Recovering Rhetoric: Addiction and Rehabilitation at the Limits of Disease Discourse

This dissertation traces various discourses surrounding addiction and rehabilitation in the United States, specifically examining how the longstanding conflict between understanding addiction as a disease (a medical issue) or as a choice (a moral issue) continues to shape options for care and treatment. This inquiry travels from the late eighteenth century to the present day, from moralizing sermons to cutting-edge neuroscience, and from the temperance movement to contemporary rehabilitation practices in Kentucky. While we might assume that technological advancements and increased scientific knowledge have fundamentally changed public views about what addiction is and how it works, this is not the case: in the United States, moralized understandings of addiction still create complex problems for medicine, scientific research, legality, and dominate the landscape of available drug treatment. In Recovering Rhetoric: Addiction and Rehabilitation at the Limits of Disease Discourse, one of my central concerns is how pervasive moral views of addiction have contributed to the United States’ ongoing opioid and overdose crises. We might expect that during such a widely publicized and nationally lamented “epidemic of addiction” and “nationwide public health emergency,” the U.S. would respond with actions that reflect the urgency these descriptions signify. But there is a wide gap between addiction discourse and practice—between publicly deploying medical terms like “epidemic,” “overdose crisis,” and “public health emergency”—and implementing medicalized care. Using a range of medical scientific texts, policy documents, public opinion polls, case studies from different U.S. cities and states, and literature produced by organizations like AA and NA, I analyze the ways the abstinence model and twelve-step discourses have circumscribed our understandings of and approaches to addiction treatment. Ultimately, I advocate for more medicalized approaches to addiction care (i.e., the immediate implementation of comprehensive harm reduction practices). I analyze the proven efficacy of harm reduction, the resistance to its deployment, and the grave consequences of its absence and continued deferral.