Publications by authors named "Adrian Farrugia"

17 Publications

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Holding 'new recovery' together: Organising relations and forms of coordination in professional sociomaterial practices of addiction recovery.

Int J Drug Policy 2021 Jul 16;97:103357. Epub 2021 Jul 16.

National Drug Research Institute, Curtin University, Melbourne, Australia.

Questions about what addiction recovery is and the mechanisms by which people 'recover' have long animated alcohol and other drug research and policy. These debates became even more intense following the advent, and increasing influence in some quarters, of the 'new recovery'. Starting from the position that recovery is ontologically multiple (Mol & Law, 2002), we trace how alcohol and other drug professionals attempted to make sense of 'new recovery' as a concept and set of professional practices during a period of Australian drug treatment system reform. Drawing on Annemarie Mol's (2002) account of organising relations and forms of coordination (addition, translation and distribution), we explore how the new recovery was enacted and coordinated in alcohol and other drug professionals' sociomaterial practices, and highlight the ontological work involved in holding such an unstable object together. First, we argue that the addition of multiple enactments of addiction and recovery contributed to the formation of a singular and serviceable problem (that was simultaneously heterogeneous and complex), making the 'disease-to-be-treated' amenable to diverse treatment approaches, including new recovery. Second, we analyse the role of metaphor in translating authoritative logics and obligations into an enactment of new recovery suitable for application in clinical settings. Lastly, we track how incompatible enactments of recovery, both new and old, were kept apart through distribution. Although new recovery ultimately failed to gain policy traction in the Australian context, we focus on the ontological work undertaken by professionals in response to its introduction as such case studies can be useful for analysing other powerfully governing policy objects and their operations.
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http://dx.doi.org/10.1016/j.drugpo.2021.103357DOI Listing
July 2021

Heavy drinking as phenomenon: gender and agency in accounts of men's heavy drinking.

Health Sociol Rev 2020 Dec 9:1-16. Epub 2020 Dec 9.

Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, Australia.

Alcohol consumption is a significant public health concern in Australia, with men disproportionately represented in treatment for health issues related to heavy drinking. Despite this, little is known about the experiences of these men or the gender dynamics that may shape heavy drinking. Increasingly, the treatment of alcohol and other drug-related issues, including those related to heavy drinking, is based on a biopsychosocial approach. Within this framework, heavy drinking is understood as a symptom of individual pathology in the context of various social 'factors' that influence individual capacity to exercise agency. Following the work of Karen Barad, this article employs a feminist science studies account of agency to formulate heavy drinking as a gendered 'phenomenon': enacted and sustained through the 'intra-action' of other phenomena. Drawing on interviews with men who drink heavily, our analysis explores how the phenomenon of men's heavy drinking materialises through the intra-actions of gender, isolation and healthcare. We argue that heavy drinking is not a sign of failed individual agency but an expression of entangled agencies. In concluding, we suggest it is possible to enhance the well-being of men who drink heavily by addressing specific gendered intra-actions in the making of heavy drinking.
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http://dx.doi.org/10.1080/14461242.2020.1850317DOI Listing
December 2020

Basic care as exceptional care: addiction stigma and consumer accounts of quality healthcare in Australia.

Health Sociol Rev 2021 Jul 9;30(2):95-110. Epub 2020 Jul 9.

Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Australia.

The discrimination faced by people understood to have alcohol or other drug addictions has been the subject of extensive research, with many studies documenting experiences of stigma within healthcare services. Building on this literature, we examine the role of stigma in shaping the healthcare expectations of people seen as affected by alcohol and other drug addictions. Our analysis draws on recent theorisations of stigma as a process of social production to analyse in-depth, qualitative interviews with 20 people who had recently attended an inpatient withdrawal management service. Participants describe as exceptional forms of care that are often taken for granted by other members of the community. We argue that routinised experiences of discrimination work to constitute basic care as exceptional. This finding is significant for two reasons: (1) people who consume alcohol and other drugs often have complex healthcare needs and already encounter obstacles to accessing the care they need, and (2) by positioning people who consume drugs outside the purview of healthcare, this dynamic obstructs their fundamental right to care. We conclude by reflecting on the implications of these findings for those who are often positioned as not entitled to high quality healthcare.
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http://dx.doi.org/10.1080/14461242.2020.1789485DOI Listing
July 2021

Corrigendum to 'Making epistemic citizens: Young people and the search for reliable and credible sexual health information' [Social Science & Medicine 276 (2021) 113817].

