” Though her family had started to welcome her back, she was still “not in a structured environment.”
More than 2 years later, she was arrested on the same corner where she had initially been arrested and placed in the SWP. She spent 130 days in treatment in jail in another county because of the accumulation of various tickets, and then returned to Detroit to stand before the judge who administered the SWP: She [the judge] always, she always, she could tell when you’ve been out there. When you really wanted to get some help, or when you was on some bullshit. Yeah, she could just about read a person, and figure out whether or not you wanted to get it right, or if you wanted help. Whether or not it was even worth her time messing with you. But she would always give you that benefit of the doubt. Say, “Well you know, you were gone two and a half years. I closed the case out. So what did you want me to do for you?” And I told her, I said, “Well listen, I know I’ve been out there quite a while. Got a little clean time under my belt. Because I don’t feel like I have as much structure in my life as of now, and I’m still scared. I feel like right now I still don’t know how to deal with my feelings and emotions properly. And because of my, uh, my history, and because of my jail status…What do you call it? Uh, me having priors and stuff. I can’t just go out, and get a job like that, so it would be hard for me, so I need some help.” She said, “Well what I can do for you?…Are you sure that you want my help this time?” I told her, “Yeah.” I said, “Whatever it is I have to do I’m willing to do.” “So, you know if I help you you’re going to have to sign another contract. You know that’s fifteen more months out of your life. For the rest of your life. That’s what you want?” I’ll take. One year ago today…[Since then, I have] never used. I’ve had a lot of thoughts of using, but like they say, this too shall pass. And then since I’ve been clean I’ve got a lot accomplished. I have gotten two of my children back into my life now. I regained my family’s trust. For my family, and with my family now. Back in school. I’m trying to get my GED [general equivalency diploma, accepted as a substitute for completion of secondary school], and get that accomplished. I just feel a whole lot better about myself today than I did at the time.
Near the end of her interview, the woman discussed how changes in her associations affected her sense of what she might do after completing her treatment program:
Because before I came into SWP it was more like, it was friends and family or what not, but the majority of my associations were people that I got high with, or people that I met in the lifestyle, so nobody that I deal with now.
Yeah. So if you were, if you were, say we did this exercise back then?
Oh my gosh.
What you have seen in terms of trust relationships?
It would have been way off. I only trusted people for certain things because of, I really didn’t have intimate close relationships with people like that. You know? I didn’t. At the time I felt like I wasn’t close to nobody.
Right.
I just dealt with people because of my addiction. You know?
Now what about in terms of you talked about, on a daily basis how many people you had used drugs, violence with, changed money with. How would that have been different if you looked at your daily basis, would you encounter violence?
Way more. Yes. Way more.
And had sexual relations?
Yes, way more.
So what would you think are the importance of all these other people that are in your life?
Well, I can say it’s, all the people that I have in my life now are striving to make something of them, something with their lives. As opposed to the people that used to be in my life, it was one-track mind kind of thing. Drugs and money, money and drugs.
Looking at the changes from the early part of her narrative to this point, we see the addition of the recovery-based networks and the accompanying “structured environment”; we also see the “knifing off” of the street network, or the “wet places and wet faces.” A little later in the same interview, she discussed some of her specific goals related to her social networks and the context of the recovery program. In this segment of the interview, we can see specific imprints of the daily routine and associations in the ideas she had about her own emotions and decisions:
And how, what do you see for yourself in the future, going forward from here? I mean in terms of this is the way your life is right now. What do you see changed in it?
Well, right now I’m going to try, like I said I’m trying to complete my GED program. Get that out of the way. I want to do some type of college courses. I’m not sure exactly what right now. I just try some of my time because I’m trying to focus on my GED. I always tend to, I tend to get overwhelmed sometimes. I’m trying not to do that because I’m learning to deal with my feelings and emotions today. I have a lot of, I have a lot of faith that I want to get my children back, but at the same time I know that it’s in God’s time. But I understand all the things that I’ve done, and been through, and put them through. So I can, I’m not going to be expecting, uh, I don’t have my hopes down, but I don’t have my expectations too high to where if they really don’t want to be bothered because of the past.…I can cope with it.
What do you think are the most significant obstacles that you’re [facing]?
Education, and employment, and housing.
Recovery, in this account, was much more than just the individual, internalized process of abstaining from drug use and crafting a new identity that did not depend on drug use. Rather, recovery was achieved through a very mundane and mechanical process of substituting different goals and routines for those that previously occupied the woman’s time and attention. Seen from this perspective, the routines and associations themselves might have been more important than what occurred within them. As we discuss in the next section, however, participants invested the repetitive and mechanical nature of those routines with meaning once they had internalized the process. Furthermore, three very concrete and specific external components—education, employment, and housing—enabled recovery as an internal, spiritual process.
