Graduation Year

2015

Document Type

Thesis

Degree

M.A.

Degree Name

Master of Arts (M.A.)

Degree Granting Department

Sociology

Major Professor

Sara Green, Ph.D.

Committee Member

Maralee Mayberry, Ph.D.

Committee Member

Khary Rigg, Ph.D.

Keywords

Alcohol, Drugs, Medicalization, Medical Model, Social Model of Disability, Stigma

Abstract

The purpose of this research is to examine the institutional narrative of substance use disorders (SUDs) in the U.S. military and the extent to which it reflects the medicalization process. Three general research questions guided my analysis of the narrative surrounding SUDs in the military: (1) How does the military characterize the problems and resolutions of SUDs? (2) How and to what extent does this narrative reflect medicalization? (3) What are the limitations inherent in the institutional narrative of SUDs in the military? In order to address these questions, I draw on three conceptual lenses: (1) The work of Loseke (2007) and others on the powers of institutional narratives; (2) The work of Conrad and Schneider (1980) in which they propose that medicalization can be understood in multiple ways and on at least three distinct levels (the conceptual, the institutional, and the interactive); and (3) The work of disability scholars on the limitations of the medical model and the importance of adopting a social model of the causes and consequences of disability (Oliver and Barnes 2012; Shakespeare 2014; Berger 2012).

In this study, I use these lenses to conduct a textual analysis of the VA/DoD Clinical Practice Guideline for Management of Substance Use Disorders. This manual was developed under the auspices of the Veterans Health Administration (VHA) and the Department of Defense (DoD) pursuant to directives from the Department of Veteran Affairs (VA). The document was designed to provide recommendations for the performance or exclusion of specific procedures or services related to identification and response to substance use among active duty personnel and veterans in all branches of the US military. The information and recommendations presented in the document were then disseminated throughout all branches of the military for implementation. This document is, therefore, a powerful codification of the institutional narrative of substance use in the military. Using Conrad and Schneider’s model as a template (1980), I examined the document in order to see how the military has framed the discussion surrounding SUDs.

My analysis began with a close reading of the manual several times without much reflection in order to get a general feeling for the story being constructed by the text. However, as I continued with the close reading, I began making comments about the practices and overall impressions the manual puts forth. After several readings and thorough note taking, it became clear that there was a significant amount of medicalization occurring throughout the military manual, and evidence for medicalization could be seen on all three of the levels suggested by Conrad and Schneider. Words and phrases of text were eventually coded and categorized into the three levels of medicalization.

The narrative within the document depicts a specific story of how the military addresses matters involving SUDs through a system of screening, assessment and treatment. First, the document’s language relating to diagnostic assessments, laboratory biomarkers and other screening devices used to categorize and measure one’s substance use can all be considered evidence for medicalization at the conceptual level. Multiple segments of text have been identified and categorized on a conceptual level. Second, clear indications of medicalization on the institutional level can be seen with references to specialty treatment, “specialty care” and “other clinics.” Again, multiple text segments have been identified as being representative of medicalization at the institutional level. Finally, evidence for interactive medicalization can be seen through the use of medical referrals, pharmacological treatments and the ongoing monitoring of medical consequences of substance use.

The findings suggest that the military has adopted what many now consider a medical model approach toward understanding substance use and evidence can be found at all three levels of medicalization proposed by Conrad and Schneider. Strengths and weaknesses of exclusive reliance on a medicalized narrative of the causes of substance use among military personnel and veterans are discussed in light of the lessons learned from the social model of disability and other critiques of medicalization. I conclude that the success of a medicalized response to substance use may be hampered by the tension between the two widely circulating cultural narratives that intersect in the case of substance use among military personnel.

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