Soc Sci Med 2021 Jun 15;279:114032. Epub 2021 May 15.

Australian Research Centre in Sex, Health and Society La Trobe University, Australia.

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http://dx.doi.org/10.1016/j.socscimed.2021.114032DOI Listing
June 2021

The "Be All and End All"? Young People, Online Sexual Health Information, Science and Skepticism.

Qual Health Res 2021 Apr 21:10497323211003543. Epub 2021 Apr 21.

Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.

In this article, we investigate young people's trust in online sexual health resources. Analyzing interviews with 37 young people in Australia using Irwin and Michael's account of science-society relations and Warner's conceptualization of "publics," we explore the processes by which they assess the credibility of online sexual health information. We suggest that when seeking medical information, young people opt for traditionally authoritative online sources that purport to offer "facts." By contrast, when seeking information about relationships or sexual practices, participants indicated a preference for websites presenting "experiences" rather than or as well as "facts." Regardless of content, however, our participants approached online sexual health information skeptically and used various techniques to appraise its quality and trustworthiness. We argue that these young people are productively understood as a skeptical public of sexual health. We conclude by exploring the implications of our analysis for the provision of online sexual health information.
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http://dx.doi.org/10.1177/10497323211003543DOI Listing
April 2021

Making epistemic citizens: Young people and the search for reliable and credible sexual health information.

Soc Sci Med 2021 05 5;276:113817. Epub 2021 Mar 5.

Australian Research Centre in Sex, Health and Society La Trobe University, Australia.

The 21st century has seen the proliferation of technologies and sources of information on issues of all kinds, including sexuality. Amid debates about the role of social media and the internet in mediating sexuality, questions about credible, reliable and objective sources of information have also arisen, particularly in relation to young people's knowledge-seeking. Drawing on theorisations of sexual citizenship, Foucault's notion of the 'episteme', and the work of science and technology studies scholar John Law, this article examines a 'collateral reality' produced by contemporary demands on young people to source, assess and act on sexual health information. Using interviews with 37 young people living in Australia, the analysis identifies a range of approaches to sexual health-seeking practices, key dynamics in the construction of reliability and fact, and the extent and nature of the accommodations young people report making to navigate incomplete and unreliable information. With the contemporary self increasingly framed through the ability to discern truth from falsehood, reality from fake news, these demands and choices have significant implications for qualification as the proper modern citizen. Accommodating information weaknesses and gaps in sexual health information, we argue, produces what we call contemporary 'epistemic citizens'; young people explicitly aware of the limits of official knowledges about sex and sexualities, and of the expectation that individual citizens must either content themselves with officially constituted sexual selves or else seek and enact marginal or unofficial alternatives using sources generally denigrated as unreliable. As we will conclude, current forms of sexual health information and related calls for youth literacy operate as a mechanism for generating a specific modern form of epistemic citizenship. Future sexuality education might consider ways to support even more literate, sophisticated epistemic citizens relieved of the responsibility to piece the truth together on their own, and who in turn feel more included.
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http://dx.doi.org/10.1016/j.socscimed.2021.113817DOI Listing
May 2021

Beyond a 'post-cure' world: Sketches for a new futurology of hepatitis C.

Int J Drug Policy 2021 Jan 13:103042. Epub 2021 Jan 13.

Social Policy Research Centre, UNSW Sydney, Australia.

