Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety

Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety

Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety

Scripting Addiction: The Politics of Therapeutic Talk and American Sobriety


Scripting Addiction takes readers into the highly ritualized world of mainstream American addiction treatment. It is a world where clinical practitioners evaluate how drug users speak about themselves and their problems, and where the ideal of "healthy" talk is explicitly promoted, carefully monitored, and identified as the primary sign of therapeutic progress. The book explores the puzzling question: why do addiction counselors dedicate themselves to reconciling drug users' relationship to language in order to reconfigure their relationship to drugs?

To answer this question, anthropologist Summerson Carr traces the charged interactions between counselors, clients, and case managers at "Fresh Beginnings," an addiction treatment program for homeless women in the midwestern United States. She shows that shelter, food, and even the custody of children hang in the balance of everyday therapeutic exchanges, such as clinical assessments, individual therapy sessions, and self-help meetings. Acutely aware of the high stakes of self-representation, experienced clients analyze and learn to effectively perform prescribed ways of speaking, a mimetic practice they call "flipping the script."

As a clinical ethnography, Scripting Addiction examines how decades of clinical theorizing about addiction, language, self-knowledge, and sobriety is manifested in interactions between counselors and clients. As an ethnography of the contemporary United States, the book demonstrates the complex cultural roots of the powerful clinical ideas that shape therapeutic transactions--and by extension administrative routines and institutional dynamics--at sites such as "Fresh Beginnings."


Imagine you ar ein exile in a foreign land and have been diagnosed with what the natives consider to be an incurable, if treatable, disease. This disease is characterized by the inability to use language to express what you think and how you feel. You are now being treated by local specialists who work to rehabilitate your relationship to language. Through a complex set of traditional ceremonial practices, the specialists teach you how to use words, phrases, and, eventually, entire plotted nar- ratives that reference and reveal your inner states. This rigorous peda- gogical program, which you have been told is therapeutic, is also the specialists’ means of evaluating you. So, as you engage in rituals of speak- ing, the specialists judge the extent to which your utterances match your inner states or—in native terms—how “honest, open, and willing” you are as a speaker and as a person. Honesty, openness, and willingness are of the highest cultural value; they are the indigenous markers of individ- ual integrity, morality, and health. This is true according to both the spe- cialists and the broader society that has ordained them as such. And, as indicated by your ritual treatment, these values are thought to manifest in and through the local tongue.

Imagine, too, that aside from your diagnosed troubles the society in which you now live has deprived you of many of the things normally provided to adult persons: a home or shelter; the means to clothe, feed, and care for yourself; a way to travel from place to place; a meaningful vocation; and even a kin network on which you can rely. Now suppose that the specialists are empowered to help you access these things but can also keep them out of your reach. Since the specialists’ evaluative powers are linked with the capacity to distribute basic goods and resources, your ritual performance—that is, the way you speak in the course of your treatment—has far- reaching material and symbolic consequences. For in- stance, if you have children, they may be taken away to be cared for by others. Or, if you have been sleeping under broadleaf trees or in strange men’s houses, you may be granted a home of your own with a well-made roof and a lock on the door.

As an initiate of these loaded rites of passage, perhaps you have come to believe—like the natives—in the reality of your “disease.” In this case . . .

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