Making Sense of Redundant Situations
Taken together, the above examples show a dramatic distinction between life in a treatment and recovery setting and life on the street in terms of the imposition of mandatory daily routines. For women in the SWP, the spatial assemblages, physical props, and institutional relationships of the recovery process were just as significant as the programming content. What is the purpose of such routines, aside from the very basic one of keeping time occupied? Though seemingly banal, the continuing round of chores and meetings and appointments took on greater significance in light of the end goal of the treatment program. In the following exchange, a woman responded to the question of what she had gained or learned from the program by citing both associations and specific skills or tools:
What is it about the program? What do you—what have you benefited from? What did you learn from the program?
Coping skills, the tools that you need to go out into the world to deal with stress, stressful situations. Knowing to just to stay away from wet places, faces, things.
So these are things you didn’t know about before? You had no idea about before, or—?
I did to an extent, but like I said, I told your partner, I’ve been in different rehabs and this is probably the best that I’ve been in because they break it down to you in terms that you can understand instead of book terminology where you have not a clue what they’re saying. And they’ll just use more book terminology to try to explain it to you and you’re like, well, you still don’t know what that means. They just get right into it, you know break it down, raw, straight to the point, you know. And it help—it gives you a better understanding because you’re out there living in—in, you know, in the real times and book terminology, its giving you, you know, giving you a fancy word for what you’re—what you’re doing out there.
And so “wet places and wet faces” for example; had you ever heard that before? Is that something you heard previously?
You know I’ve been in and out of, uh, treatment centers, so I have heard that before. As far as the coping skills and my defense mechanisms and things like that . . .
What about in terms of relationships? Do you feel like you’ve made any—any of the relationships that you’ve formed here, are those significant in terms of where you are?
Some of them are, ’cause you have, um, you have peers that you, um, you value their opinion and they help you—help you cope with a certain situations better where you can talk to them and they can break it down to you. And different opinions, options.
These comments reveal some of the components of the treatment program that its place- and relationship-based approach reinforced; in this case, the counselors in the program, the peers, and the circulating concepts or “tools” became mutually reinforcing. Again borrowing from Latour (2005), we can see these components of the recovery assemblage as “localizers” or “articulators” (p. 194). Terms such as “wet places and wet faces” effectively serve to localize concepts about social networks and risk environments that might be employed in clinical or scholarly circles; this function is evident in the participant’s distinction between “book terminology” and “break[ing] it down, raw.” At the same time, different individuals can adopt, interpret, and apply these messages in different ways. As Latour insisted, members of actor networks are not merely intermediaries, but mediators. Messages are not simply transmitted through chains of association; they are distorted, adapted, and transformed along the way.
For example, both the daily life routine and the teachings of recovery impart the key lesson that coping with boredom is a basic life skill, one that women engaged in active substance use did not generally possess. The following passages from an interview describe how the participant came into the program with the intention of returning to the streets as quickly as possible. After being in treatment for about 3 months, she described the interconnection between the external structure and her internal growth process as she had come to understand it:
These are things I learned the first time in treatment. A lot of it is common sense but it’s just a matter of—it’s like knowing what to do; it’s a matter of doing it, you know. I just made it, a lot of that harder with, you know, getting a record and, and hurting or doing things that I did to people. So I have to start by changing myself before I can change anything, and the only thing I can do is try to show the progress the best that I can. But before I start to get a lot of opportunities, you know, they wipe our record. They give us a head start in some of these areas that we might not have even had a start in. So there’s a lot of benefits from it as far as school and—
So what kind of things have you learned about doing SWP, specifically that you weren’t, didn’t know about before?
I guess I didn’t know a lot of school opportunities. I didn’t know that as—you know, I didn’t know how easy it was—you know, it’s just about doing it. I know that people can be successful and can change things around. I already knew that. Because I’m still early in the SWP program, I’m still yet to see a lot of the benefits, but I know that there are benefits there. You know, it’s going to take work and time for me to get them. But I do want to be a part of them. I don’t think that any of them would be bad.
In terms of the paths that are—that are sort of offered through SWP.
Yes. I don’t like the time period. I’m probably not going to like any of the costs or the redundant situations we have to go through to get there, but I hope that eventually it gets easier. And the more I get to know other people and learn the hang of things, probably the easier—
You said “redundant situations.”
Well, like, yes, you know, like coming back to court all the time and having to go to, you know, aftercare and, and follow-up and—you know, like right now, I’m getting up every day like that, not being able to sleep in yet, it sucks.…You know, eating when they want you to eat. But that’s what I mean with structure. You know, because when you get a family and you work, there’s a time that you have to work and there’s—obviously, there’s certain time between the time you get off and the morning when you start again that you only have so much time before you have to go to sleep. And in between that time, you have to eat—you’re going to have to schedule your day. But, you know, you can call off days on work, not much, but you know what I’m saying? And you can go eat what you want and not what is cooked for you. You have that freedom. And here, it’s—you can’t. We can’t leave when we want. I can’t call in and say, “I don’t want to go to treatment today.”
Interviewed again a year later, the same woman held a position of responsibility at the treatment program, supervising newer residents. At this point, she stated simply, “I might be here by force but I stay here by choice.” Here we see the central paradox of substance abuse recovery, which Brigham (2003) described as empowerment through the assumption of powerlessness, presented in another way. The coercive element of the program and the “knifing off” of associations are seen as a necessary prelude to meaningful choice.