Australia's recent investment in, and optimism about, direct-acting antivirals to treat hepatitis C brings with it the promise of new drug futures, including the possibility of a post-hepatitis C world and a revolution in the lives of people affected by the disease. But is the situation more complicated than we might assume? What expectations are being produced about post-cure lives? And what is being overlooked along the way? We argue that hepatitis C policy, practice and research can instantiate a problematic orientation towards medicine and 'the future' and explore ways of moving beyond these orientations. The essay then proceeds into two main stages. First, combining critiques from existing research with preliminary insights from a new study on hepatitis C 'post-cure' lives, we outline some of the key logics regarding cure and post-cure, and explain why such logics are problematic. We argue against the assumption that the availability of a medical cure will alone reverse the entrenched social, political and structural dynamics that drive infections and limit service access. To do so, we note, is to overlook the net of meanings and power relations that co-constitute hepatitis C and injecting drug use and render those associated with them marginalised and disenfranchised. Such optimism erases the legacy of laws and policies devised in a pre-cure world, and their role in generating and limiting new ways of being. Second, we introduce new ideas to the field and articulate a vision for what we call a 'futurology' of hepatitis C, designed to counter these assumptions and take us beyond problematic temporal logics. Our futurology is inspired by the work of Cuevas-Hewitt (2011) on the 'futurology of the present'. Cuevas-Hewitt's approach discards linear temporalities, expectations of revolution and reform, and instead pays attention to multiplicities of becoming in the perpetual present. Taking up ideas from Cuevas-Hewitt, we introduce our own sketches for a 'futurology of hepatitis C'. This is a set of practices for thinking, researching, writing about and otherwise engaging with hepatitis C, characterised by attention not to what an imagined, singular future might look like, or to assumptions about treatment as revolutionary, but to what Cuevas-Hewitt (2011) calls the multiple 'perpetual presents' already with us, and aims to foment hope for change.
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http://dx.doi.org/10.1016/j.drugpo.2020.103042DOI Listing
January 2021

Exclusion and hospitality: the subtle dynamics of stigma in healthcare access for people emerging from alcohol and other drug treatment.

Sociol Health Illn 2020 11 13;42(8):1801-1820. Epub 2020 Oct 13.

Centre for Social Research in Health, University of New South Wales, Kensington, NSW, Australia.

This article explores the role of drug use-related stigma in constraining access to healthcare services. Drawing on interviews with 20 people conducted shortly after leaving an Australian alcohol and other drug withdrawal management unit, the article explores their willingness and ability to access primary care, hospital and further services. It finds repeated descriptions of feeling ignored and shamed during efforts to access care, with some descriptions relating to subtle signs of disapproval or condemnation, and others to being ignored or dismissed. Some accounts additionally emphasise unwelcoming atmospheres, and exclusion by omission of signals of welcome and encouragement. The article goes on to consider, for the first time in this field, contemporary notions of welcome and hospitality as outlined within the cosmopolitanism tradition, asking whether they offer insights into how healthcare may become more accessible for people who regularly experience stigmatisation. In concluding, the article considers the need to think further about forms of exclusion that occur when social and individual histories of stigma are not institutionally recognised, and measures to counter these histories are not actively adopted.
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http://dx.doi.org/10.1111/1467-9566.13180DOI Listing
November 2020

Addiction stigma and the production of impediments to take-home naloxone uptake.

Health (London) 2020 Jun 12:1363459320925863. Epub 2020 Jun 12.

King's College London, UK.

Opioid overdose deaths are a major health issue in Australia and around the world. Programmes to provide opioid consumers with 'take-home' naloxone to reverse overdose exist internationally, but uptake by mainstream health services and consumers remains inconsistent. Researchers have identified a range of important educational, training and logistical impediments to take-home naloxone uptake and distribution, yet they have focused less on the social dynamics that can enhance or limit access, such as stigma. In this article, we also explore impediments to uptake, drawing on qualitative interview data gathered for an Australian research project on take-home naloxone. Mobilising a performative approach to stigma, we argue that overdose and prevention are shaped by the social dynamics of stigma and, as such, responsibility for dealing with overdose, as with take-home naloxone, should also be considered social (i.e. shared among peers, the public, communities and governments). Our interview data illuminate the various ways in which addiction stigma limits the possibilities and capacities of take-home naloxone and overdose prevention. First, we focus on how stigma may impede professional information provision about take-home naloxone by limiting the extent to which it is presented as a matter of interest for opioid consumers, not just those who consume opioids illicitly. Second, we explore how stigma may limit the scale-up and expansion of programmes and access points. From here, we focus on how stigma co-constitutes the politics of overdose and prevention, rendering take-home naloxone ill-suited to many social settings of overdose. In closing, we point out that stigma is not just a post hoc impediment to access to and use of take-home naloxone but is central to opioid overdose production itself, and to effective prevention. While take-home naloxone is an excellent life-saving initiative, uncritically valorising it may divert attention from broader goals, such as the de-stigmatisation of drug consumption through decriminalisation, and other ambitious attempts to reduce overdose.
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http://dx.doi.org/10.1177/1363459320925863DOI Listing
June 2020

'Potential issues of morbidity, toxicity and dependence': Problematizing the up-scheduling of over-the-counter codeine in Australia.

