Making addiction in screening tools

validity paper word cloud 2In a newly published article by Dr Robyn Dwyer and Professor Suzanne Fraser, standardised addiction screening and diagnostic tools used widely in Australia and around the world are analysed to illuminate their role in defining addiction and rendering it measurable. A key element in expert knowledge-making, the tools play a central role in establishing the ‘reality’ of addiction. In the article, Dwyer and Fraser explain that the tools are given legitimacy and authority through the use of scientific validation techniques. These techniques are critically examined in the article, and their limitations opened up to scrutiny. This kind of examination is of pressing importance because the knowledges produced via the tools carry with them important political implications. They contribute to influential statements about substance users and people labelled ‘addicts’, are used to justify public policies and programs, and directly inform decisions about resource distribution and service delivery.

The article draws on two theoretical concepts to structure the analysis: Ian Hacking’s (1999) concepts of ‘refuting’ (showing a thesis to be false) and ‘unmasking’ (undermining a thesis). Under ‘refuting’, Dwyer and Fraser consider the methodological validation processes on their own terms, finding contradictory claims, weak results and inconsistent application of methodological standards. Under ‘unmasking’, they critically analyse validation as a concept in itself. Here they identify two fundamental problems with the concept and its use in relation to addiction: symptom learning and feedback effects; and circularity in claims of independence and objectivity.

As lead author Robyn Dwyer explained, “promoted as accurate and objective, the tools turn out to rely on a range of questionable assumptions and processes. Viewed on their own terms and also when subjected to more searching analysis, the validity claims they make fail to hold up to scrutiny.”

In concluding, the article considers some of the effects of the assumptions and processes identified. Not only do the tools create certainty where there is none, they actively participate in defining and shaping addiction and ‘making up’ addicted people and communities. The tools invite self-regulation and can introduce or alleviate stigma by fostering imaginaries of normal consumption and practices of the self. By acculturating individuals into the concepts and expectations at work in diagnosing addiction, tools can come to produce people who genuinely see themselves in the ways the tools offer and allow, whatever their consumption habits. In unpacking in detail the legitimacy of the tools, the article illuminates the processes by which the measurement of addiction legitimates it and turns it into an object of knowledge – an apparently objective ‘fact’. This, in turn, poses the question of how research might help make or unmake addiction otherwise.