Conclusion: Changing Habitus vs. Reassembling the Social
As noted in the introduction, the concept of habitus suggests that structure gets inside of social actors in ways that are durable and resistant to change. In effect, society “gets under our skins,” and shapes us from the inside out as well as from the outside in. How does this process occur, and can it be undone or overwritten by another such process? Envisioned as a form of baggage, packed by structural forces, habitus seems like a poor candidate for achieving change; it would involve unpacking and repacking the bags of every individual, each of which overflows with decades of layered and accumulated beliefs and experiences. However, Bourdieu himself cautioned against such static interpretations of habitus, stating that “it is necessary to abandon all theories which implicitly treat practice as a mechanical reaction, directly determined by the antecedent conditions and entirely reducible to the mechanical functioning of pre-established assemblies” (1977, p. 73).
Latour (2005), for his part, openly rejected the existence of a structural force that acts independently of the concrete associations that form groups: “For ANT, if you stop making and remaking groups, you stop having groups. No reservoir of forces flowing from ‘social forces’ will help you” (p. 35). Latour’s statement does not mean that no connection exists between the things that we normally refer to as “actors” or “agents”—individual human beings—and the things we label as “structures”—institutions, governments, religions—but it does mean that we have to show the connections and vectors of force, not simply assert their existence. In Latour’s terms, we have to pay the cost of every connection, showing exactly where and how (for example) people in recovery and those who interact with them, as well as their daily environments, reproduce and reaffirm the ideology of recovery.
As Bourdieu did (1977, 1990), Latour (2005) emphasized the active process by which individuals assemble the social world. In the case of women actively engaged in street sex work and substance use, who abruptly enter the restrictive settings of jail and residential treatment, the spatial and temporal compression of “role exit” makes the deliberate process of reassembly more visible. As the examples demonstrate, the process of establishing routines, networks, and identities oriented toward recovery involves very specific components. Although the participants’ cases certainly demonstrate similar patterns, we do not aim to establish a simple mechanistic cause for the success or failure of treatment and recovery, nor do we aspire to judge the rightness or wrongness of the approach taken by the SWP. Instead, we wish to understand the process on its own terms and in all its complexity. The examples in this article illuminate some steps that these particular women took along the path to recovery.
In these accounts, we can see the importance of external facts such as daily circumstances and relationships, as well as the messages delivered within and through these associations. Although we can interpret these messages as reflecting other factors—such as the preferences of the state for individualized as opposed to structural explanations of women’s oppression—we still need to pay attention to the use that women themselves made of these messages. For example, concepts and terms such as “wet places and wet faces” and messages concerning the importance of education and individual responsibility were meaningless slogans unless the program participants internalized them and imported them into their mental life. This internalization occurred through intensive autobiographical work that participants engaged in, and was revealed in their own reconstructions of the past as well as their visions for the future.
In this article, we focus on how women made sense of the present, especially the rituals, routines, and requirements of the residential treatment setting. If we can identify a sociological paradox to match that presented by recovery’s insistence on surrendering control to take responsibility, then Latour’s statement sums it up: “As to emancipation, it does not mean to be freed from bonds, but well-attached” (2005, p. 218). The women in the SWP were clearly not being freed from bonds; in some respects, one redundant situation simply replaced another, as the respondents noted. However, in going through the program, the participants made (and remade) attachments that they hoped would serve them better, in tangible and measurable ways.
A growing recognition of the importance of supportive environments and networks has led to the development of more holistic approaches, such as recovery-oriented systems of care (Davidson et al., 2007; Gagne et al., 2007). Likewise, the development of Structural Ecosystems Therapy represents an attempt to systematically engage intimate social networks in treatment processes (Mitrani, Prado, Feaster, Robinson-Batista, & Szapocznik, 2003; Prado et al., 2002; Szapocznik et al., 2004). The concept of “enabling places” or “enabling environments” (Duff, 2009, 2011a, 2012) expands this thinking even further. According to Duff (2012), “The primary innovation associated with the notion ‘enabling places’ is the presentation of a relational account of place incorporating its diverse material, social, and affective constituents” (p. 1389).
These approaches recognize the importance of embedding supportive networks within daily routines, while at the same time systematically excluding or crowding out the sites and associations that could lead back to substance use. No single path ensures a successful recovery (Laudet, 2008; White, 2007); however, qualitative research can contribute to a more nuanced empirical understanding of the role of places, routines, and relationships in the recovery process. Such an understanding can guide and inform the design of recovery-enabling environments.
Footnotes
Acknowledgements
We thank all of the program participants, employees, and administrators who generously shared their time and expertise with us in the course of this research.
Authors’ Note
Portions of this article were presented at the North Central Sociological Association Annual Meetings, Cleveland, Ohio, April 2011.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this research was provided by the National Institute on Drug Abuse (NIDA 1 R21 DA027145-01).