Addiction and Respectability

This is the third and final post in my series on how we talk about addiction. So far we have discussed Essentialism and Pity, and today we conclude with Respectability.

“Respectability politics” is a theory of putative worthiness from Black political struggles. The idea is that by dressing, speaking or behaving in particular “respectable” ways, Black people can minimize or avoid oppression by racism and state violence. It follows, at least implicitly, that they must maintain a certain image and reputation to prove they deserve basic rights and safety. The Movement for Black Lives defied such requirements with the slogan “Black Lives Matter,” which insists on all Black people’s unconditional worth and dignity.

Addiction affects all demographics, of course, but the “war on drugs” and addiction’s worst stigma has always targeted urban communities of color. Respectability politics in addiction makes similar demands on people: don’t let anyone find out—or if you can’t hide it, at least be “one of the good ones” in this despised population. Be a reliable employee, financially stable, who maintains a home and family and meets all your own needs. People with addictions who meet this description—and who dress, speak or act respectably—are held up as the ones who deserve support rather than punishment.

Amid the white-coded “opioid epidemic,” respectable people with addictions are also typically white. The classic profile: a white working person who was first prescribed opioids for chronic pain, became dependent, lost access to their prescription and wound up a reluctant heroin user. Advertising for opioid maintenance medications like Suboxone featured testimonials like this specifically from white patients (leaving out the heroin bit). It is a message of reassurance: respectable (white) people sometimes develop addiction, and Suboxone is a respectable way to treat it. Prescribers tout Suboxone as friendly to patients’ work schedules—did I mention employment as a staple of respectability?—compared to having to buy opioids on the street or visit a methadone clinic every day.

This classic profile is one I have rarely seen in my twelve years as an addiction counselor—and my clients have nearly all been white, representing the full socioeconomic spectrum. In other words, most people with opioid addictions I have worked with started out with illicit pills, if not street opioids, and were not seeking pain relief. I am not disparaging anyone by sharing this; I am challenging respectability politics. I do not believe anyone must have a certain appearance, lifestyle, or backstory in order to deserve empathy and care. And punishment is no more helpful to people with addictions who are unhoused, unemployed, or without families than it is to their respectable counterparts.  

The ultimate route to respectability with addiction is to embrace abstinent recovery, as in 12-step culture and “drug-free” treatment modalities. Here addiction is seen as a permanent trait, but people can free themselves from it by getting and staying sober. This is an elegant solution that has saved countless lives. The recovery community has contributed deep knowledge and wisdom to substance use work, and their ideas are not “old” or “outdated.” The problem is simply that abstinent recovery does not work for everyone. Again, respectability delineates who is worthy of care and support—in this case, people in recovery—and suggests that people with addictions who continue to use deserve punishment and not services. But the fact that some people with addictions can, and want to, quit forever, should not mean everyone else is on their own.

I hope this series has been useful to you. These three tropes are not the only ones operating in addiction policy or treatment—any others you’d like to pick apart?

Coming up: Moral Injury in clinical substance use work.

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