Int J Drug Policy 2020 06 28;80:102538. Epub 2019 Jul 28.

Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Vic, Australia.

Until February of 2018, Australians were able to purchase low-dose codeine products (LDCPs) over-the-counter from pharmacies. In 2017, following review and public consultation, Australia's therapeutic drug regulator rescheduled LDCPs to prescription-only, in line with other higher-dose codeine and opioid products. In this article, we draw on Bacchi's 'what's the problem represented to be' approach to 'work backwards', analysing this 'solution' and the particular 'problematisation' of codeine it produces and relies on. We analyse the 'final decision and reasons for decisions' document, which outlines the consultation and decision-making process leading to the rescheduling of LDCPs. We contend that abuse and dependence of codeine by people with chronic pain is the 'problem' constituted by the decision to reschedule LDCP. We consider the ethical and political implications of this problematisation. First, we argue that this problematisation limits the ways the LDCP consumption, particularly by people with chronic pain, can be understood. This problematisation effaces the multiple reasons people with chronic pain may consume LDCPs long term and works to naturalise notions of 'misuse'. We next argue that notions of the 'legitimate patient' and the 'illegitimate consumer' or 'abuser' are in different ways positioned as primarily responsible for managing their health. From here we argue that the problematisation of LDCPs in Australia produces codeine as the sole agent of harm in ways that background wider harm-producing social arrangements. Our analysis also suggests that the 'problem' of LDCPs unreflexively reinforces medical authoring and expertise as the primary solution. Finally, we suggest that the use of LDCPs in Australia could instead be re-problematised as an issue of 'chronic health mismanagement'. Responses to this problematisation would require a reorientation away from attempts to reduce accessibility such as up-scheduling to significantly more focus on long-term healthcare engagement for people consuming LDCPs to manage chronic health issues.
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http://dx.doi.org/10.1016/j.drugpo.2019.07.033DOI Listing
June 2020

Commentary on Elliott et al. (2019): How stigma shapes overdose revival and possible avenues to disrupt it.

Authors:
Adrian Farrugia

Addiction 2019 08 27;114(8):1387-1388. Epub 2019 Jun 27.

Social Studies of Addiction Concepts Research Program, Faculty of Health Sciences, National Drug Research Institute, Curtin University, Melbourne, Vic, Australia.

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http://dx.doi.org/10.1111/add.14660DOI Listing
August 2019

Take-home naloxone and the politics of care.

Sociol Health Illn 2019 02;41(2):427-443

National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.

'Take-home naloxone' refers to a life-saving intervention in which a drug (naloxone) is made available to nonmedically trained people for administration to other people experiencing an opioid overdose. In Australia, it has not been taken up as widely as would be expected, given its life-saving potential. We consider the actions of take-home naloxone, focusing on how care relations shape its uses and effects. Mobilising Science and Technology Studies insights, we suggest that the uses and effects of naloxone are co-produced within social relations and, therefore, this initiative 'affords' multiple outcomes. We argue that these affordances are shaped by a politics of care, and that these politics relate to uptake. We analyse two complementary case studies, drawn from an interview-based project, in which opioid consumers discussed take-home naloxone and its uses. Our analysis maps the ways take-home naloxone can afford (i) a regime of care within an intimate partnership (allowing a terminally ill man to more safely consume opioids) and (ii) a political process of care (in which a consumer takes care of others treated with the medication by administering it 'gently'). We conclude by exploring the political affordances of a politics of care approach for the uptake of take-home naloxone.
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http://dx.doi.org/10.1111/1467-9566.12848DOI Listing
February 2019

Grievable lives? Death by opioid overdose in Australian newspaper coverage.

Int J Drug Policy 2018 09 30;59:28-35. Epub 2018 Jun 30.

