Addiction and living in the shadow of death: impact of the body on agency and self-control

Aims: To explore the lived experience of self-control by people with opioid and alcohol dependence. Design: A longitudinal qualitative study. Participants: The sample consisted of 69 persons with alcohol or opioid dependence, mostly from low socio-economic backgrounds in Sydney, Australia. People were recruited in both a detox facility and a maintenance treatment. Measurements: Semi-structured interviews. Findings: The bodily effects of substance dependence impact profoundly on the self-control of substance-dependent people. This change to self-control happens in two ways: by forcing substance users to take a local perspective on their lives, and by changing both their self-concept and their beliefs about what they can achieve. These bodily effects on self-control resemble other chronic diseases. Conclusion: Understanding the role that the body plays in impairment of self-control in substance dependence can help to prevent these harms and contribute to overall recovery and well-being. Good quality health care, rendered by non-judgmental professionals, contributes immensely to the normative and diachronic agency of those struggling with addiction by minimizing somatic damage and damage to the self. Knowing how a loss of trust in one’s body can impair self-control may help health care professionals support people struggling with addiction in regaining trust in their body, future and self-control mechanisms.