Centre for Alcohol Policy Research, La Trobe University, 215 Franklin St., Melbourne, VIC 3000, Australia. Electronic address:

Opioid overdose deaths are increasing in Australia and around the world. Despite this, measures aimed at reducing these deaths such as safe injecting facilities and take-home naloxone continue to face obstacles to uptake. The reasons for this are manifold, but a key contributor is public discourse on opioid consumption and overdose. In this article we explore this public discourse using Judith Butler's work on 'grievable lives'. The article analyses mainstream newspaper coverage of opioid overdose in Australia to map key articulations of overdose and to consider how public understandings of overdose are shaped. It then goes on to consider ways these understandings might be reshaped, looking at what have been called overdose 'anti-memorials' and a new website Livesofsubstance.org. In concluding we argue that until the lives of opioid consumers come to be considered grievable, the measures known to reduce overdose deaths may struggle to find public support.
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http://dx.doi.org/10.1016/j.drugpo.2018.06.004DOI Listing
September 2018

Prehending Addiction: Alcohol and Other Drug Professionals' Encounters With "New" Addictions.

Qual Health Res 2017 Nov;27(13):2042-2056

1 Curtin University, Fitzroy, Australia.

This article investigates the ways new forms of addiction are encountered by professionals working in the area of alcohol and other drugs. Combining interviews with policymakers, service providers, and peer advocates in three countries (Australia, Canada, and Sweden), and Mike Michael's utilization of the notion of prehension for science communication, we track the notions of addiction, drugs, and subjectivity that emerge when alcohol and other drug professionals encounter what Fraser, Moore and Keane call the addicting of nonsubstance-related practices. The analysis has three parts: constituting addiction unity, questioning addiction unity, and conflicting logics of addicting processes. We argue that specific articulations of drugs and health and specific health professional and addiction subjects are made anew in these encounters. These notions of drugs, health, and subjectivity shape how alcohol and other drug professionals engage with substance-related addictions. In concluding, we consider the implications of new addictions for professional practice.
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http://dx.doi.org/10.1177/1049732317731539DOI Listing
November 2017

Science and scepticism: Drug information, young men and counterpublic health.

Health (London) 2017 11 10;21(6):595-615. Epub 2016 Feb 10.

Curtin University, Australia.

It is perhaps no surprise that young people can be sceptical of the drug-related information they receive in school-based health education, health promotion and the media. Significant societal anxiety surrounds young people's drug consumption, so it is tempting to approach this scepticism as a problem to be solved. In this article, we look closely at a group of young Australian men (nā€‰=ā€‰25), all of whom hold deeply sceptical views about the drug information they received in schools, social marketing campaigns and public speech generally. We do not approach their scepticism as a problem to be solved in itself, however. Instead, we analyse its origins and how it relates to the way knowledge is constructed in drug education, health promotion and media accounts of drug use. To conceptualise this scepticism, we draw on Irwin and Michael's analysis of the changing relationship between science and society, Warner's theorisation of publics and counterpublics, and Race's related notion of 'counterpublic health'. The article organises the data into three key themes: scepticism about the accuracy of the claims made about drug risks and dangers, scepticism about representations of drug users, and scepticism about the motivations behind the health messages and drug policy in general. We then draw these different aspects of scepticism together to argue that the young men can be seen to constitute a health 'counterpublic', and we consider the implications of this approach, arguing for what has been described as a more diplomatic engagement between science and publics.
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http://dx.doi.org/10.1177/1363459315628042DOI Listing
November 2017

Assembling the dominant accounts of youth drug use in Australian harm reduction drug education.

Authors:
Adrian Farrugia

Int J Drug Policy 2014 Jul 5;25(4):663-72. Epub 2014 May 5.

National Drug Research Institute, Curtin University, Melbourne, Australia. Electronic address:

Education programs are a central element of Australian harm reduction drug policy. Considered less judgmental and more effective than the punitive policies of Australia's past, harm reduction drug education is premised on the goal of reducing 'risks' and harms associated with illicit drug use rather than an elimination of use per se. In this article I analyse two sets of key texts designed to reduce drug related harm in Australia: harm reduction teaching resources designed for classroom use and social marketing campaigns that are targeted to a more general audience. I identify two significant accounts of young people's drug use present in Australian harm reduction drug education: 'damaged mental health' and 'distress'. I then draw on some of Deleuze and Guattari's key concepts to consider the harm reducing potential these accounts may have for young people's drug using experiences. To demonstrate the potential limitations of current drug education, I refer to an established body of work examining young people's experiences of chroming. From here, I argue that the accounts of 'damaged mental health' and 'distress' may work to limit the capacity of young drug users to practice safer drug use. In sum, current Australian harm reduction drug education and social marketing may be producing rather than reducing drug related harm.
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http://dx.doi.org/10.1016/j.drugpo.2014.04.019DOI Listing
July 2014
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